Transforming Veteran Audiology Care: Data-Driven Evidence for the Department of Veterans Affairs (VA) Teleaudiology Expansion

The data also demonstrates significant opportunities for continued growth. Utilization varies considerably across Veterans Integrated Service Networks (VISNs), suggesting opportunities to replicate successful operational models, expand asynchronous workflows, and further integrate teleaudiology into broader VA access strategies.

The evidence indicates that the VA's teleaudiology investment is producing measurable value for Veterans. The next phase is not proving teleaudiology's effectiveness, but scaling successful approaches, strengthening operational consistency, and supporting emerging models that further improve access to hearing healthcare.

1. The Audiology Access Challenge

Infrastructure

Traditional audiology care delivery depends on specialized infrastructure that creates fundamental access barriers. Sound booths represent the standard environment for audiometric testing, but these controlled acoustic spaces require significant capital investment, dedicated facility space, and technical maintenance. The result is geographic concentration of audiology services in larger VA medical centers (VAMCs), leaving Veterans in rural and remote areas facing substantial travel requirements for routine hearing care.

Workforce Distribution

Workforce distribution compounds the infrastructure challenge. Audiologists tend to concentrate in urban areas where professional opportunities, continuing education access, and quality of life factors attract and retain specialists. This geographic mismatch between provider supply and veteran population distribution creates access gaps that traditional facility-based models cannot address. Veterans living far from major VA medical centers (VAMCs) face hours-long roundtrips for appointments, often requiring time off work and navigating transportation challenges. The VA also bears significant travel costs through mileage reimbursement for these trips.

Accessibility & Mobility Limitations

The access problem extends beyond inconvenience. Hearing loss affects a significant portion of the Veteran population, with service-related exposure to loud environments, blast injuries, and occupational noise contributing to higher prevalence rates than the general population. Untreated hearing loss correlates with social isolation, depression, cognitive decline, and reduced quality of life. Early detection and intervention improve outcomes, yet access barriers delay care precisely when timely treatment matters most.

Veterans with mobility limitations face compounded challenges. Those using wheelchairs, managing chronic conditions, or living in assisted care settings find facility visits particularly burdensome. For these populations, the barrier is not merely an inconvenience but a genuine impediment to accessing necessary care. The traditional model assumes veteran ability to travel to centralized facilities, an assumption that fails many who need services most.

Appointment Scarcity

Appointment scarcity represents the final constraint. When sound booth infrastructure limits testing capacity and audiologist availability concentrates in specific locations, scheduling backlogs develop. Veterans wait weeks or months for initial evaluations, follow-up appointments stretch across extended timelines, and routine adjustments require the same facility visit process as comprehensive diagnostic workups. The system operates at capacity constraints that infrastructure expansion alone cannot solve within realistic budget parameters.

2. VA's Teleaudiology Solution: Hub-and-Spoke Model

The VA has deployed an alternative approach that separates audiology expertise from sound booth infrastructure requirements. The VA operates approximately 2,200 GlobalMed telehealth stations across 1,000 of the VA's 1,300 medical facilities, with 350-400 stations dedicated specifically to audiology services in 292 of their medical facilities. This represents the nation's most extensive teleaudiology deployment.

The VA supports three distinct care delivery models, each addressing different clinical scenarios and veteran needs. Understanding how these models function reveals the flexibility that drives adoption across diverse VA settings.

Clinical Video Telehealth (CVT)

Clinical Video Telehealth connects audiologists with veterans in real time using integrated diagnostic equipment. A Veteran visits a local VA clinic equipped with a telehealth cart containing audiometry equipment, video otoscopy capability, tympanometers, audiometers, and other diagnostic devices. The audiologist, potentially hundreds of miles away, conducts the examination remotely by controlling cameras and software, viewing results in real time, and interacting with the Veteran and the onsite Telehealth Clinical Technician (TCT) via video connection. This model delivers the same diagnostic protocols as traditional sound booth exams while eliminating the booth requirement and connecting distant audiologists with Veterans who need care.

CVT accounted for 99,120 exams serving 59,079 veterans in FY 2025, representing 81.6% of all VA teleaudiology activity.¹ The model dominates because it replicates familiar clinical workflows while solving the geographic access problem. Audiologists work from locations with concentrated specialist capacity, while Veterans access care at nearby clinics.

Clinic-to-Home Telehealth

Clinic-to-home telehealth extends audiology services directly into Veterans' homes through VA Video Connect (VVC) and remote hearing healthcare technologies. Current applications include hearing aid programming, aural rehabilitation, tinnitus management, counseling, and follow-up care that can be delivered without requiring travel to a VA facility.

