Healthy Kids - Summer 2021

Building the Way Forward Probably the biggest logistical hurdle for telemedicine before the pandemic was a mundane aspect of hospital business—namely, that many insurance providers, whether private or public, offered only limited reimbursement for telemedicine visits, compared to the amounts paid for in-person visits. But the urgent need to accommodate social distancing practices last spring spurred federal and state governments to address this right away, expanding reimbursement for a wide variety of telemedicine services. This newly created parity means that, rather than public or private insurers paying only for the time a doctor interacts with a patient by video, they instead must reimburse the hospital as they would for a normal visit. This also accounts for the time a doctor takes to perform routine yet crucial tasks, like reviewing patient charts, analyzing lab results or documenting the visit. Some of these expanded reimbursements—such as for audio-only telehealth visits—are temporary, and likely to expire with the pandemic. However, others will stick around, thanks to California legislation requiring payment parity that went into effect this January. Although this legislation applies only to private insurers, the political will to expand telemedicine reimbursements for public health coverage seems to be growing, at both the state and federal levels.

to learn that Rady Children’s was offering a wider range of telemedicine options due to the pandemic. “It was a blessing in disguise,” she says, not only because she was anxious to protect her family from the virus, but because as flu season approached, Gracie remained vulnerable to any number of ailments most people don’t think twice about. “She is still more immunocompromised than other children, so if she doesn’t physically have to go into the office and be weighed or touched for some reason, I always choose to do it that way, for her sake.” Telemedicine Pros and Cons Aside from obvious advantages of telemedicine, such as not having to drive, find parking or spend time in waiting rooms, Megan points out that it’s helpful not necessarily having to cancel an appointment if the baby is sick. Specialists tend to book appointments months in advance, and there’s always a chance Gracie won’t be up for a trip to the doctor’s office when the day finally arrives. “I can’t even bear the thought of waiting for months and then having to skip our appointment,” she says. “Sometimes I’ve called in the morning and said, ‘I’m so sorry; Gracie is sick, but I don’t want to cancel. Can we convert this to telemedicine?’ That, to me, has been incredibly valuable.” Not every in-person doctor visit can be substituted with telemedicine, of course. Most diagnostic tests require a patient’s physical presence, for instance if it relies on expensive medical equipment, such as an MRI, or is by definition hands-on. But some types of doctor visits are particularly well suited to online video sessions, like mental health counseling. Prior to the pandemic, most Rady Children’s telemedicine visits involved counseling sessions with psychologists or psychiatrists. These have been helpful to adolescents experiencing anxiety. For a generation innately comfortable with technology, being able to access therapy from a place of comfort—such as their bedrooms— may allow them to open up to a degree they wouldn’t otherwise. Other visits that rely on conversation also make prime candidates for telemedicine. Seeing a doctor to discuss test results, for example. Or postoperative follow-up visits, or those concerning the management of chronic conditions—routine situations where little or nothing may have changed with regard to the patient’s health, and the physician needs only to ask a few questions or make a simple visual assessment. For these types of visits, one begins to wonder why it even took a pandemic to make telemedicine the norm. It’s possible that most physicians haven’t been comfortable conducting remote visits due to a lack of experience with the format, or out of concern they won’t be able to provide the same quality of care over video. Patients have shown reluctance for similar reasons, including concerns that they won’t get as much face-to-face interaction with their health care provider. But after the crash course in telemedicine that Rady Children’s doctors and patients experienced in 2020, most found it to be a success. The Hospital has received generally positive feedback, and data shows the amount of time doctors spend with each individual patient is comparable to in-person visits—in other words, switching to telemedicine didn’t change the number of patients a doctor can see in a day, nor did patients (or the parents of patients) generally feel they were missing out. After experiencing Gracie’s mix of in-person and video appointments over her first six months at home, Megan reports very little difference in how the doctors conduct the visit. “They’re still just as thorough,” she says. “They hit on all the topics that they normally would.”

Data shows that switching to

telemedicine didn’t change the number of patients a doctor can see in a day, nor did patients generally feel they were missing out


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