Dispatches from the vascular front: Embracing telemedicine in COVID-19 era

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William P. Shutze

DALLAS—William P. Shutze, MD, has not long since finished his day’s practice—a shift in which he carried out somewhere in the region of 13 televisits.

This is a new era for life in general as the world struggles to adjust to a new way of being following the interruption of the COVID-19 pandemic—and for Shutze as a vascular surgeon. Across medicine and in vascular surgery, a transformation is afoot: the emergence of telehealth and telemedicine as a more widespread means of delivering care as physical surgery visits and all-but emergent procedures were curtailed.

Like many vascular surgeons, for Shutze that has meant a veritable crash course in all things telehealth in order to fill the care void created by the virus. He’s in an ebullient mood. Despite teething problems, the televisits are proving to be a helpful platform in these uncertain times, the partner at Dallas- and Plano-based Texas Vascular Associates tells Vascular Specialist.

“It’s not perfect by any stretch of the imagination,” Shutze relates. “The patients, the providers—we’re all trying to figure out the technology and make it work. There’s glitches with the cameras, the speakers, the microphones, the connections. Sometimes you have to call back.

“Sometimes you need two open lines of communication, one through the computer and the other via phone. But everyone’s been really patient with it, and understands the reasoning behind it.”

The practice of telehealth picked up in late March after the Centers for Medicare & Medicaid Services (CMS) issued a series of temporary regulatory waivers and new rules designed to help the U.S. healthcare system respond to the COVID-19 pandemic.

The Society for Vascular Surgery (SVS) quickly pivoted to help members ready themselves for the altered regulatory environment.

Novice

So it was that during an SVS Town Hall on telemedicine last month, Shutze—chair of the SVS Clinical Practice Council—was a panelist. The session, a comprehensive discussion and analysis of how use of the medium was playing out, saw Shutze identify himself as a newcomer in the practice of telemedicine—a useful foil for the many surgeons in a similar boat.

“I’m a total novice at [telemedicine], I never had any experience with this platform for delivering healthcare, I never had any interest in this type of platform,” he explains. “I grew up with face-to-face visits—hands-on. Anything less than that supposedly wasn’t good care, unless you’re trying to manage something over the phone when a patient calls in with a problem.

“Starting with a baseline experience of nothing, it turned out to be not that hard since the platforms are pretty easy to use. Most of the patients have some form of technology, whether it’s a smartphone or a computer, or both, that will allow them to participate. Then it’s just a matter of getting the workflow in place that fits your office.”

At the outset, Shutze didn’t want to dive straight in. So he started with a few patients in order to find his feet, expanding as tweaks and comfort levels improved the process.

“Actually, from a doctor’s perspective, the televisits are going a little bit faster, so a little bit more efficient,” he says “I don’t have to walk from room to room to see patients. I sit right at my desk. All the materials are right there in front of me. If a patient is early or late, it’s much easier to accommodate with the virtual waiting rooms. [To other doctors] I would say, ‘Throw away your trepidations and test the water. If you like it, then jump in.'”

Yet, there are, of course, limitations.

“Most relevant for our specialty is the evaluation of the pulses,” Shutze continues. “That’s where you’re really going to run into the barriers. If you have situations where that is an essential component to your visit then you’re going to have to make arrangements for that person to come in to be seen face to face. But, as we’re finding out, those components might not be essential in times of duress like now.”

Into the future

Beyond the shackles placed on healthcare by COVID-19, once normal practice is able to resume, Shutze sees an expanded future for televisits in vascular surgery.

“The most enduring aspect will be the introduction of this entity as another way to service our patients into our speciality in a more broad manner,” he explains. “Up to this point, it has been very limited to just a few providers in our specialty—out of several thousand. This catastrophe has brought telemedicine into daily use in many situations, and now that the vascular world has had a taste of it, I think we’re going to see that many vascular surgeons are going to try to find a way to keep some component of this integrated in how they service their patients.”

The unanswered question remains how much of the relaxed telemedicine regulatory environment survives once the pandemic is overcome, and authorities look to restore order.

“Right now, that is out of our hands,” admits Shutze. “That will be the big determinant into whether this just creeps in a little bit more than it had been—or whether it can become much more widespread. But that being said, we’re not alone in that in vascular surgery. All the other specialties that require patient contact have moved into this realm as well. So, hopefully that will have created a little bit of a tidal wave to push back on some of the regulations that prevented this from becoming more of a way we practice than it had been.”

Financial impact

Meanwhile, like many in private practice, COVID-19 unleashed testing moments for Texas Vascular Associates as a business.

“It’s still an unstable situation,” Shutze says. “Initially, we were staring over the edge of a precipice when this whole thing started to roll out, when the lockdown started, with no potential sources of revenues or relief.”

Government efforts like the Payment Protection Program eventually helped stem the tide. “Our practice was fortunate enough to be in the first wave of approval,” Shutze goes on. “Many, many other practices were not and they have suffered for that. Being in the first wave, it really gave us some solid financial footing for the interim, helping us tide things over for six-to-eight weeks. We were also able to take advantage of the Accelerated and Advanced Payment programs to get three months of projected revenue into our bank account to have as a reserve to be used in case of an emergency.”

Shutze notes further relief programs remain an option should they be required, and tipped his hat in the direction of Texas Vascular Associates’ malpractice insurance carrier, which cut premiums in the face of reduced work volume and therefore risk, as well as the landlord at one of the business’ practice locations who rolled over a month’s rent into the remainder of its lease.

Others were not quite so forthcoming. “I don’t wish ill on anybody,” Shutze considers, “but I hope that companies and entities that have acted in a self-serving manner will receive the appropriate vilification down the road.”

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