Telemedicine has the “potential to transform the practice of pediatrics,” the American Academy of Pediatrics declared in a 2015 policy statement. Citing the technology’s ability to “improve access to care, provide more patient- and family-centered care, and increase efficiencies in practice,” the AAP recommends equitable payment for telemedicine, interstate licensure for physicians offering telemedicine, and implementation in the context of the medical home.
Although many of these goals have yet to be realized, there’s no doubt telemedicine is being adopted by hospital systems at an increasing rate, with the technology poised to change how care is delivered. How can independent pediatricians keep pace with developments? What are the benefits and potential challenges? What’s the best way to get started? Learn more from Dr. Mick Connors, a pediatric emergency medicine physician and founder and CEO of Anytime Pediatrics and Anytime Telehealth, a company that offers a telehealth software platform and consulting.
Telemedicine or telehealth are two terms often used interchangeably, and at the most basic level they can be defined as a medical consultation that occurs with both a video and audio component, says Dr. Connors. Although telemedicine refers to an exchange of information between patient and clinician, telehealth could encompass exchanges between a primary care clinician and specialist, between clinicians for continuing professional education, or between a clinician – perhaps a nurse or mid-level clinician – and a group of patients for educational purposes.
One way telemedicine stands to improve patient care: It provides much more information than a phone call. You can see the patient, whether it’s a rash or a fever or a sunburn, without the need to interpret the condition only via a parent’s description. And then there’s the benefit of observing the child and parent themselves – their demeanor and interactions – subtle cues that are missing on the phone.
“There’s the clinical piece, but there’s also understanding the parents’ level of concern, facial expression, there’s so much body language that goes into a communication,” says Dr. Connors.
In this way, telemedicine more closely tracks a patient’s experience during an office visit, with the potential to improve outcomes while saving a potentially costly trip to an emergency room, urgent care center, or retail clinic.
Offering behavioral health services via telemedicine often serves as a starting point for pediatricians, says Dr. Connors. Some other options: Lactation consultations, nutrition counseling, and chronic care management follow-up. They’re all popular choices for a first foray into telemedicine, as they require minimal to no physical exam. For example, a new mom could join a ten minute video call to ask some questions about breastfeeding instead of driving to the office, causing less disruption for the baby and other family members.
That’s not to say that telemedicine has to be limited to consults divorced from the physical exam. As a former ER physician, Dr. Connors sees a huge opportunity for offering sick visits via telemedicine. The goal is to save your patients time and money as well as improve continuity of care. By extension, you’re capturing revenue that would otherwise be leaving your practice.
“We see more and more kids who aren't calling their pediatric offices,” he says. “They just go to the local urgent care or retail clinic because it's easier to go there. I see the upside for the pediatricians being able to offer sick visits as well, so they can see minor illnesses or do triage. They’re losing a lot of those patients to other services.”
The convenience and accessibility of telemedicine stands to keep patients connected to their medical home. Dr. Connors cites statistics from the American Medical Association and Wellness Council of America: Nearly 75 percent of all doctor, urgent care, and ER visits “are either unnecessary or could be handled safely and effectively over the phone or video.” If in-person care is required, telemedicine triage can be the first step to getting the patient in the door.
“It’s fostering that relationship,” says Dr. Connors. “Your pediatrician knows your history, they know your medical record, they know the kinds of things that are going on with you. Unfortunately, when people go to other places, a lot of times that information isn’t shared back with the pediatrician.”
And the trend is clear: Large hospital systems are adopting telemedicine services at a blistering pace. According to a March 2019 article in Modern Healthcare, the percentage of hospitals and medical centers “fully or partially using telehealth” has increased from 35 percent in 2010 to 76 percent in 2017. Why are hospitals out ahead with telemedicine? Already having the IT infrastructure in place gives them a distinct advantage. But they also recognize the demand from patients as well as the opportunity for additional revenue. o In an era of consolidation and increasing pressure on many private practice pediatricians to join hospital networks as employees, offering telemedicine stands to give independent pediatricians a competitive advantage. There’s an opportunity to seize control of a new way of delivering care.