In FY 2025, clinic-to-home telehealth supported 18,696 episodes of care for 12,948 Veterans, representing approximately 15.4% of all teleaudiology activity. These encounters demonstrate the growing role of home-based virtual care in improving convenience and access, particularly for Veterans facing transportation, mobility, or scheduling challenges.

In parallel, the VA continues to evaluate emerging technologies that may further expand home-based audiology services. Pilot programs involving automated audiometric testing platforms, including AMTAS Flex, are exploring opportunities to support additional diagnostic capabilities in both clinic and home-based settings as integration and workflow requirements mature.

Store-and-Forward

Store-and-Forward (SFT) using GlobalMed's Automated Audiology Clinical Extender (AACE) represents asynchronous care delivery. Veterans complete hearing tests, outer ear imaging, video otoscopy, and audiometry at local facilities with TCT support. The system captures all diagnostic data, which audiologists review and interpret later, eliminating the need for real-time audiologist presence during testing. This model increases throughput by separating test administration from expert interpretation.

AACE supported 3,740 episodes of care for 3,665 Veterans in FY 2025, representing 3.1% of teleaudiology activity. The platform enables automated hearing evaluations and diagnostic data collection that can be reviewed asynchronously by an audiologist, increasing flexibility in care delivery and extending access to Veterans in locations where real-time specialist involvement may not be practical.

Infrastructure and Clinical Capability

The hub-and-spoke architecture connecting these models creates geographic flexibility that traditional centralized care cannot match. High-volume facilities deploy multiple stations to increase throughput. Community-based outpatient clinics (CBOCs) serving rural populations install single or multiple stations providing local access. The FY 2025 deployment spans 292 facilities: 241 CBOCs, 50 VA medical centers, and 1 ATLAS site.² This distribution brings audiology capability directly into communities where veterans live rather than requiring travel to specialized centers.

The system integrates diagnostic devices that distinguish teleaudiology from simple video consultation. Audiometers measure hearing thresholds across frequency ranges. Tympanometers assess middle ear function. Video otoscopes provide high-resolution ear canal and tympanic membrane visualization. These clinical-grade peripherals connect to the telehealth platform, allowing remote audiologists to conduct complete diagnostic exams. The technology replicates sound booth capabilities without requiring the booth itself, maintaining diagnostic standards equivalent to traditional examinations while expanding geographic reach.

Why the VA's Teleaudiology Investment Matters 

Over more than a decade, the VA has transformed teleaudiology from a series of pilot programs into a nationally deployed clinical capability. National synchronous teleaudiology efforts began in FY11 and were subsequently expanded through initiatives involving the VA Center for Innovation, Office of Rural Health, Office of Connected Care, and local VISN-led programs.

Today, teleaudiology supports multiple care delivery pathways, including clinic-to-clinic evaluations, clinic-to-home services, hearing aid support, rehabilitation programs, and asynchronous diagnostic workflows. The FY25 workload data demonstrates that these services are no longer experimental but are now integrated into routine care delivery across hundreds of VA locations.

The significance of this investment extends beyond encounter volume. Teleaudiology enables the VA to connect Veterans with audiology expertise regardless of geographic location while supporting broader organizational priorities related to access, virtual care, and workforce efficiency. The opportunity moving forward is to expand successful models and ensure more consistent utilization across the enterprise.

3. Utilization and Impact

The VA’s FY 2025 data demonstrates teleaudiology's operational viability at scale while revealing significant expansion capacity. Across all care models, the platform delivered 121,556 examinations to 75,692 unique Veterans, generating approximately 7,600 clinician workdays of audiology care.¹,³ Performance variation across VISNs shows that current utilization represents only a fraction of potential capacity. This variation stems from deployment maturity, operational support, and provider adoption rather than inherent model limitations.

CVT accounts for 81.6% of activity with 99,120 exams, connecting veterans at local clinics with remote audiologists for real-time diagnostic evaluations.¹ Clinic-to-home testing delivers 15.4% of exams (18,696), bringing care directly to veteran residences.¹ SFT using AACE represents 3.1% of volume (3,740 exams), supporting asynchronous screening where technicians administer tests for later audiologist interpretation.¹

The dominance of real-time CVT reflects mature deployment and provider familiarity, while lower percentages in clinic-to-home and AACE indicate early-stage adoption with substantial growth potential.

Source: VA FY 2025 Audiology Exam Data

The top five regions account for 59% of all CVT activity. Performance variation across VISNs reflects differing levels of teleaudiology maturity, operational support, local adoption patterns, and care delivery models. High-performing VISNs demonstrate what is possible when teleaudiology is fully integrated into clinical operations, while lower-volume regions may represent opportunities to expand successful practices and share lessons learned across the enterprise. 

