Surgery centers located in places with patients traveling from rural areas or that draw patients from long distances could make presurgery consultations more efficient and easier through telemedicine.
Many surgery centers already use telemedicine for post-surgery follow-up because it is easy to use the solution to connect briefly with patients to ask them about incisions, pain, redness, and complications, says Ryan Spaulding, PhD, vice chancellor, Institute for Community Engagement, and acting director, Center for Telemedicine and Telehealth at the University of Kansas Medical Center.
“We find that a lot of our patients from rural communities are not comfortable driving into the city, so these telehealth visits are satisfying for patients,” he reports.
Precertification/preoperation visits are another and newer area that could benefit from telemedicine. For reimbursement, video calls are set up between the surgery center and the patient’s local provider or hospital. “Telemedicine in patients’ homes is not reimbursed, so that’s a barrier to patients using smartphone videos in their homes,” Spaulding notes.
For patients who live far away from the surgery center, telemedicine could save them a long drive for a consultation that would last only 15 to 30 minutes. “We’ve done the presurgery certification through telemedicine for four years. The farthest site we’ve contacted is 376 miles away, a 5.25-hour drive,” Spaulding says. “It saves a lot of drive time for a routine presurgery visit, and it’s well-received by patients and providers.”
The telemedicine visits almost always are video conversations. Patients see physicians through video conferencing that is high definition and good quality. “They can look right at the patient and talk to the patient,” Spaulding observes.
For post-surgery telemedicine, physicians can see patients’ wounds, burns, or rashes via the video feed. “We did a study with burn patients and looked at still images ... and compared whether you can properly diagnose the level of the burn and how well it’s healing,” Spaulding recalls. “The study was positive. Both video and still images can be used effectively.”
The technology involves either a video system or a computer system. The surgery center and/or surgeon sets up the relationship with the patient’s local provider to facilitate the telemedicine visit. The local provider only has to put the patient in a room where the video conference will take place, Spaulding explains.
Insurers, including Medicare and Medicaid, pay an originating site fee to the place where the patient is sitting during the telemedicine visit. Payers give the surgeon a consult fee and pay the distant site, which is the surgery center or hospital where the surgeon is located during the video call, Spaulding says.
Another consult that can be conducted via telemedicine is the preanesthesia visit. “Sometimes, patients come to surgery centers because of their airway or maybe their vital signs are [problematic], and they cannot have anesthesia,” Spaulding says. “We’ve worked with an anesthesiologist here to set up a preanesthesia clinic.”
Turning these visits into telemedicine sessions would be especially helpful for patients who drive many hours for the clinic visit. Also, this could prevent patients from driving several hours to a clinic, only to hear they could not undergo the procedure.
“We’re still trying to get these telemedicine visits set up,” Spaulding says. “We have had no consults yet ... but we think it will be fairly easy to do once we work out the logistical and location issues.”
During the preanesthesia visit, the anesthesiologist talks with the patient, examines the patient’s airway, and ensures it is clear. Then, the patient is ready for anesthesia. Some places already handle these visits via video conferencing. “It’s an exciting use of telemedicine,” Spaulding adds.