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  • Urologic Surgery
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What will the post-COVID-19 telemedicine landscape look like?


The COVID-19 pandemic has had wide-ranging effects on the practice of medicine. These include cancellations of in-office visits, surgery postponements or cancellations, social distancing in the office, and the explosion of telemedicine. As a result of the pandemic, the federal government has instituted emergency measures that lift restrictions on the use of telemedicine. This Urology Times® webinar, featuring experts in telemedicine, practice management, and coding and reimbursement, examines the impact this public health emergency has had on the practice-related aspects of urology and how urologists can prepare for the future once the emergency declaration is lifted. (To view the webinar in its entirety, see bit.ly/uttelemedwebinar.)

The panelists were moderator Jonathan Rubenstein, MD, chief compliance officer, Chesapeake Urology Associates, Towson, MD and clinical associate professor, department of surgery, University of Maryland School of Medicine, Baltimore; John Gore, MD, MS, professor of urology, University of Washington, Seattle; Aaron Spitz, MD, a urologist in private practice at Orange County Urology Associates, Laguna Hills, CA and assistant clinical professor of urology at the University of California, Irvine; and Eugene Rhee, MD, regional coordinating chief of urology at Kaiser Permanente Southern California.

In this segment, the panelists make predictions on how the practice of urology and the use of telemedicine will look in the post-COVID-19 era.

Rubenstein: Let's talk about the future. Where do you see this all heading?

Gore: The easy answer is, I don't really know. What I hope will happen is novel ways to think about physician medical licensure. The fact that we have state-to-state licensure is a historical way that we've done it.

In terms of telemedicine, I'm really hopeful that a lot of the changes that Medicare has made, with the exception of some of things like the use of non-HIPAA relevant platforms, persist. A lot of our private payers and even state-specific Medicaid have been ahead of Medicare on a lot of the telemedicine reimbursement initiatives. I hope that will persist once this is all over.

I can tell you, from the patient perspective, they really want it to persist. That's been a real positive out of this. I think that patient advocacy will definitely help.

Rubenstein: Dr. Spitz?

Spitz: Again, it's not clear. I think it depends on how long we remain in a stay-at-home posture. The sooner this ends, the greater the chance that there will be a retraction of the payments and the loosening of regulations. The sooner we go back to business as usual, the smaller percentage of these advances will be retained, in my opinion. The longer it takes for us to go back to business as usual, the more these practices become more established and more than norm, and the harder it will be to turn them back. I think a big part of the future of telemedicine rests on what the current status is with COVID and when we are going back to business as usual.

Having said that, to the extent that we retain telemedicine as a reimbursed and standard part of our practice, this will have very important and profound effects on our reimbursement. As proceduralists, much of our fee-for-service reimbursement cannot be realized through telemedicine. I think there will be a major review and perhaps revision in the way we value our services and in the way we attempt to be compensated, at least in a fee-for-service environment if telemedicine becomes a bigger part of our practice. That's not to say we can't find parody or possibly even thrive.

Certainly on the patient side of the equation, I really don't see a downside. I see nothing but upside for the patients because as I said before, it's not an either/or scenario. It's “yes/and.” That's how I view the future of telemedicine and what the implications may be.

Rubenstein: Dr. Rhee?

Rhee: I’m speculating; I'll put in that caveat. I think the patients are going to want to be connected from home, and I think that's going to have a big profound effect on everything else. But I do believe that payers and the government are going to understand, particularly with the social distancing and the things that we're going through, that this will be in the mindset of everybody in the future.

Connecting from home is going to be where I think the origination site requirements are going to be lifted. The other part of it, I think, is that the HIPAA compliance is probably going to come back. I think it's a little too loosey-goosey now. The issues we're seeing with Zoom, as an example-we're seeing some data, people have been able to log on without actually getting a password-these things are of concern and I think the HIPAA compliance will be coming back.

I think the medical decision-making kind of billing that we are all familiar with, that's going to sit. That's the only way you're going to have to be able to compare apples to apples and compare telemedicine versus face to face. In the end, 6 months ago would we ever think that we'd be doing a webinar for our urologists on telemedicine? I'm flabbergasted. I'm still stunned as to what's transpired in a month.

Rubenstein: I do want to mention some resources that are helpful. These are listed on the slide below.

One site that I think is really good is the American Urological Association, which has a whole COVID-19 Information Center. There are a couple of other links that are on the slide below. The Center for Connected Health Policy, Alliance for Connected Care, and the Federation for State Medical Boards are good sites to look at for individual state policies and state rules. Click on those to find your individual states. It talks about which states you might be able to practice in, getting a license in another state, and where the rules have been relaxed.

I thank Urology Times for sponsoring this webinar. I hope the people who are listening learned a few things and able to troubleshoot and move forward for the good of our practices, the good of our patients, and the good of the health of the citizens in the United States who we're providing health care for across the nation. Thank you Dr. Gore, Dr. Spitz, and Dr. Rhee for your participation and your expertise, and for allowing us to pick your brains and spending this hour with us.

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