SFT testing shows even more concentrated adoption. VISN 23 alone performs 35% of all national AACE volume with 1,299 exams, while 13 VISNs each conducted fewer than 200.² VISN 23 also ranks third in CVT activity, demonstrating that regions investing in teleaudiology infrastructure deploy across multiple modalities as operational experience builds. The minimal AACE activity in most regions indicates untapped screening capacity rather than model failure.

Clinic-to-home adoption similarly concentrates in specific regions. VISN 8 leads with 4,061 exams while also ranking fifth in CVT volume.² Multiple VISNs show strong performance across two or all three care models, supporting the pattern that mature teleaudiology programs expand beyond single-modality deployment.

Worforce Efficiency Impact

The workforce efficiency impact becomes clear when exam volume translates to clinician time. At 30 minutes per exam across an eight-hour workday, these examinations represent roughly 7,600 workdays of audiology care.³ This capacity extension allows existing audiologists to serve more veterans without geographic practice limitations. The hub-and-spoke model multiplies workforce reach rather than replacing headcount, addressing audiologist supply constraints that hiring alone cannot solve. This operational impact translates into substantial financial value.

4. Operational Value of Teleaudiology

The primary value of teleaudiology is improved access to care, expanded geographic reach, and more efficient deployment of audiology expertise. While teleaudiology may contribute to reductions in travel burden, community care utilization, and workforce constraints, these impacts vary across VISNs and depend on local operational factors. Therefore, financial estimates should be interpreted as directional indicators rather than direct measures of realized savings. 

Savings on Community Care Referrals

When teleaudiology delivers care within the VA system, it prevents referrals to external community care providers where costs are higher. Community care audiology visits average $200 to $350, with $275 representing a reasonable midpoint estimate.⁴ The proportion of teleaudiology exams that avoid community care referrals depends on case complexity, local capacity, and referral patterns. Conservative modeling applies avoidance rates of 25% to 40% to the total teleaudiology volume.

Scenario A (Conservative - 25% Avoidance):

• 121,556 total exams × 25% = 30,389 visits avoided
• 30,389 × $275 per visit = $8.35 million saved annually

Scenario B (Moderate - 30% Avoidance):

• 121,556 total exams × 30% = 36,467 visits avoided
• 36,467 × $275 per visit = $10.0 million saved annually

Scenario C (Aggressive but Realistic - 40% Avoidance):

• 121,556 total exams × 40% = 48,622 visits avoided
• 48,622 × $275 per visit = $13.37 million saved annually

These estimates represent direct cost avoidance from keeping care within the VA network rather than referring to community providers. Even the conservative scenario demonstrates significant financial impact from preventing external referrals.

Travel Cost Reduction

Veterans accessing care at local clinics through teleaudiology avoid travel to distant medical centers. At an average reimbursement rate of $0.415 per mile and assuming a 40-mile round-trip per visit,121,556 teleaudiology exams avoid approximately 4.8 million miles of Veteran travel.⁴ This generates roughly $2 million in additional indirect savings annually when accounting for mileage reimbursement and time burden reduction.

Workforce Capacity Extension

The 7,600 clinician workdays generated by teleaudiology equate to 30 to 35 full-time equivalent audiologists without hiring a single additional provider.⁴At GS-12 salaries ranging from $89,508 to $116,362 plus benefits, overhead, and support costs, avoiding recruitment of 30-35 additional FTE positions represents multi-million dollar savings in personnel expenses.5 More importantly, it addresses workforce constraints that hiring alone cannot solve, given audiologist supply limitations and geographic distribution challenges.

Model Limitations and Assumptions

These estimates rely on assumptions about community care costs, avoidance percentages, travel distances, and workforce equivalency. Actual financial impact varies by VISN based on local cost structures, referral patterns, and geographic factors. The models provide conservative baseline estimates rather than precise measurements. A comprehensive cost-benefit analysis would require VISN-specific data on community care utilization, referral rates, and facility-level operational costs.

The financial case strengthens the utilization evidence. Teleaudiology delivers substantial exam volume while generating millions in cost avoidance and extending workforce capacity equivalent to dozens of additional providers. Performance variation across VISNs suggests that underutilized regions leave both access improvements and cost savings unrealized.

5. Expansion Opportunities

Performance data suggests several opportunities to build upon the VA's existing teleaudiology success. Rather than requiring new clinical models, many opportunities involve expanding proven approaches already operating successfully within the enterprise. These opportunities include broader adoption of established teleaudiology workflows, increased use of asynchronous care models where appropriate, and continued evaluation of technologies that support home-based care delivery. 

Standardization Across VISNs

Bringing underperforming regions to median utilization levels would substantially increase veteran access without new technology. The infrastructure exists, clinical workflows are validated, and high-performing VISNs provide implementation models to replicate. What varies is operational deployment consistency.

