Do You Give Your Patients an Option for Virtual Visits, and What Now?

A missed opportunity, or a more-challenging interaction?

The CORRelations Chart of the Week “Do You Give Your Patients an Option for Virtual Visits?” points to poor utilization of virtual visits by specialists, including orthopaedic surgeons, ophthalmologists, and podiatrists. By contrast, mental health professionals, infectious diseases specialists, and obstetricians lead the way in utilization of this sometimes-helpful tool.

We used virtual medicine when we had to during the pandemic, but usage has dropped precipitously. Is this a missed opportunity?

No doubt virtual visits are easier in mental health than in surgical subspecialties, but I’m intrigued that some specialties where a component of physical examination may be as important as it is in orthopaedic surgery — perhaps including infectious diseases and obstetrics — are using it more than we are.  

In my practice, we have tried to incorporate these visits into our workflow, but our physicians complain of the limitations on physical examination and the decreased hands-on (and sometimes, even the difficulty of seeing things clearly) we get with telemedicine visits. And of course, coordinating the taking of radiographs is challenging when performing virtual visits.

But I believe orthopaedic surgeons can use telemedicine more frequently without losing effectiveness. I suggest starting off with callbacks on MRI results or routine postoperative questions. As your comfort increases, you can broaden your use of these calls to include more routine follow-up visits when radiographs or critical physical examination is unnecessary. In particular, your physician assistant or nurse practitioner may find telemedicine useful.

One challenge that I had as AAOS Advocacy Council Chair was to persuade CMS that virtual visits were more work-intensive than believed. Many patients struggle with the technology, and interactions can be more challenging than in-person visits. Patients often judge the quality of care based on perceived value, and this perception is often diminished in the telemedicine context. Although it can be unattractive to base decisions on reimbursement, the necessity of running a practice and paying overhead is an absolute reality. For this reason, I think telemedicine visits are best used to discuss imaging results, for simple aftercare during the global period, and perhaps by physician extenders more than orthopaedic surgeons.