Why was telehealth one of the AUA Advocacy Summit priorities for the third year in a row? Why does the AUA census include questions about telehealth use? Almost everyone had to use telehealth during the COVID-19 public health emergency. We had to. People were afraid. Clinics were shut down. Social distancing was a necessity, and it was enforced.

Telehealth was the only way to ensure patients had some way to connect with their doctors, surgeons, and other providers. Initially, emergency declarations led to broad flexibility in how telehealth could be used. FaceTime (and other modalities that are not US Health Insurance Portability and Accountability [HIPAA] compliant), care delivery across state lines, and even reimbursing equally for audio-only (phone call) visits were temporarily allowed across the states. As federal and state emergency declarations began to fade, many of these changes were rolled back.

However, certain key flexibilities remain in place until December 31, 2024, thanks to the Consolidated Appropriations Act of 2023.¹ Language included in this appropriation bill was supported by AUA members and leadership during the 2022 Advocacy Summit as part of a coalition including the American Medical Association, Alliance of Specialty Medicine, Alliance for Connected Care, and the American College of Surgeons, among many others. At the federal level, key regulatory flexibilities remain in place (Figure):

• Waiving of originating site requirement (patient can engage in telehealth from home; rurality/health care provider shortage not required)
• Payment parity for telehealth and in-person visits by medical decision-making
• Virtual supervision included in direct supervision (residents, advanced practice providers)

Importantly, data support the continued use of telehealth. Even before the pandemic, numerous studies in urology demonstrated high satisfaction and equivalent clinical and safety outcomes.^2,3 Even more recently, a narrative review of telehealth looking at data beyond urology highlighted improved patient-centered outcomes such as cost and time savings, health-system outcomes supporting virtual care used as a substitute for in-person visits, and similar clinical outcomes compared to clinic encounters.⁴ Telehealth should be an option for patients to connect with their urologists; it is not a novel intervention, simply a different way for patients to access specialty care.

Beyond continuing the current public health emergency telehealth flexibilities, there is also ongoing work to prevent the creation of a digital divide—that is, unequal access to telehealth services due to preferential reimbursement for video visits, which require broadband internet and smart devices.⁵ For patients who cannot connect with video, phone encounters with evaluation and management of medical conditions should be covered and reimbursed similarly. Otherwise, health systems will be disincentivized to offer anything but in-person or video visits, and the promise of improved access to care will not be realized for rural and marginalized communities.

As of this writing, 34 federal bills support the expansion of telehealth services, including the AUA-endorsed Connect for Health Act, with bipartisan support from 59 senators. If this affects your patients, your loved ones, or your practice, then I encourage you to get involved. Join the AUA Advocacy efforts. Go to the Advocacy Summit, donate to the AUA Political Action Committee, contact your representatives by using our Action Center, join your section health policy committee, and help make the voice of urology heard so we can continue to shape the future of modern medicine.