Jaspal Singh, MD, MHA, MHS, on How I Practice Now: Overcoming the Logistical Challenges of Telemedicine

Using telemedicine comes with several logistical challenges, including reimbursement and office communication. In this video, Jaspal Singh, MD, MHA, MHS, reviews the challenges and how to overcome them. 

Jaspal Singh, MD, MHA, MHS, is medical director of both pulmonary oncology and critical care education, as well as a professor, at Atrium Health in Charlotte, North Carolina.


aspal Singh: Hi, I’m Jaspal Singh. I’m at Atrium Health. I’m the medical director of both pulmonary oncology as well as critical care education for the Pulmonary and Critical Care Network.

I think telemedicine is hopefully here to stay. I will say, CMS has come out very boldly and advocated for telemedicine reimbursement to stick for a while. Whether it will stick to the same rates that it is right now is left to be determined. I think a lot of us are looking at the financial picture as virtual visits—whether it be phone or whether it be full virtual—and what the regulations look like moving forward will affect things. Will the states recognize people who are managed across different state lines? Right now, luckily, we’ve had this interstate, sort of, emergency privileges you might say, that work very well in our region for managing people in different states. But if that changes or the states say, you know what, we’re going to go back to the way that things were, that may affect the adoption of telemedicine in certain communities, especially those with, you know, close to border states, for example, where we have to be mindful of interstate borders and interstate traffic.

But there’s a lot to be learned. I will say one of the best things about virtual medicine, besides the flexibility, is the absolute convenience for the patient. It used to be where basically I may see a patient in the office, do a test or diagnostic intervention, and then I have to sort of either call them or work around the follow-up visit a week or two later, and if they miss that appointment, had to reschedule. You had to get them back in. Whereas now, I can literally just say, “Okay, let’s schedule a phone visit or virtual visit 2 days from now.” And not only is that a legal sort of tracked mechanism of what I’ve done with that patient and my office can see it, but also I get some credit for that. Whether that’ll be paid for or not, or how much has to be paid for, it’s hard to say, but these are some work credit, and I think a lot of us want to be recognized for the work that we do. And so I think from that perspective, it’s very nice. I can see patients more often not be afraid that I’m just having to work around an already challenging schedule and kind of work around both my life and the patient’s life a little bit better. So from that perspective, it’s very satisfying. 

The negative side, of course, we’re still kind of figuring out, well, if I’m virtual and my staff is virtual and we’re not all next to each other, we may not be as smooth. We may be spending a lot of time communicating, or even overcommunicating, or stepping over each other a little bit here and there, causing some more confusion. So I think working that out with your team, drawing out like who’s got what role when and then making sure you’re very clear in your communication as to who has the next process, who has the next step. And if the next step is missed, how are we going to sort of pick up where we are? So a lot of communication. A lot of basic principles come to play here.