The COVID-19 pandemic had an immense impact on the adoption of telehealth across the country, but how it is integrated into future models of pediatric care has yet to be determined.
While many barriers to telehealth and payment restrictions were lifted temporarily during the pandemic — leading to widespread adoption — pediatricians and other health care providers are now advocating for policies that address the unique needs of children and youths. Recent transformational changes on the pediatric workforce also should be considered to optimize the utilization of telehealth by pediatricians and pediatric medical and surgical subspecialists.
A new AAP policy statement addresses how telehealth can be used to increase patient access to high-quality, cost-efficient primary and subspecialty pediatric care, especially those in under-resourced areas, and support care provided in the medical home. It also advocates for equitable telehealth access for children and youths and adequate payment for telehealth services.
The policy Telehealth: Improving Access to and Quality of Pediatric Health Care, from the Section on Telehealth Care, Committee on Practice and Ambulatory Medicine and Committee on Pediatric Workforce, is available at https://doi.org/10.1542/peds.2021-053129 and will be published in the September issue of Pediatrics.
Ensuring equitable, high-quality care
Telehealth — an all-encompassing term referring to use of technology to provide medical care at a distance — can take several forms, including directly to a patient via audiovisual connection (direct-to-consumer care), in-home monitoring of physiologic and other parameters (remote patient monitoring) or from one health care facility to another (interfacility telehealth).
Telehealth promises to lead to changes in the way we practice and offer opportunities to improve access to specialized pediatric care. This underscores the need to adhere to the highest quality standards of clinical care, while also ensuring that technology implementation is not widening health care disparities, a phenomenon called the digital divide.
The opening sentence of the policy states that “All children and adolescents deserve access to quality health care regardless of their race/ethnicity, health conditions, financial resources, or geographic location.” This statement verbalizes what the AAP has championed for decades. The policy advocates that the digital transformation of health care address barriers such as language, digital literacy, disability and access to and payment for technology infrastructure to ensure that underlying disparities are not exacerbated.
The policy also states that quality care standards cannot be sacrificed with the implementation of new tools to deliver care, and pediatricians are key stakeholders in determining these metrics for children. There will be significant opportunity for development of evidence-based best practices in this new era of health care delivery.
Role of the medical home
With the understanding that pediatric patients deserve access to coordinated and personalized health care, the medical home model has been foundational for pediatric care. The integration of digital health into a model that provides continual, integrated care for patients — including both in-person and virtual care as appropriate — is essential. The concept of the medical home likely will evolve in response to technology, but the core component of avoiding fragmented and episodic care will remain.
Payment reform
Pediatric health care providers should be compensated for the care they provide to patients, and telehealth and digital health are no exception, according to the policy. There are costs associated with implementing new technology, and the time commitment to perform a virtual visit may be longer than for an in-person visit.
Telehealth visits should be paid at parity with in-person visits, and quality standards should establish which conditions are appropriate for remote care, the policy states.
“Telehealth can help reduce inequities and improve children’s overall health and well-being by expanding the reach of the medical home, particularly for children with special health care needs and children who have not had access to high-quality care in the past,” the policy concludes. “Adequate payment for these services is necessary to ensure that they will continue to be available to children.”
Dr. Curfman is a lead author of the clinical report and a member of the Section on Telehealth Executive Committee.