Robin Warner, M.D., a solo pediatrician at Union Pediatrics in Union, Kentucky, hopes to launch a telemedicine service by January 1, 2020. The goal is to provide another way for families to continue to choose her practice, especially with a large hospital network in the area planning to launch a telemedicine service in the next year.
“Parents are more engaged now,” she says. “I’d much rather have them stay connected to their medical home.
As millennials become parents – more than one million women born from 1981 to 1996 are giving birth every year, according to the Pew Research Center - pediatricians need to take stock of a generational shift. These new parents turn to their smartphones first to access information, goods and services. Connecting with their pediatrician via a digital platform is to-be-expected.
Offering telemedicine services allows pediatricians to meet these parents where they are, says Dr. Connors. A 2019 white paper from Anytime Telehealth includes statistics from the 2019 Accenture Digital Health Consumer Survey. The numbers paint a vivid picture of what parents want:
Telemedicine deployed in the pediatrician’s office has the potential to keep patients connected to their medical home by offering an alternative to the convenience of the retail clinic.
“The upside for the families is huge,” says Dr. Connors. “They can feel comfortable knowing they’re going to see their pediatrician or someone their pediatrician trusts.”
Another opportunity where telemedicine stands to improve care: Providing access to patients served by Medicaid. If transportation is a challenge – think rural areas with minimal public transit, or inner cities where many doctor’s offices may be located outside of the urban core – telemedicine has the power to bring them into the fold.
“There’s more and more conversation about getting folks an Uber or a Lyft [to the doctor’s office], says Dr. Connors. “If we could help them access the technology and utilize it, they would stay connected to their pediatrician.”
The short answer: It depends on where you practice. Every state has different rules and regulations. Dr. Connors seeking additional information from your state’s health director. According to the Centers for Medicare and Medicaid Services, states “have the option/flexibility to determine whether (or not) to cover telemedicine.” It is left to states to determine what telemedicine services and provider types are covered. In January of 2019, the AAP published an overview to billing for telemedicine services, including a list of procedural codes that can be reported as telemedicine.
Overall, the trend is towards more comprehensive coverage for telemedicine. Some states have parity laws that require private insurers to reimburse telemedicine at the same rate as an office visit. According to the National Consortium of Telehealth Resource Centers, 39 states and Washington D.C. have a law on the books that governs “private payer telehealth reimbursement policy.”
When it comes to the technology necessary to launch a telemedicine service, pediatricians shouldn’t be intimidated, says Dr. Connors. Basic requirements include a secure high speed internet connection and a video conferencing platform that is HIPAA compliant. Anytime Pediatrics provides training to help providers become accustomed to communicating via video, including how to make sure the lighting is optimal, and tips for communicating virtually (one hint: eye contact is key, just like an in-person visit).
Pediatricians can also decide how and when to offer telemedicine visits, depending on their practice model and the needs of their patients. Some block part of the day for telemedicine consults; others use it for after-hours care or for early morning appointments. A nurse or mid-level provider may also staff a telemedicine service, providing important help with triage. Anytime Pediatrics connects pediatricians with urgent care clinics of their choosing so that patients who request a telemedicine visit when they aren’t available will be routed to a trusted provider. The AAP offers a Teleheath Support Compendium, with comprehensive guidance and many additional resources.
Treating patients across state borders via a telemedicine consult currently poses some challenge, as physicians are required to have a license in both states. The American Telehealth Association promote removing licensing board barriers to telemedicine; options they recommend include multi-state compacts or a “one state license” rule. An Interstate Medical Licensure Compact Advocacy Action Guide from the AAP provides resources for chapters on this issue.
We’ve only just begun to see the potential applications of telehealth to pediatrics, says Dr. Connors. In the not-too-distant future, remote patient monitoring may become commonplace. For example, a pediatrician caring for a patient with diabetes is able to access health data via a wearable device in real time and adjust treatment plans accordingly. Smartphone applications, rigorously tested for accuracy and with oversight in place, may play a role in the physical exam. An app that measures blood pressure or heart rate, for example, could connect to the electronic health record, easing workflow and improving accuracy.
“There's a huge opportunity in remote patient monitoring,” says Dr. Connors. “You can keep track of your patients - which is critically important for the primary care provider - because you're managing chronic disease.”