Telemedicine reduces patients' needs to travel to hospital
PHILADELPHIA – Direct-to-consumer pediatric telemedicine gave clinically acceptable results while saving patients and their families from making trips to the clinic that might have delayed treatment, a researcher reported here.
In a 3-year period, the telemedicine program was activated 39 times for cardiology-related pediatric "visits," and in a median follow-up of 187 days, no patients presented urgently to the hospital for a cardiology-related diagnosis after a direct-to-consumer visit, said Aaron Phillips, MD, of Children's National Hospital in Washington, D.C., at the annual scientific sessions of the American Heart Association.
He also reported that the direct-to-consumer visits are also reimbursed by insurers, albeit at a lower rate than office visits.
"We have seen telemedicine work very well in a lot of different modalities but there has not been a lot of discussion about direct-to-patient in the outpatient setting with kids," Phillips told MedPage Today at his poster presentation. "We created a model to see if it was feasible, fiscally possible, whether it could be reimbursed, and whether we could save the patient time and money."
The system being tested at Children's National uses a Zoom Video Conferencing platform. "We had a situation where a school had a concern with a child and the parent was at a conference in Wisconsin," Phillips said. "The school principal Skype'd in with Dr. Ashraf Harahsheh [director of resident education in cardiology at Children's National], and the parents Skype'd in from their location, and the situation was resolved. This telemedicine platform can be applied to everyday life."
"So far, the system has been utilized to do 39 direct-to-consumer visits," Phillips said. "All of these were follow-up visits; they had established a relationship with the clinic previously. Most of the concerns involved hyperlipidemia, there were a few syncope follow-ups, and we also reviewed results of diagnostic tests."
"The families seem to really enjoy the direct to consumer telemedicine visits because a lot of these visits to the clinic would have been quite a trek," Phillips said. "The average distance from the hospital to the home of our average patients is 27 miles – and in the Maryland-Virginia-D.C. area that can be quite a trip, depending on traffic. The fact that they can Skype in on something minor such as a medication correction or a diagnostic follow-up is beneficial to them. In one case, the mother couldn't remember the dose of the medicine, but by holding the medicine bottle to the camera we were able to ascertain the proper dose so a trip to the office wasn't required."
Phillips acknowledged that reimbursement represents an issue in telemedicine. "Reimbursement is the big problem," he said. "For an in-person visit we were charging $205 and insurance was reimbursing us $110. For a telemedicine visit we are charging $156 and our reimbursement is $67, but we are getting a reimbursement. Your time is still valued. I think the efficiency of telemedicine makes up for the reduced reimbursement."
Phillips said he would like to expand the telemedicine program to perform follow-up check-ups on children after discharge. He said that the technology is sufficient to be able to determine if the child is recovering well or if there may be a problem.
In commenting on the study, Brent Gordon, MD, director of the Loma Linda Children's Hospital cath lab in California, said, "We are not using telemedicine now at our facility but it is something we are exploring. As with Dr. Phillips we have a large area to cover in the Los Angeles area with a lot of traffic problems too."
"The major limitations to this kind of work is going to depend on state-to-state regulations and reimbursements," he told MedPage Today. "Some insurance companies may recognize this and others may not. There are a lot of hospital codes that exist that insurance companies just won't pay. So reimbursement is a huge limitation, but this project is a worthy attempt especially since we already do all these telephone encounters following procedures and even though these follow-ups can take a while, we don't now get reimbursed."
Gordon noted, "This works in other fields, and doctors in those fields such as in radiology love telemedicine, so I think we should be able to jump in with it as well. I think we have to be very careful with some of these patients, especially in cases of syncope. You have to be careful there."
Phillips, Harahsheh, and Gordon disclosed no relevant relationships with industry.
American Heart Association
Source Reference: Phillips A, et al "Direct-to-Consumer Cardiology Telemedicine: A Single Large Academic Pediatric Center Experience" AHA 2019; Abstract Su4040.
Read the original article on Medpage Today: Telemedicine reduces patients' needs to travel to hospital