LAUSR

Even if you are not familiar with the term “telemedicine,” you probably practice it daily. Synonymous with telehealth, virtual care and ehealth, telemedicine is a way of communicating with patients and delivering health care by telephone, email, video or secure messaging. While we may not be directly reimbursed for it, urologists practice telemedicine when we call patients with computerized tomography results, respond to patient portal messages and send text messages to patients to see how they are recovering following surgery. Payers are aware that telemedicine is an important part of the contemporary practice of medicine and that patients benefit when telemedicine is integrated into their care plan. In this issue of The Journal Finkelstein et al (page 159) examine the role of telemedicine in pediatric urology, focusing specifically on a pilot study at Boston Children’s Hospital in which surgical patients and their parents were offered a video visit (a form of telemedicine) as a substitute for a traditional postoperative visit. Patients enrolled in the pilot study underwent a wide range of procedures, including circumcision, hydrocele repair, orchiopexy and ureteral reimplantation. After completing more than 100 postoperative video visits the authors determined that this virtual form of care not only is technically feasible, but also is associated with high rates of patient and provider satisfaction. Moreover, patients saved a significant amount of travel time for a visit that, on average, lasted approximately 7 minutes. While it is difficult to draw definitive conclusions without a control group, the authors have set the stage to study key outcomes in a future randomized controlled trial. The authors’ conclusions are consistent with the findings of other studies on urological video visits, ie video visits reduce travel time, and result in cost savings and increased satisfaction for patients, without compromising care. According to Viers et al, traditional clinic visits and video visits are shown to be essentially equivalent regarding physician face time, patient wait time, total time devoted to care and patient perception of quality of care. But with telehealth the patient benefits from less travel time and fewer travel expenses as well as decreased time away from work. Similar findings can be observed in surgical fields outside urology. Moreover, unlike telephone calls and secure messaging, video visits are currently reimbursed by nearly all payers. Nevertheless, despite the known advantages of video visits, our analysis of commercial and Medicare claims data found that less than 1% of urologists use video visits. The barriers that impede telehealth adoption can be grouped into economic and noneconomic categories. The single largest economic barrier to video visit adoption is called the “originating site requirement,” a regulation mandating that patients be located at a medical facility in a rural area to qualify for a video visit. In other words, physicians cannot conduct video visits with patients while the patient is at home. In recent years multiple commercial payers have eliminated this burdensome regulation. In addition, the Medicare program has waived the requirement for Medicare Advantage plans and select alternative payment model programs. However, until the traditional Medicare program allows patients to participate in video visits from home the majority of health care institutions and urology practices will be slow to invest in the telehealth infrastructure necessary to conduct reimbursable video visits and video visits during the postoperative global period. Aside from the economic barriers several noneconomic barriers have also slowed the adoption rate of video visits. First, regulations prevent physicians from performing video visits with patients located outside the state where they are licensed to practice medicine. This rule is particularly cumbersome for providers who practice near a state border or whose patients spend winters in warmer climates. In addition, implementation of video visits requires significant workflow changes. For example office staff need to be trained in scheduling video visits, answering video visit related questions from patients and following up on prescription orders after the visit is completed. While seemingly minor,