Telemedicine Justification

ABSTRACT

Funding: None. Synopsis Because of COVID-19, re-imbursement restrictions for medical services have been relaxed, both to continue provision of healthcare services and afford physicians a stream of revenue. While telemedicine may have relevance in medical and psychiatric practices, its benefits appear less tangible for vascular surgical patients. Those patients, most of whom have multiple co-morbidities, have a high acuity of illness and assessment absent physical examination has the potential for providing a lower standard of care. Many articles laud telemedicine without determining if telemedicine is non-inferior to customary hand-on care. To determine if telemedicine is equivalent, a retrospective review was performed to ascertain if telemedicine provides equivalent care Methods: A retrospective, single observer, the charts of 100 consecutive patients were reviewed to determine if their condition could have been adequately treated via telemedicine. Data were collected from patient records and each chart was reviewed to determine if physical patient contact was essential to the assessment and treatment strategy. Result(s) Of the 100 patient encounters, 78 patients were determined to require an in-depth interview and physical examination. 40 were new patients and 60 were established patients, seen either for post-surgical follow-up or manifestation of a new problem. There were 55 males and 45 females. Average age was 56.2 years with 59 patients older than 65. Diagnoses and clinical severity were recorded and the determination was made if a face-to-face encounter could have been conducted via telemedicine. Those conditions requiring direct contact included chronic kidney disease, differentiation between vascular and neurogenic symptoms, aneurysm, carotid stenosis, wound complications, and musculoskeletal disorders. (TABLE 1) Conditions that could have been safely managed with telemedicine included venous insufficiency, carotid ultrasound results, lymphedema, and pre-operative patients. Of the 100 patients, only 7 seven patients were candidates for telemedicine. (TABLE 2) Not included in this study were 57 additional patients who underwent ultrasounds/non-invasive studies and whose results were transmitted to the patients by a mid-level. Conclusion(s) A small minority of vascular patients are adequately treated via telemedicine. While Medicare payments for the telephone evaluation and management visits are equivalent to established office/outpatient visits, care must be taken to assure that equivalency exists between telemedicine and face-to-face encounters. Controlled outcome studies with larger populations should be performed to determine if telemedicine and in-person visits provide equal patient benefit. [Formula presented] [Formula presented] Institution Memorial Healthcare System, Davie, FLCopyright © 2022