Surgeons prefer in-person visits to telehealth for preop visits

New research shows that most surgeons are not open to using telehealth for preoperative visits, largely due to malpractice concerns; however, more than half said they would use telehealth for postoperative consultations.

Published in the journal Surgery, the study aimed to examine surgeons’ attitudes toward telehealth. Prior research has shown that surgical specialists are less likely to use telehealth than their peers. Data from the 2021 National Electronic Health Records Survey revealed that nearly half of surgical specialists (49.7 percent) indicated telehealth was inappropriate for their specialty or type of patients compared to 15.5 percent of primary care physicians and 26.7 percent of medical specialists.

The new survey polled 170 surgeons across six specialties from August 2022 to March 2023.

Most disagreed with using only video visits for preoperative surgical consultations, even if provided with the necessary medical history, laboratory reports, and imaging. Nearly 43 percent stated that a physical examination was needed for preop visits, while 58 percent felt that video visits were associated with a greater malpractice risk than in-person visits. Additionally, 37 percent cited technology concerns, and 27 percent billing and reimbursement issues.

However, surgeons appeared more open to telehealth for postoperative visits, with 60 percent saying they would use telehealth for postop consultations in uncomplicated surgeries.

Perceptions of telehealth use also varied across surgical specialties. For instance, 88 percent of the urologists who responded to the survey said they use telehealth with at least some patients. Additionally, 56 percent of urologists said they would operate on a patient they had only seen virtually before the surgery, compared to 17 percent of general surgeons and 22 percent of orthopedic surgeons.

Even among those open to virtual postop visits, specialty plays a role, with 77 percent of otolaryngologists open to the idea compared to 20 percent of orthopedic surgeons.

The survey further reveals that 67 percent of surgeons believe their practice lacked motivation for telehealth implementation. The uncertainty of the telehealth reimbursement could be driving this lack of motivation.

“The uncertainty about the future of reimbursement rates that still hangs over the field of telehealth, because federal-level policies have been temporary to date, may be a major factor in surgeons’ decision-making about investing in changing their protocols to allow for more video visits,” said  Chad Ellimoottil, MD, medical director of virtual care for the University of Michigan (U-M) Medical Group and a telehealth researcher at the U-M Institute for Healthcare Policy and Innovation, in a press release.

Despite surgeons’ hesitation, prior research has highlighted how telehealth can improve aspects of surgical care.

For example, a study published last month showed that telehealth-based interventions can help lower the risk of readmissions and emergency department (ED) visits after abdominal surgery. The study assessed 19 randomized controlled trials (RCTs) and cohort studies with 10,536 patients.

Of the 11 studies reporting hospital readmission rates, seven RCTs and six cohort studies reported data on ED visits. Researchers found that telehealth groups experienced a reduction in readmission rates and ED visits compared with usual care groups, with low to moderate heterogeneity.

Additionally, the American College of Surgeons recently released a statement highlighting the critical role telehealth can play in surgical care and outlining standards for using it. Per the statement, telehealth is most appropriate for consultations, preoperative assessments, follow-up and monitoring, and multidisciplinary collaboration in surgical care.

The association also noted the best practices for using telehealth in surgery, including that surgeons must adhere to all state and federal telehealth regulations and maintain a technical infrastructure that includes a secure, high-speed internet connection and user-friendly telehealth platform.