Store-and-Forward Scaling

AACE represents the largest untapped capacity. Asynchronous testing has barely penetrated potential applications.¹ The model suits primary care screening, rural outreach where clinics lack real-time audiologist access, and early detection pathways. Most VISNs show minimal AACE activity, not because the technology fails, but because deployment hasn't prioritized this modality. Early adopters prove scalability is achievable.

Clinic-to-Home Evolution

Current deployment brings care to local facilities. The next phase extends directly to Veteran homes, eliminating all travel requirements. Pilot programs involving AMTAS Flex currently include multiple VA facilities, including Cheyenne, Asheville, Cincinnati, Miami, Memphis, and Denver. These initiatives are evaluating automated audiometric testing workflows and their potential role within future teleaudiology care pathways. 

The technology supporting home deployment already exists. Consumer-grade headphones provide adequate audiometric stimuli for many diagnostic purposes. What's needed is systematic expansion beyond pilots to standard care delivery options.

Broader Telehealth Implications

The teleaudiology deployment demonstrates that integrated diagnostic telehealth functions at the VA scale. The same hub-and-spoke architecture applies to specialties where peripheral devices enable remote clinical assessment: dermatology using digital dermoscopy, ophthalmology using fundus cameras, cardiology using digital stethoscopes, and ECG. Audiology validates the model. Other specialties can replicate it.

Table 2: Current Hub-and-Spoke vs. Future Clinic-to-Home Model

6. Conclusion: Building on a Proven Investment

The VA's FY2025 teleaudiology data demonstrates the success of a long-term investment in virtual hearing healthcare. More than 121,000 episodes of care delivered across 292 sites illustrate that teleaudiology has evolved into a mature clinical capability supporting access to care for tens of thousands of Veterans.

The data highlights the strength of multiple care delivery models, including synchronous clinic-to-clinic services, clinic-to-home telehealth, and asynchronous store-and-forward workflows. Together, these approaches expand access to audiology expertise while reducing geographic barriers that have historically limited care.

Perhaps most importantly, the data suggests that significant opportunities remain. Variability across VISNs indicates that successful operational models can be replicated more broadly. Emerging technologies such as AMTAS Flex may further expand access as pilots mature and integration requirements are addressed.

The question is no longer whether teleaudiology works. The evidence demonstrates that it does. The opportunity now is to build upon a proven investment, expand successful practices, and continue advancing access to hearing healthcare for Veterans across the nation.

Take Action

Contact GlobalMed to discuss VA teleaudiology expansion strategies and clinic-to-home deployment planning.

+1 (480) 922-0044 [email protected] globalmed.com

References

1. VA FY 2025 Audiology Exam Data. Total Tele-Audiology Activity.
2. VA FY 2025 Audiology Exam Data. Tele-Audiology Sites of Care.
3. VA FY 2025 Audiology Exam Data. Estimated Audiology Telehealth Capacity.
4. VA FY 2025 Audiology Exam Data. Cost Modeling and Assumptions.
5. U.S. Department of Veterans Affairs. (2026). Audiologist Position Announcement (GS-12). USAJobs. https://www.usajobs.gov/job/863615300 

Appendix A: Glossary

AACE (Automated Audiology Clinical Extender): GlobalMed's store-and-forward platform integrating automated audiometry, video otoscopy, tympanometry, and ear imaging with remote audiologist interpretation.

CBOC (Community-Based Outpatient Clinic): VA facilities located in communities to provide outpatient services closer to where veterans live, typically smaller than VA Medical Centers.

Clinical Video Telehealth (CVT): Real-time telehealth connecting providers and patients using video technology and integrated diagnostic devices.

Hub-and-Spoke Model: Care delivery architecture where specialist providers (hub) serve multiple access points (spokes) remotely, distributing expertise geographically.

Store-and-Forward: Asynchronous telehealth where diagnostic data is captured locally and transmitted for later specialist review and interpretation.

VISN (Veterans Integrated Service Network): VA's 18 regional networks that organize healthcare delivery across geographic areas.

About GlobalMed

Founded in 2002 by a Marine Corps Reserve Veteran to bring healthcare access to the underserved, GlobalMed has become a global leader in virtual health technology. The company's platform supports patients at any point in the continuum of care, with integrated software and data-capturing tools that empower providers to deliver evidence-based treatment and improved outcomes.

GlobalMed technology has enabled 100 million consultations in over 60 countries. Built to the highest standards of security and compliance, GlobalMed's virtual health platform has earned the U.S. Defense Health Agency's Authority to Operate on the DoD network. The technology serves diverse settings from the VA and White House Medical Unit to rural hospitals, correctional facilities, oil rigs, and remote villages worldwide.

Contact Information: +1 (480) 922-0044 [email protected] globalmed.com