Dr. Gadzinski is a senior fellow and acting instructor of urologic oncology, University of Washington, Seattle; Dr. Ellimoottil is assistant professor of urology, University of Michigan, Ann Arbor; Dr. Odisho is assistant professor of urology, University of California, San Francisco; Dr. Watts is assistant professor of urology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; and Dr. Gore is professor of urology, University of Washington, Seattle. Disclosure: Dr. Odisho had a prior consulting relationship with Vsee from January 2019 to January 2020.
In response to the COVID-19 pandemic, multiple emergency measures have dramatically changed the policies and requirements for telemedicine in the United States. On March 13, 2020, Secretary of Health and Human Services (HHS) Alex Azar authorized waivers and modifications under Section 1135 of the Social Security Act, retroactive to March 1, 2020, to lift telemedicine restrictions. Medicare Part B beneficiaries are now eligible to participate in video visits from any location, including their home, CMS announced.
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We aim to briefly summarize these changes, provide resources for urologists (from the AUA and CMS), and give practical guidance for quickly launching or scaling a telemedicine program. We primarily focus on video visits, which are live simultaneous audio and visual interactions with patients via a videoconferencing platform. (Also see a summary of updated Medicare Part B policy on video visits in the table below.)
Given that most urologic outpatient visits are non-urgent, almost all in-person visits should be eliminated out of appropriate concern for COVID-19. Continuing urologic care now will mitigate the later surge of patients needing care once this crisis is over. Video visits may also provide some financial stability to urology practices during this time when surgical reimbursements will be greatly reduced. Finally, with uncertainty surrounding the duration of the current State of Emergency and the enacted telemedicine changes beyond this emergency period, investing in telemedicine now will likely benefit urologists in the long term.
Technology and equipment
Several platforms can be used to perform video visits. Most insurance companies require that the visit has an audio and visual component for real-time communication. A desktop, laptop, smartphone, or tablet can all be used as long as they have a webcam and microphone. The visit should be performed through a reliable and secure platform, which can be integrated into the electronic medical record or be a stand-alone product. Many platforms, such as Skype for Business, Updox, VSee, Zoom for Healthcare, Google G Suite Hangouts Meet, and Doxy.me meet HIPAA compliance requirements.
During the COVID-19 pandemic, the HHS Office for Civil Rights announced that providers can use non-HIPAA-compliant tools to deliver medical care. Because this federal rule may not impact individual state's laws, providers should prioritize a HIPAA-complaint platform. This will allow for sustainability of new telemedicine programs post-pandemic.