What is the “digital front door?” Imagine walking through a door and choosing which hallway to walk down. Should I go to the right or left, or keep walking straight? Physicians, patients, and members of the community use technology to make decisions in health care every day. Telemedicine and telehealth are an integral part of a digital health strategy to connect patients and consumers with health care providers. Accelerated by the COVID-19 pandemic, we have opened this digital front door and entered into the world of virtual health care. As a profession, urologists tend to embrace innovation; our adoption of and ongoing efforts to advocate for telehealth are no exception.

The 2023 AUA Advocacy Summit was held February 27 to March 1 in Washington, DC, and this year’s theme was “Rise and Renew.” Experience with telehealth during the COVID-19 pandemic has repeatedly demonstrated its utility and success in every domain of our profession. With the impending termination of many public health emergency waivers that not only permitted the rapid adoption of telehealth in our field, but also enabled it to thrive, it is essential that Congress understands the impact of these waivers on our practices.

We are witnessing a new digital revolution wherein technology augments, and in some cases replaces, legacy health care services. Now is the time to extend the congressional and financial landscape to support telehealth permanently. We met with attendees of the Advocacy Summit to educate the group on the following 5 priorities prior to meeting with legislators:

1. Eliminate originating site requirement
2. Payment parity
3. Continued support for audio only
4. Role of virtual supervision
5. Interstate licensure

Eliminate Originating Site Requirement

Originally telemedicine was developed with the purpose of expanding health care delivery to reach individuals in rural states. Patients were required to “join” a virtual visit from an “originating site”—a designated rural medical clinic with adequate broadband access and a HIPAA (Health Insurance Portability and Accountability Act)-compliant platform to use synchronous audio and video. The consulting physician, in turn, participates at the “distant site.” Ongoing waivers during the COVID-19 pandemic permit patients to engage in telehealth encounters from any location, including their own domicile. This waiver has significantly expanded the reach of telemedicine and facilitated access for many patients, in turn broadening health care delivery to patients in all locations.

Payment Parity

Ongoing utilization of telehealth by urologists is dependent on equitable reimbursement. In a country with an ongoing shortage of practicing urologists, our expertise is in demand and our time is valuable. Research and experience have demonstrated that successful integration of telehealth into a practice requires a modified system and workflow compared to in-person encounters. Digital literacy and access to broadband-containing devices varies from patient to patient. Scheduling and preparing a patient for a virtual visit requires dedicated and trained staff, a HIPAA-compliant platform, audio/visual equipment, and possibly IT (information technology) or other trained staff to ensure everything runs smoothly. At the same time, most urologists also maintain their “brick and mortar” office(s) to support in-person care. If urologists are not reimbursed fully and commensurate with the medical care being provided, then many urologists will struggle to continue to offer this option to their patients.

Continued Support for Audio Only

This ask has been highlighted by every medical specialty. The digital divide is very real depending on individual patient barriers. Reliable broadband access, digital literacy, age, and social determinants of health all play a role as to whether or not a patient can engage successfully with a video visit. Beyond these challenges, numerous research studies comparing audio to video visits have demonstrated equivalent satisfaction among both patients and urologists. Ongoing reimbursement for audio-only visits will continue to support the growth of telehealth within our field.

Role of Virtual Supervision

Virtual supervision of medical trainees or professionals is increasingly occurring, particularly as it pertains to teaching medical students, residents, and nurses. In a number of areas, particularly rural states, that lack primary care and specialty physicians, this concept has already been integrated into health care systems. Continuing to reimburse physicians for remote supervision and, in turn, expanding health care delivery to rural areas is not only forward thinking, but also essential.

Interstate Licensure

All of us have patients who want to continue their urological care if they relocate or, perhaps, vacation in a different state. Both physicians and patients would benefit from a permanent waiver on interstate licensure requirements. The Interstate Medical Licensure Compact was created to help with multistate licensing, but this has not proven to be an effective solution. Each state has its own requirements and protections in place for patients, and in turn, physicians will face hefty state licensure fees and burden to deliver telehealth across state lines once the waiver ends. We asked Congress to develop a more effective solution to facilitate virtual health care delivery across state lines and continue to provide better access to health care overall.

We concluded our talk with a parting message: Be a Telehealth Champion. Open the digital front door and help develop a strategy to engage your patients in innovative urological care.