Urology Telehealth

Highlighting our Rapid Response to the COVID-19 Crisis

By Dr. Deborah Glassman

Jefferson Urology has been at the forefront of telemedicine for years, and we were well prepared to rapidly pivot to telehealth visits at the start of the 2020 Covid-19 pandemic. Since 2016, when Jefferson Health led by Dr. Judd Hollander, Associate Dean for Strategic Health Initiatives, initiated the telehealth program, we have been committed to seeing patients virtually for a variety of urologic conditions.

Our Department has been a recognized leader in telehealth within the Jefferson Enterprise. Over the last few years, Drs. Glassman, Gomella and Trabulsi have all won institutional awards for our program. Even more noteworthy is that our Department has been nationally recognized as early adopters of this technology. In 2016 we published our initial experience in Urology Practice, a peerreviewed journal of the American Urologic Association and companion to The Journal of Urology1. Our team has also presented at a variety of national meetings, including the American Urologic Association, Society of Urodynamics, Female Pelvic Medicine and Urogenital Reconstruction (SUFU) and the American College of Surgeons (ACS).

On March 11, 2020, when the pandemic was officially declared, we had to reduce our inperson visits for patient safety and to preserve resources, our Department was well poised to continue our patient care virtually. The Jefferson Enterprise’s vision for telehealth and its encouragement of the faculty to use the platform for so many years prior to the pandemic allowed us to easily transition to an almost exclusively virtual office. As the accompanying table demonstrates, we rapidly and successful increased our telehealth visits ten-fold within a month’s time. Of course, we were not alone in increasing our virtual visits; across the country the health numbers went up. Improvements in reimbursement for telehealth visits, secondary to the pandemic, have incentivized these remote care opportunities to increase. Our previous experience with the telehealth platform made for a smooth transition. In March, the Centers for Medicare & Medicaid Services (CMS) announced that it would reimburse for telemedicine services at the same rate as regular, in-person visits as part of the federal government response to the pandemic. Later, CMS waived the video requirement for certain telephone evaluation and management services.

As we have progressed through the pandemic and were able to re-open our office doors to more face-to-face visits, the quantity of telehealth visits have drifted back down but remain at a much higher level than before the pandemic (see illustration). Patients have begun to embrace the telehealth encounter. Should in person medical office visits be limited again, we will once again be able to easily increase our virtual telehealth visits to ensure the best, safest and timeliest care for our patients.

Through the pandemic our department has been able to collaborate with other institutions to deepen our understanding of telehealth usage, barriers and efficacy. A multicentered working group was formed named the ROUTER Collaborative: Research and Outcomes in Telehealth in uRology. In addition to our work with the ROUTER group, we are about to launch a randomized control trial looking at efficacy and satisfaction of telehealth vs in-person visits in post-operative patients. While the pandemic certainly has presented many challenges, our telehealth success has been a positive experience and will impact how we provide routine patient care in the future.

_______________________________________________ 1. Glassman, DT, Puri, AK, Weingarten, S, Hollander, JE, Stepchin, A, Trabulsi, E, and Gomella, LG (2018). Initial Experience with Telemedicine at a Single Institution. Urology Practice, 5(5), 367–371.