What to Know About Telehealth With a Urologist

Although telehealth was regarded as a temporary measure to relieve the burden on hospitals and clinics during the height of the COVID-19 pandemic, it is being embraced as a mainstream facet of health care by many medical specialists, including urologists.

Urology is a field well suited for telehealth, with practitioners utilizing it for the complete spectrum of adult and pediatric consultations, preoperative and postoperative evaluations, and routine care for skilled nursing home residents.

With the decision by the Centers for Medicare and Medicaid Services (CMS) to pay for telehealth services at the same rate as in-person visits, telehealth today is regarded as a means to expand access to urologic services safely and effectively—particularly in rural communities, where urologists are historically in short supply.

This allows urologists to remotely treat a broad range of urologic conditions affecting the male and female urinary tracts and male reproductive organs. This includes preliminary assessment of infections, obstructions, incontinence, congenital malformations, traumatic injuries, male sexual dysfunction, and urinary tract cancers.

When to Use Telehealth With a Urologist

While many aspects of urology require a traditional hands-on examination, there are numerous conditions and phases of treatment that can be managed as effectively with a telehealth consultation.

In some cases, the initial online consultation might precede a hands-on exam, allowing doctors to review symptoms and medical history before ordering next-step procedures. At other times, a urologic condition can be diagnosed and treated entirely online.

A telehealth appointment with a urologist may be appropriate in the following situations:

• The diagnosis and treatment of uncomplicated urinary tract infections (UTIs)
• The diagnosis and treatment of erectile dysfunction (ED)
• The routine monitoring of lab results for benign prostatic hyperplasia (enlarged prostate)
• The post-treatment monitoring of Peyronie's disease (PD)
• The management of delayed or premature puberty in boys
• The monitoring of vesicoureteral reflux (urinary reflux) in infants and children
• The initial and follow-up consultation for prostatitis (prostate inflammation)
• The initial consultation for hematuria (blood in the urine)
• The initial consultation and ongoing management of premature ejaculation, low libido, delayed ejaculation, and other types of male sexual dysfunction
• The initial consultation and ongoing management of hypogonadism (low testosterone)
• The initial consultation and ongoing management of male infertility (including the assessment of semen analyses, hormone and genetic tests, post-ejaculation urinalysis, imaging, and potential partner workup)
• The initial and follow-up consultations for interstitial cystitis (painful bladder syndrome)
• The initial and follow-up consultations for urinary incontinence
• The initial and follow-up consultations for overactive bladder (OAB)
• The initial consultation and follow-up evaluation of kidney stones or bladder stones
• The initial consultation and follow-up management of varicoceles
• The initial consultation and post-treatment monitoring of a traumatic injury (such as straddle injuries to the perineum or urethral strictures and bleeding caused by crush injuries)
• Preoperative and postoperative consultations for vasectomy
• Preoperative and postoperative consultations for hypospadias, epispadias, and other congenital malformations in males
• Preoperative and postoperative consultations for bladder, kidney, prostate, or testicular cancer

Benefits and Challenges

Telehealth services have their benefits and limitations and may not be appropriate for everyone. In the end, there are times when a telehealth visit is extremely useful and others in which a physical exam is crucial to rendering the correct diagnosis.

Benefits

Telemedicine is now being used across many urology subspecialties, expanding the reach of a medical practice and the volume of patients a urologist can see.

Among some of the benefits of a telehealth urology visit:

