Telehealth era brings opportunities, obstacles to urology


“Patients have rising expectations for telehealth services as new technology-based ways and preferences for consuming services are shifting into health care. Therefore, it is important for urologists to gear up to meet the market demand,” explains Christian Milaster, MS.

Chicago-Telehealth is here to stay and growing, and there are not only many opportunities for leveraging it in urology, but also good reasons why urologists should be implementing telehealth services into their practice, said Christian Milaster, MS, at the LUGPA annual meeting in Chicago.

“The best time to get started in telehealth was 5 years ago, and the second best time is now,” said Milaster, founder and principal of Ingenium Healthcare Advisors, a nine-advisor consultancy that helps organizations establish telehealth programs and services.

“Patients have rising expectations for telehealth services as new technology-based ways and preferences for consuming services are shifting into health care. Therefore, it is important for urologists to gear up to meet the market demand,” he explained.

“Telehealth also brings value for lowering cost of care and improving health outcomes, and it can increase provider satisfaction too.”

Milaster noted that telehealth is a trend that started many decades ago, but early on was mostly used at academic medical centers, in programs supported by grant funding. As various barriers began to come down, it became much more feasible and reasonable for community practices to become involved in telehealth services as well.


Opportunities abound

The opportunities for telehealth for urology group practices are divided into outbound and inbound services. Through outbound telehealth, urologists can share their knowledge and expertise with patients and other clinicians outside of the walls of their practice, Milaster explained.

“Large urology group practices are most likely situated in urban areas and technology today makes it possible to also connect with people in rural areas, and it is much better and oftentimes also reimbursable to communicate via video than over the phone or through email,” he said.

Inbound telehealth services provide urologists with opportunities to better serve their existing patient population and attract new patients by bringing non-urology expertise into their practice. For example, urologists could collaborate with specialists who have expertise in areas such as genetic or behavioral health counseling to offer patients more comprehensive care.

“These kinds of telehealth services that provide patients with the convenience of ‘one-stop shopping’ can be particularly valuable to a practice that is operating in a competitive market,” Milaster said.

Next: Barriers coming downBarriers coming down

In the past, technology was one of the biggest obstacles to success with telehealth.

“The technology needed for telehealth was not ready for prime time. It was expensive, clunky, and unreliable and there were major issues with usability, performance, and connectivity. All of that has changed as technology and infrastructure have advanced by leaps and bounds,” Milaster said.

Remaining barriers include limits created by existing laws. Milaster explained that regulations for telehealth services are set by state medical boards and vary. Some states still require an inpatient visit to establish the physician-patient relationship, and in most states physicians must be licensed in the state where the patient is located.

“The landscape, however, is changing as licensure compacts are being created specifically for telehealth,” Milaster said.

In 2018, financial issues pose the biggest obstacle to becoming involved in telehealth, but there are developments on this front as well. Milaster explained that not all forms of telehealth visits and services are reimbursed, and there are fragmented reimbursement policies that vary among Medicaid, Medicare, and commercial insurers.

In terms of providing care to patients with commercial insurance, the good news is that most states now have legislation mandating payment for a telehealth visit if an in-person visit for the service would have been covered. Medicaid policies are also becoming more favorable for telehealth services, but Medicare is lagging behind in changing its policies.

At the same time that reimbursement is improving in some areas, new business models are being developed that circumvent the issue altogether. For inbound services, practices can enter into subscription models, while outbound telehealth services can be provided on a fee-for-service basis, which is becomingly increasingly accepted by patients.

“Because of high-deductible insurance plans, our health care economy is shifting to a self-pay model, and people are also willing to spend their own money for something that provides convenience and saves them time,” Milaster said.

New business models for telehealth services are also being created. For example, urology practices might think of opportunities to provide services ancillary to their core practice for patients with diagnoses that might make them reluctant to seek medical care in person.

“Urologists might think about implementing a telehealth program for patients with sexually transmitted diseases or sexual dysfunction. Even if they are not offering full-service care online with diagnosis and treatment, an initial consultation offers a way to establish the initial relationship with a patient,” Milaster advised.


“Urologists who want to get into telehealth should start small, figure out what type of service they would like to offer, plan to launch a limited trial, and get expert help along the way.”

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