As telehealth continues to grow and evolve, a research network is embarking on studies that could help providers overcome barriers to starting their own programs.
“Our goal is to address some of these on the national level, level the playing field to a certain extent,” said Christina A. Olson, M.D., FAAP, a member of the AAP Section on Telehealth Care and the Supporting Pediatric Research on Outcomes and Utilization of Telehealth (SPROUT) Executive Committee. “Make the barriers to entry lower and really look at the clinical outcomes and make sure what we’re doing is driven by clinical outcomes as opposed to the business models.”
To lay the groundwork for future studies, SPROUT, a telehealth research network, recently conducted an in-depth survey and analyzed data from 52 such programs in 30 states. Results shed light on staffing, barriers, processes, technology and funding sources.
The most common established telehealth specialty services were neurology, psychiatry, cardiology, neonatology and critical care, according to SPROUT’s report “The Current Pediatric Telehealth Landscape” (Olson CA, et al. Pediatrics. 2018;141:e2017233, http://pediatrics.aappublications.org/content/141/3/e20172334).
Programs vary in their structure due in large part to differences in state laws. To connect with patients, most programs used integrated video cameras. More than half used handheld cameras, specialty exam scopes and digital stethoscopes. The AAP Section on Telehealth Care is evaluating the most useful and cost-effective technology for primary care practices.
Telehealth programs receive funding from multiple sources. Investment from institutions, fee-for-service billing and contracts with other facilities were among the most common.
Respondents said some of the key barriers to starting a telehealth program were physician interest, licensing and reimbursement. Reimbursement also was the most common barrier to program expansion.
The number of states requiring private insurance to cover telehealth at the rate of in-person visits had reached 33 and Washington, D.C. as of May 2017, up from 12 states in 2010, according to the study.
Payers have different levels of interest and while some are enthusiastic about telehealth, it takes time to work out the details, according to Dr. Olson, a pediatric hospitalist and telehealth medical director at Children’s Hospital Colorado.
“Efforts to improve reimbursement for telehealth services hinge on the demonstration of cost savings and improved outcomes to payers and legislators,” the study says.
With this baseline data in hand, SPROUT is embarking on research into video-based sign-outs for complex neonatal intensive care unit patients. It also is looking at using video feeds to support transport teams in the field.
Dr. Olson said telehealth has moved past the fringe, and she is excited about the future.
“We don’t necessarily know what it’s going to look like,” she said. “We have ideas, but we know that it’s going to be even better … for patients, better for institutions, better for health care.”