• Access: Telehealth services can connect residents in underserved communities to consistent, quality urological care.
• Convenience: Telehealth services offer convenience to people with mobility issues, including those in nursing homes or skilled nursing facilities.
• Choice: Telehealth services provide people a greater choice of specialists, as providers are less constrained by distance.
• Information access: Telehealth services increasingly allow patients to review lab tests, scans, and other results with their doctors, satisfying the CMS's requirement for the "meaningful use" of electronic health records.
• Group participation: Telehealth services allow you to bring family members and others into the online visits, particularly in cases of illness or incapacity.
• Dual consultation: Some telehealth services enable multiple specialists (such as your urologist and oncologist) to sit in on a consultation.
• Asynchronous visits: For people in need of chronic care or who have nonurgent symptoms, asynchronous telehealth allows them to message their urologist and receive a reply, usually within a day.
• Less waiting time: Compared with in-office visits, waiting times for telehealth appointments are reduced by around 50%, according to the American Urological Association.
• Cost: Telemedicine was found to save people an average of $19 to $121 per visit, due largely to the avoidance of emergency room visits.
• Insurance coverage: Telehealth services are covered in part by Medicare Part B, Medicaid (either in part or full depending on the state), and many private and employer-based health insurance plans.
• Consultation times: The time spent between a urologist and patient during a telehealth visit is essentially the same as an in-office visit, according to a 2020 review of studies in European Urology.
• Satisfaction: With the increasing acceptability of telehealth services, the rate of satisfaction is generally on par with that of in-office urologist visits.
• Impact on care: The completion rate of certain urological treatments, such as prostate cancer treatments, is the same for telehealth patients as for traditional patients.

Challenges

Despite the high levels of acceptance among consumers, telehealth services are not without their limitations. This is particularly true in urology, where subtle symptoms often point the doctor in the right direction.

Among some of the things that can undermine a telehealth urology visit:

• Lack of broadband access: According to data published in the Journal of Law and Medical Ethics, approximately 24 million people in the United States live without broadband access, including 19 million rural Americans and 1.4 million Americans living on Tribal lands.
• Technical limitations: Even in areas with broadband access, problems with host reliability, outdated hardware, and incompatible software can hinder telehealth service. Even the type of mobile device used can limit interactions due to screen size, volume, or image resolution.
• Cost: Even if the cost of telehealth is covered by insurance, the costs of acquiring a mobile device and broadband services are not. This places an undue burden on people who are unemployed or have limited incomes.
• Diagnostic limitations: Many urological conditions require a hands-on examination to feel for masses, swelling, or changes in the size, structure, or texture of an organ. Examples include a digital rectal exam (DRE) for people with enlarged prostate or the palpation of fibrous plaques in people with Peyronie's disease.
• Missed observations: Providers who rely heavily on telehealth can miss subtle changes, such as the onset of neurological symptoms in people with neurogenic bladder. Some symptoms, such as a full bladder or undescended testicle, can only be detected manually. Without these subtle clues, conditions can be misdiagnosed and incorrectly treated.
• Liability and malpractice: Not all liability insurers cover telehealth malpractice. It is for this reason that high-risk specialists, like neurosurgeons, less commonly provide telehealth services. Those offered by other specialists tend to treat conditions that are less subject to malpractice suits.

Although certain state regulations were relaxed in response to COVID-19, such as the issuance of waivers for in-state licensing of telehealth providers, it is unclear how long (or if) these measures will last.

State laws pertaining to the prescribing of medications can vary, with some states requiring a hands-on exam before certain drugs can be prescribed. Check the laws in your state before a telehealth visit so that you are aware of any restrictions.

How to Prepare for a Telehealth Visit With a Urologist

Some preparation is needed before scheduling a telehealth visit with a urologist. If you already have a urologist, they will be able to tell you if a telehealth appointment is appropriate for your condition.

If you don't yet have a urologist, you can ask your family doctor, gynecologist, or pediatrician for a referral and request an initial telehealth appointment.

If the urologist does not offer telehealth services, you can use the digital health directory offered by the American Telemedicine Association (ATA) and endorsed by the Department of Health and Human Services (DHHS).

Finding a telehealth doctor is only the first step in preparing for an online visit. In addition, you will need to:

