Are there scenarios that new visits/consults with patients can be done virtually amidst the COVID-19 outbreak?

Starting 3/16, we began offering lower-complexity / lower-risk patients the option of having a Tele-medicine consult vs re-scheduling to a later date. This offer has been extended broadly to all new consults at our facility when the provider indicates that s/he can extend comparable service virtually. We have used Tele-medicine consults in cases ranging from HR+ DCIS to 2nd opinions regarding treatment options (when both the patient and referring oncologist feel comfortable with this, and we have relevant outside studies available for review). Patients who strongly desire an in-person visit continue to be accommodated at this time.

Our expectation remains that patients starting chemotherapy or therapeutic clinical trials, or those of highe...

Updates

CMS issued new policy guidance on 3/30/2020 that further relax existing telemedicine and supervision requirements. Below is a list of key changes significant to radiation oncology with section and page references to the attached CMS document.

- Weekly management visits (CPT code 77427) can now be conducted via telehealth (audio & video), if deemed appropriate (section II.17, pg 40).

- CPT codes 99441-99443 that cover audio-only communication with patients will receive payment with RVUs established by the RUC in 2008 (section S, pg 122).

- History and physical examination documentation requirements will be removed for new or established patient encounters if performed by telehealth (audio & video) with selection of level of encounte...

We are moving to telemedicine for consult, FU and OTV whenever feasible.

Our department is rapidly evolving to move almost all patient encounters to be virtual. We have an existing telemedicine platform but there is limited infrastructure. To supplement we have Zoom meetings with patients in exam rooms or at home. As an ad hoc solution, we purchased iPads with the Zoom app for use in the clinic. Attending and resident can both participate from separate locations. These encounters also include undertreatment visits where the physician is physically present in the facility but not in the same room. This required some compliance discussion in the context of the pandemic. Note that CMS has relaxed rules for the platforms that are used. I admit that the tumor types that I treat may be more amendable to an initial vi...

Telemedicine is an important and useful tool that allows us to practice valuable social distancing to protect our patients and staff. ASTRO has released guidance on the use of Telehealth during the COVID-19 pandemic based on the waiver CMS issued on March 17th. Telehealth visits for new or established patients will be reimbursed by Medicare at the same rate as face-to-face visits. Medicare has requested private payors to follow suit. It's important to note that currently these telehealth visits still require BOTH audio and visual components. CMS granted a HIPAA waiver as part of this emergency to allow for video chats through products such as FaceTime and Skype.

On a COVID stakeholders call that CMS convened on 3/24, many providers raised c...

As of today at Washington University in Saint Louis, we have been approved to do telephone consults and follow-ups. OTVs we still have to see physically, but hopefully that will be solved. We don't have a telemedicine solution yet available, although there is some piloting going on.