Mark Hirschhorn has served as the CEO of TapestryHealth since 2022, where he has focused on scaling the company through expansion and diversification of business operations, with a particular emphasis on in-home care. Much like the push for expanded telehealth services in skilled nursing facilities led by industry leaders like Mark Hirschhorn, the gradual acceptance of virtual care for pre- and post-op visits among surgeons reflects a broader trend in healthcare towards embracing telehealth
Due to the hands-on nature of an operation, surgeries must naturally be conducted in-person rather than via telehealth, as surgeons can’t operate on their patients via a screen over the Internet. However, pre- and post-op appointments with patients, which are typically conducted in a surgeon’s office before and after the patient has their operation, offer some leeway and can be conducted via video link if surgeons are so inclined.
However, according to a study that was recently published in the scientific journal Surgery, most surgeons are not yet in favor of virtual appointments for pre-op visits, even if their patients have undergone all of the required testing, scans, etc. that are necessary to help the surgeon make informed decisions regarding the operation. However, while most surgeons are opposed to virtual pre-op visits, half of those surveyed would consider telehealth visits for post-surgery appointments, the study found.
Urologists embrace telehealth
While the study’s findings suggest that surgeons from a broad range of fields are not embracing telehealth with any enthusiasm, urologists were the exception. The study found that 88% of the urologists surveyed utilize telehealth with some of their patients, while a third revealed they use it for at least 5% of their patient visits.
The study, which was conducted by a team of researchers from Michigan Medicine, the University of Michigan’s academic medical center, is the first to survey and compare the views of surgeons across a broad spectrum of specialties regarding their attitudes toward telehealth.
While the number of surgeons surveyed represents a small percentage of the total number of surgeons practicing, the researchers suggest that the study’s findings could help inform administrators of healthcare facilities and surgeons alike. They also believe the study will help to inform decision-makers responsible for formulating future policies related to the payment of physicians and other healthcare providers for virtual healthcare services under Medicare and Medicaid.
Telehealth visits could ease the burden on patients
When patients undergo surgery, they are likely to have pre-surgery appointments, as well as two or three post-surgery visits with their surgeon, explains Ashwin Kulkarni, a medical student at the University of Michigan, and the lead author of the paper. Conducting at least one of those visits via telehealth could ease the burden on patients and their families/caregivers, especially if they have to travel from far away to visit their surgeon or have challenges surrounding transportation, mobility, finding a caregiver to care for children in their absence, or work commitments.
Of the 170 surgeons surveyed, 47% believe that offering patients the option of telehealth visits would contribute to providing more patient-centered care. Urologists are more inclined to consult with their patients via telehealth, as they are able to offer their patients non-surgical medication-based alternatives, the authors suggested.
However, when surgeons were asked to share their views about utilizing teleheath for a portion of the care for a patient undergoing the most common surgical procedure in their field, urologists (44%) were the most open to operating on a patient they had only consulted with via telehealth prior to the day of their operation, with ear, nose, and throat specialists (42%) following closely behind. At the lower end of the scale, only 17% of general surgeons and 22% of orthopedic surgeons indicated they were comfortable with this notion.
Many surgeons favor using telehealth for post-surgery visits
While surgeons were reluctant to make use of pre-op telehealth visits, they were more open to utilizing telehealth for post-surgery follow-up visits to assess how effective the surgery was, and how the patient’s wound was healing.
If the operation was successful without any complications, 49% of the surgeons interviewed indicated their willingness to consider using telehealth for some post-operative care. However, there was a fairly large disparity between surgeons in different specialities who were open to using virtual care, ranging from 77% of ear, nose, and throat specialists down to 20% of orthopedic surgeons.
Surgeons’ key concerns
The four key concerns that surgeons had with telehealth visits included: not being able to conduct a physical examination (43%), technology limitations (37%), reservations regarding the level of care patients receive (35%), and billing/reimbursement concerns (27%).
“The uncertainty about the future of reimbursement rates that still hangs over the field of telehealth, because federal-level policies have been temporary to date, may be a major factor in surgeons’ decision-making about investing in changing their protocols to allow for more video visits,” said co-author Chad Ellimoottil, medical director of virtual care for the U-M Medical Group and a telehealth researcher at the U-M Institute for Healthcare Policy and Innovation. Ellimoottil, testified before a Senate subcommittee about Medicare policies related to telehealth last fall.
While this new study highlights the level of concern that surgeons have with regard to pre-surgery telehealth visits, an earlier study co-authored by Ellimoottil, who is a urologist, revealed that urology surgery patients received the same level of care regardless of whether their pre-op visit was conducted via telehealth or in-person prior to being operated on.
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