key: cord-0051909-o6lu45r5 authors: Patel, Nisarg A.; Harris, Jack A.; Ji, Yisi D.; Odera, Sampeter L. title: A telemedicine checklist for effective communication during virtual surgical visits date: 2020-10-22 journal: J Oral Maxillofac Surg DOI: 10.1016/j.joms.2020.10.031 sha: 05fbc2dd56879457673bf73f9c983362430014a5 doc_id: 51909 cord_uid: o6lu45r5 nan Telemedicine, which refers to the application of electronic and digital platforms to assist health care providers in providing remote health services, patient-level education, and information on public health, has remained a relatively underutilized approach to enhancing access to medical services nationally. 1 Traditionally, telemedicine has primarily provided health care services to individuals residing in rural communities, those impacted by natural disasters, military personnel, and veterans, as well as for emergency department consultations and the delivery of mental health services. 2 In early 2020, Medicare began paying clinicians for e-visits, which are patient-initiated non-face-to-face communications through an online patient portal. However, in response to the COVID-19 pandemic and associated social distancing guidelines, interest and utilization in telemedicine has surged. Before the pandemic, approximately 13,000 Medicare beneficiaries received telemedicine services each week. By the last week of April 2020, nearly 1.7 million beneficiaries received telemedicine services each week. Through mid-June, over 9 million beneficiaries had received telemedicine services. While telemedicine visits have been most prevalent in ambulatory primary care, there is value in utilizing this technology for non-procedural visits in surgical specialties. However, major challenges with telemedicine in practice, including differences in state-specific policies and jurisdiction of medical practice, unreadiness for telemedicine visits among the elderly and underserved, and disparities in access to care due to regional gaps in internet access, merit discussion when considering the scope and deployment of telemedicine technology. This perspective characterizes the payer response to telemedicine, the process by which oral-maxillofacial surgeons (OMSs) can initiate and bill for telemedicine visits, and provides practical guidance for surgeons to virtually care for a diverse patient population, many of whom may be experiencing this unfamiliar treatment modality for the first time. Oral-maxillofacial surgery-specific vendors have also designed products for telemedicine services. OMSVision, a practice management software product designed and developed for oral-maxillofacial surgery practices, has recently expanded its capabilities to deliver telemedicine services for oral and maxillofacial surgery providers and practices. The Oral and Maxillofacial Surgery National Insurance Company, endorsed by AAOMS, has also expanded its liability coverage to include telemedicine and virtual office visits insofar as they are provided in accordance with local, state and federal regulations. Regardless of services rendered, it is crucial that OMSs are aware of local and state mandates and provide healthcare within their scope of practice as recognized by the appropriate authorities and licensing boards. Although the technical and payment infrastructure for telemedicine is now in place, demographic challenges continue to limit the scope of telemedicine services. Approximately 40% of Medicare beneficiaries lacked access to a desktop or laptop computer with high-speed internet connection at home, and 26% of beneficiaries had neither a computer or smartphone with a wireless data plan. Among those 100% below the federal poverty level, 50% lacked digital access, compared to only 11% of those with incomes over 400% of the federal poverty level. 4 This gap highlights the challenge of reaching Medicaid patients with telemedicine services. Additionally, among the Medicare population, 38% are not ready for video visits, predominantly due to inexperience with technology. Other factors contributing to unreadiness include difficulty hearing, communicating, or dementia. 5 In order to ease patient and provider unfamiliarity with medical-grade video conferencing software during the COVID-19 pandemic, the Department of Health and Human Services announced that they would waive penalties for HIPAA violations against health care providers that serve patients through more familiar consumer products, such as Apple FaceTime, Zoom, or Skype. Furthermore, akin to the World Health Organization Surgical Safety Checklist, we J o u r n a l P r e -p r o o f have developed a telemedicine-specific checklist for surgeons to quickly onboard patients into this unfamiliar visit modality, define comfort and expectations, and reduce the risk for technical errors and privacy violations during virtual encounters (Figure 1 ). Although the permanence of CMS changes to telemedicine policy and payment rate parity remain uncertain, the rapid adoption of telemedicine services by both providers and patients is a promising sign for the longevity of this technology. OMSs can proactively help CMS and other payers determine when telemedicine visits, as opposed to in-person visits, are clinically appropriate for specific acute patient needs in oral-maxillofacial surgery to inform future coverage policies and payment rate adjustments. Telemedicine has served as a lifeline for both providers and patients during this state of national emergency; however, this crisis may also be the spark the technology needs to level access to care for our nation's underserved. Utilization of Outpatient Telehealth Services in Parity and Nonparity States 2010-2015 The Role of Telehealth in the Medical Response to Disasters American Academy of Oral and Maxillofacial Surgeons Assessment of Disparities in Digital Access Among Medicare Beneficiaries and Implications for Telemedicine Assessing Telemedicine Unreadiness Among Older Adults in the United States During the COVID-19 Pandemic No funding was allocated for this study.Nisarg A. Patel is a cofounder of and shareholder in Memora Health, Inc.