Mahatma Gandhi once said, “First they ignore you, then they laugh at you, then they fight you. Then you win.”
Although telemedicine has been part of the health care system for nearly 20 years, many physicians have been resistant to its adoption as they face various barriers in implementation, including the unfamiliarity of digital technology, equipment costs, logistical office challenges, and navigating regulatory constraints and reimbursement restrictions.
This article will discuss obstacles that urologists typically must address when implementing telemedicine into their practice. We will also address initial steps urologists looking to incorporate telemedicine should take as well as the potential return on investment from implementing telemedicine into existing practices.
In a busy urology practice, inevitably certain patients do not necessitate an in-person visit for effective urologic care. Imagine an afternoon clinic with 30 patients; how many of those patients need a physical exam for effective care? Do the four men scheduled for annual PSA surveillance need a digital rectal exams at each visit? Do the three men with BPH presenting for symptom check need a live visit to refill their alpha-blocker prescription? Do the three women on anticholinergics for overactive bladder (OAB) need a face-to-face encounter to get their medication?
And do the three men taking testosterone self-injections need to be seen live for symptom assessment and PSA testing? Or, alternatively, can the urologist safely, efficiently, and effectively manage these 13 patients utilizing teleurology?
Removing the barriers
Urologists have always been at the forefront of technological advances for diagnosis and treatment of disease. Urologists were early adopters of robotic surgery, minimally invasive laser treatment, and enhanced imaging techniques. While urology has been progressive in the adoption of new technologies, the medical field as a whole generally lags behind other industries like finance, hospitality, real estate, retail, and even dentistry in utilizing technology.
That point is illustrated simply by the fact that most medical offices still rely on fax machines to receive results, CDs to transmit images, and phone calls to make appointments. Telemedicine is a technology available to most physicians that can enhance the doctor-patient interaction, yet it is not yet widely used in urology. Technology and connectivity can be an important resource for patient care, rather than an obstacle, especially when the barriers to implementation are overcome. As doctors increase their utilization of telemedicine, obstacles they face include reluctance to forego a face-to-face encounter, legal liability of deferring a physical examination, and the potential for no, or reduced, reimbursement.
Addressing each of these barriers takes time and effort but adoption of a telemedicine practice can be achieved with the right resources and open mindedness.
While adopting a tele-practice may take clinicians out of the comfort zone of their office, realizing that a televisit is an extension of practice rather than a replacement helps alleviate the potentially unsettling feeling of sitting behind a computer during a patient encounter. The legal ramifications of telemedicine must be considered when adopting a tele-practice, and urologists considering telemedicine should seek legal advice before doing so. Issues that may need to be addressed include: state licensing requirements, confirming malpractice coverage, state prescription requirements and restrictions, and establishing informed patient consent.
Urologists should also be attentive to state-specific limitations on reimbursement for televists. Nationally, reimbursement for televisits is gradually expanding. Currently nearly every state has legislation that allows physicians to be reimbursed through Medicaid for remote consults. Furthermore, Medicare advantage patients will be covered for televisits as part of their core benefits starting in 2020.