Implementation of telehealth at outpatient pediatric offices prior to the COVID-19 pandemic was limited due to a number of factors. These factors included: limited insurance coverage, limited pool of patients willing to pay out of pocket for telehealth services, complexity and cost of starting a telehealth operation.
There was much investment into telehealth companies that included strong marketing programs of telehealth services over the last few years. Many of these telehealth companies are Direct-to-Consumer (DTC) telehealth companies charging a small fee for services. Some interesting research reported in JAMA Network Open that was published on December 8, 2020 showed that in late 2019 about 87% of the DTC teleHealth usage were from three concerns – Urinary Tract Infection (53%), erectile dysfunction (21%) and contraception (13%). Most of the patients leveraging the telehealth services via the DTC companies were 18-44 and lived in Urban areas.
To further read the study results, read the full article at:
Prior to the COVID-19 Pandemic, some larger Pediatric practices started to implement and provide some ‘out of pocket’ telehealth options. Telehealth service options for families was very uncommon at smaller Independent Pediatric Practices (Pediatric practices with less than seven Pediatric providers) When the COVID-19 Pandemic started in March of 2020, almost all payers reimbursed for services provided to patients at the same rate for telehealth visits as an office visit. Additionally, Pediatric practices were able to choose from free as well as paid telehealth systems available. While seeing a patient in person is preferred, the COVID-19 environment and payer reimbursement pushed rapid implementation of telehealth by the small, independent Pediatric practice. Due to the national shutdown in April, the telehealth use was the highest across the pediatric practices during the second quarter of 2020. The total percentage of telehealth visits decreased in the summer months as practices and patients became more comfortable with bringing patients to the office for most visits and conditions. The use of telehealth was the highest in the 2nd Quarter of 2020 and decreased each quarter to about 8% of the total pediatric visits in the 4th Quarter of 2020. There were many learnings on telehealth use by the independent pediatric office including that certain types of visits align well to telehealth such as follow-up care for some conditions, ADHD, Anxiety, and Depression. Another learning is that many ‘core’ Pediatric practice visits such as well care visits, vaccine visits are not effective via telehealth.
The COVID-19 Pandemic provided the ability for a patient’s Pediatric Medical Home to provide telehealth services due to the payers removing the reimbursement concern. It is unknown if the payer will continue to cover all services or limit telehealth to certain conditions such as follow-up care, ADHD, depression and behavioral health. While the reimbursement is currently the same as in office care, it is unknown if the reimbursement will be the same for telehealth visits or if the payer will provide a reduced reimbursement rate.
A cost effective and integrated telehealth platform aligns well to most small Pediatric practices. This platform should include the ability for Pediatric providers to just click on an icon and launch into the telehealth platform for which they can engage with patients without entering additional demographic information. A cloud-based Pediatric EHR provides the ability for providers to streamline the workflow for telehealth and minimize record keeping/data entry in two systems.