Dr. Ellimoottil discusses controversies in telemedicine


"If payments are cut, our overall cost per visit goes up, which could be another disincentive to use virtual care," says Chad Ellimoottil, MD, MS.

In this video, Chad Ellimoottil, MD, MS, discusses his AUA Quality Improvement Summit presentation "Telehealth Policy: History and Current Controversies." Ellimoottil is an associate professor of urology and director of telehealth for the University of Michigan, Ann Arbor.


I think most people are on board and believe that telehealth is here to stay. That's kind of a broad consensus among policymakers, on both sides of the aisle. One of the things that I talked about at the summit was that even if we want telehealth to continue, there is a possibility that, because of certain types of regulation and certain decisions that are made, that it may make it hard for urologists to use telehealth. [I discussed 4 areas.] Number one was coverage fragmentation among payers.Medicare tends to set the standard for coverage, and so commercial payers tend to follow what Medicare does. And so if Medicare keeps extending it and not making it permanent, I think there's a concern that commercial payers can start to peel away coverage too. Number 2 is that if there is a loss of certain types of telehealth that are important, like audio-only telehealth, then there's a concern that that could make telehealth very difficult for urologists and health care providers across the country. If you're set up to do a video visit with the patient, and then all of a sudden, the patient can't connect, the standard thing that most people do is pick up the phone and call them. If that moves from an encounter where you can get credit and you can bill for vs an encounter that you can no longer bill for because the video component wasn't there, it just creates a strong disincentive to even offer video visits at all. The third thing I talked about was that there's a concern and some controversy about how much these visits should be paid. Should they be paid the same amount or should they be paid less? There are arguments on both sides. But I think that fundamentally, a lot of us as urologists understand that our practice expenses are not necessarily going down if 10% of your visits are being done virtually. That's the reality for us. If payments are cut, our overall cost per visit goes up, which could be another disincentive to use virtual care. Finally, the other important thing is that, in general, if there are rules that just make it hard to actually provide good clinical care; for example, if every 6 months, you need to see the patient in person even though there's no guideline that says that you need to see that patient in person, but you just have to because that may help prevent fraud and abuse, those kinds of guardrails can also create a big disincentive to use telehealth as well. One of the things I talked about at the summit was that the Office of the Inspector General actually did a very large study where they looked at 700,000 telehealth providers and found that less than half a percentage of these providers had any sort of pattern of fraud and abuse. When you set up these rules because you're worried that people are going to overuse telehealth, you actually just ended up penalizing the 99% of providers who are never going to do anything like that. The end of 2024 is the expiration date for the current Medicare telehealth coverage, and so we'll have to see how things play out this year and the decisions that are made in order to see what the final shape and form of telehealth coverage will be.

This transcription was edited for clarity.

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