The American Academy of Pediatrics is advocating for the expansion of pediatric telemedicine to increase access to care for underserved communities and improve quality of care for children.
In an opinion published online June 29 in Pediatrics, the AAP called for a reduction in ongoing barriers to telemedicine, equitable pay for telemedicine doctors, and further efforts to facilitate interstate licensure (Pediatrics 2015 [ doi:10.1542/peds.2015-1253 ]).
At the same time, AAP warns that fragmented telemedicine services should be avoided, and that use of telemedicine for episodic care should be done within the context of the medical home. The timing is right for the AAP opinion because of increasing telemedicine technology, and the need to distinguish between responsible telemedicine and otherwise, said Dr. James P. Marcin , lead author of the opinion and a pediatrician at the University of California, Davis, Children’s Hospital in Sacramento.
“The technologies are booming and becoming more and more available, including things that might take [telemedicine] in the wrong direction, such as direct-to-consumer, online services,” Dr. Marcin said in an interview. “Telemedicine is a really great opportunity to strengthen the medical home, increase access, and provide better, more efficient care to children, but there’s also market forces in place [affecting telemedicine] that may not address the priorities of the AAP.”
In its opinion, the AAP writes that the use of telemedicine technologies by primary care pediatricians, pediatric medical subspecialists, and pediatric surgical specialists has “the potential to transform the practice of pediatrics.” For example, telemedicine technology may improve models of care within the medical home by enhancing communication among health providers and contributing to better, more efficient care, according to the policy statement. Such models also may serve as a platform for more continuous care and the linking of primary and specialty services to better treat complex patients.
In addition, pediatric physicians working in remote locations can use telemedicine to receive ongoing medical education. Consultations, case discussions, and ongoing clinical support also can be enhanced by telemedicine, according to the AAP policy statement.
However, the academy adds that telemedicine used for episodic care by nonmedical home providers could disrupt continuity of care and “create redundancy and imprudent use of health care resources.” Such fragmentation is not the proper way to practice telemedicine, and the usage should be avoided, the AAP said in its opinion. The practice of telemedicine instead should be coordinated through the medical home.
“Companies are coming out that will charge a certain fee to be able to provide [telemedicine services] to patients at home, but that adds to fragmentation” of care, Dr. Marcin said. “If you see a doctor online and get treated for an ear infection, and go see your regular doctor, and go to a retail-based clinic the next day, you have three different providers, three different opinions, and maybe three different prescriptions. That’s not going to help further the care of the child.”
Among its recommendations, the AAP calls for reducing barriers to telemedicine, such as the cost of telemedicine implementation and support, and the lack of reimbursement for physicians who provide telemedicine. Not all states pay equally for telemedicine services nor recognize rules by the Centers for Medicare & Medicaid Services and the Joint Commission on privileging by proxy for telemedicine providers.
Insurance coverage for telemedicine services greatly depends on the state and each state’s Medicaid program, explained Dr. Mary Ellen Rimsza , chair of the AAP Committee on Pediatric Workforce and a professor at the University of Arizona, Tucson.
“For private insurance companies, [coverage] is highly variable,” Dr. Rimsza said in an interview. “Particularly, if they don’t have a big network of physicians, it would be especially important to [cover] telemedicine. Obviously, physicians can’t do it if they are not going to get paid.”
Other obstacles include a general absence of malpractice coverage for telemedicine, and failure to consider the delivery of telemedicine in hospital and practice-based credentialing and privileging policies. Stable funding methods should be developed by both public and private payers to support the continued growth and maintenance of telemedicine, the AAP recommended in its opinion. The academy also stressed the importance of further research to study the effectiveness of telemedicine and the development of financial incentives for health providers that demonstrate health care improvements linked to telemedicine usage.
The opinion notes that telemedicine topics should be included in existing medical school and residency curricula, as well as CME courses. In addition to the opinion, a separate paper in the June 29 Pediatrics ( doi:10.1542/peds.2015-1517 ) discusses applications for telemedicine in pediatric medicine.
Dr. Rimsza hopes the AAP’s policy statement helps to increase knowledge about telemedicine, possible usages for pediatricians, and challenges faced by physicians who use the technology.
“We hope that it will raise awareness about some of the barriers to telemedicine and the importance of how the care is delivered, within the medical home, especially,” she said. “We plan to use the policy statement as various legislation is presented both at the national and local levels.”
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