• Compare prices. If you don't have insurance, shop around for the best price and ask the provider if they offer financial assistance, no-interest payment plans, or discounts for upfront payment.
• Determine what type of visit it will be. Will it be a phone call, a one-on-one video conference, or a Zoom-like consultation with more than one provider? If scans or other files are being shared, for example, you may want to use a laptop or tablet rather than a smartphone.
• Ask what to expect. The appointment scheduler should be able to walk you through what to expect. If vital signs or lab tests are needed, they will tell you where to get these done. They should also tell you if you are seeing a doctor, nurse practitioner, or some other healthcare professional.
• Check your Internet connection. If your WiFi at home is spotty, find someplace with a strong connection (like a friend's house) where you can conduct the consultation privately. Avoid public places that not only lack privacy but offer less secure connections.
• Prepare your space. If the appointment is audiovisual, find a well-lit room that is relatively quiet. Avoid sitting in front of a sunny window, as you will likely be hard to see on the screen.
• Check your audio. This is especially true if you're using a laptop or tablet and have never done videoconferencing before. Test and adjust the audio settings in advance, and turn up the volume if needed so that you can better hear.
• Dress for the appointment. If you have a lump you want the doctor to see or a surgical wound that needs to be checked, wear something that is easily removed and replaced.
• Make a list of questions. Write down any questions you have so you don't forget, as well as a list of symptoms with dates that can aid in the diagnosis.
• Forward relevant files. If your primary care physician has lab reports, scans, or other information relevant to your appointment, ask that they be forwarded electronically several days in advance. Send only relevant materials, not your complete medical history.
• Complete your intake forms. You will likely be forwarded intake documents, including informed consent and medical history forms, to fill out in advance of your appointment. Today, most are done via online portals that you can complete on your smartphone or laptop.
• Prepare contact information. This includes the names, addresses, and telephone numbers of your primary care doctor or pharmacy.

Will Insurance Cover Telehealth With a Urologist?

Medicare Part B covers certain telehealth services. With Original Medicare, you pay 20% of the Medicare-approved amount for the doctor or health provider's services, and the deductible applies.

Medicare Advantage Plans may offer more telehealth benefits than Original Medicare. Check your plan to see what telehealth services are offered.

For beneficiaries of Medicaid and the Children's Health Insurance Program (CHIP), telehealth benefits can vary by state. Even if a state decides to cover telehealth, it may do so only for certain providers. Call your state Medicaid office for information about covered services in your state.

Telehealth benefits for those with private insurance, including employer-sponsored insurance, can also vary. While more private health insurers are offering telehealth benefits for primary or urgent care, they may not do the same for specialists like urologists.

If you have private insurance, check that the telehealth provider is covered, whether they are in-network or out-of-network, and what the copay or coinsurance costs will be.

What Happens During the Visit

At its heart, a urology telehealth visit is the same as an in-office visit, albeit without the means for a physical exam.

Oftentimes, the office will call you shortly in advance of the appointment to confirm that you are ready or to let you know if they are running behind. They may also take prepayment with a credit or debit card.

Just before the meeting is to start, turn off any TVs, radios, or mobile devices that might interrupt the consultation. Let everyone in the house know that you are not to be disturbed. If they are to join you, have them there with you when you begin rather than hunting them down halfway through the appointment.

When it is time for your consultation, the appointment will follow the same basic steps as any other telehealth appointment:

1. Using the link provided by the office, sign in to the secure portal and wait in the virtual "waiting room."
2. The doctor or other healthcare professional will greet you and discuss your concerns, symptoms, and medical history. To streamline the appointment, save your questions for last.
3. If a visual examination is needed, the healthcare professional will walk you through what to do and what they need to see.
4. If lab reports or scans are reviewed, ask what they mean and be sure that they are shared with your primary care provider.
5. Ask any questions you have prepared or have come up with during the consultation. If something is unclear—particularly what a diagnosis means or doesn't mean—do not hesitate to ask.
6. The provider will summarize what was discussed, including any tests, procedures, or treatment plans you have agreed to. If an in-office visit is needed, that will be discussed as well.
7. The provider will confirm what medications, if any, have been prescribed and confirm to which pharmacy the prescription will be sent.
8. If an in-office or follow-up appointment is needed, you will be forwarded to a scheduler. Confirmation of the appointment will be sent by email and/or text.
9. If further tests are needed, a nurse or physician assistant will give you a rundown of what to do and forward instructions by email if needed. Referrals will also be shared if requested.

A Word From Verywell

Telehealth, initially seen as a way to alleviate the burden of COVID-19 on hospitals, is today revolutionizing health care as we know it. It is not only attractive to patients, offering convenience at generally lower costs, but allows specialists like urologists to reach underserved communities and housebound residents.

Even so, telehealth is not a one-size-fits-all substitute for in-office care. If you are experiencing signs of a urological emergency, do not turn to telehealth services. Seek emergency care without delay.