Robert Lee, DO, FAAP
(Dr. Robert Lee, DO, MS, FAAP is a pediatrician and Associate Pediatric Residency Program Director at NYU Langone Hospital – Long Island. He is the Chair for the AAP Section on Osteopathic Pediatricians, Vice President for NYS AAP Chapter 2, and Co-Chair of the NYS AAP Chapter 2 Foster/Kinship Care Committee.)
Telehealth during the COVID-19 Pandemic
The AAP believes the best place for infants, children, and adolescents to receive preventative services and problem-oriented care is at a pediatrician’s office. Telehealth or “virtual visits” with the pediatrician using technologies such as live, interactive audio and video became an option and necessity during the peak of the COVID-19 pandemic with stay-at-home orders and families not wanting to engage with others. Pediatricians were able to leverage telehealth with the relaxation of regulations and adequate payments in order to sustain their businesses.
According to Physician Xpress, the average total visit count per pediatric office was 52% less in April 2020 as compared to April 2019. Of the total visits in April 2020, the average pediatric office had 40% of visits conducted via telehealth. As the economy opened and children/parents started to engage in activities, the average total in-person visits each month increased, however, it was still 5% less overall compared to 2019. The percentage of visits each months that were telehealth also reduced each month. In September 2020, ~8% of total visits were telehealth although many practices reported having less than 3% of their visits as telehealth.
This percentage of telehealth visits is similar here in New York Chapter 2 as well. Pediatricians who I spoke to in January 2021 reported between 5-10% of total visits were telehealth.
Future of Telehealth
In an independent study reported in Healthcare IT News, 92% of pediatricians believe that telehealth will remain part of pediatric practices in the future. All of the 787 pediatricians who responded to the survey reported currently using a telemedicine platform, with 96% saying they offered telehealth during regular business hours.
More than 60% of respondents reported that families and patients find it relatively easy to use. The number-one factor that is driving the use of telehealth in pediatric practices is patient demand. Other factorssuch asstate levelpayment parityand revenue potential have been driving adoption.
The most common types of visits that lend themselves to telehealth include behavioral/mental health concerns, simple sick visits (e.g. URI, rashes, or pinkeye), refills for medication, and chronic condition check-ins.
The majority of respondents conducted telehealth on an app on their smartphone.Respondents reported that they would seek EHR integration, connectivity, price and flexible workflows from telemedicine platforms in the future. Respondents also say they would love to see peripheral device integrations, translation services during visits, documentation and platform availability in multiple languages. And respondents say audio-visual quality, ease of use and connectivity, flexible workflows and live support are essential technical components that affect both patients and pediatricians.
AAP Chapter Telehealth ECHO Project
The AAP Chapter Telehealth ECHO project is supported by the Health Resources and Services Administration (HRSA) of the US Department of Health and Human Services (HHS) as part of an award totaling $6,000,000. AAP Chapter 2 is a recipient of the grant and we just completed a 3-month tele-mentoring program with expert faculty team from AAP Chapters 2 and 3. Over the six sessions, AAP Chapters 2 and 3 members learned through didactic and case-based presentations on a wide range of topics to help pediatricians incorporate best practices for telehealth. All the didactic video recordings are available.
- ECHO Session 1: Telehealth 101– Marc Lashley, MD, FAAP
- ECHO Session 2: Coding and Billing for Telehealth – Steven Goldstein, MD, FAAP and Jesse Hackell, MD, FAAP
- ECHO Session 3: Using Telehealth for Behavioral/Developmental Concerns – Jack Levine, MD, FAAP
- ECHO Session 4: Confidentiality and Telehealth for Adolescents – Linda Carmine, MD, FAAP
- ECHO Session 5: Liability Issues in Telehealth – Jesse Hackell, MD, FAAP
- ECHO Session 6: Other Telehealth Considerations – Robert Lee, DO, FAAP
Conclusion
Telehealth will never be the right answer for all pediatric visits. There are times when pediatricians still need to perform a comprehensive physical exam and administer immunizations. If the relaxation of regulations and adequate payments become permanent, telehealth can become an integral part of the medical home. And if telehealth is here to stay then pediatricians have to increase their knowledge, competency, and self-efficacy regarding the use of telehealth to provide care within the medical home.
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