American Academy of Pediatrics supports telemedicine, but only if PCP-led

By Jonah Comstock
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TeladocVideoVisitThe American Academy of Pediatrics has issued a policy statement on telemedicine, coming out in favor of better reimbursement and regulatory support for telemedicine, but against direct-to-consumer telemedicine offerings like Teladoc.

Although quality telemedicine care promises to increase access to pediatric medical subspecialty and surgical specialty care for patients in underserved urban and rural areas, and at the same time curtail unnecessary emergency department and hospital care, this must be done in support of and integrated with the [patient-centered medical home], not in place of it," the AAP wrote. "The use of telemedicine care by virtual health care providers, such as those linked to retail-based clinics, entrepreneurs, or insurers whose business model is to provide health care services to patients via smart phone, laptop, or video-consult kiosk without a previous physician-patient relationship, previous medical history, or hands-on physical examination (other than what can be accessed via the technology), can undermine the basic principles of the PCMH model."

The policy note goes on to lay out the AAP's primary objection to mobile or kiosk-based telemedicine not offered through the patients primary care provider: that such services lead to fragmentation of care when doctors don't have access to the patient's medical records and can't update those records with the results of the visit. It also suggests that the lack of an in-person examination or necessary lab tests leads to "suboptimal care".

"Although such novelty care appeals to parents because it can be faster, more convenient, and more affordable than an office visit, the loss of continuity of care, quality of care, and patient safety shows why this telemedicine care model should not be embraced,” the policy note concludes.

The AAP's take on direct-to-consumer telemedicine providers is especially timely because Teladoc's imminent IPO and ongoing court battles have put such services in the spotlight. Earlier this month, the American Medical Association was set to weigh in on the issue with its own set of ethical guidelines for telemedicine, but decided to table the matter after an objection from a member of the same Texas Medical Board that's currently involved in a legal battle with Teladoc.

The AAP's comment were a fairly minor part of the eight-page document, which mostly extols the virtues of telemedicine for pediatricians. It encourages the use of telemedicine for urban as well as rural pediatric patients and encourages government bodies and insurers to reduce the barriers to telemedicine in terms of regulation and reimbursement, including encouraging state medical boards to sign licensure compacts. It also cites studies that say telemedicine increases efficiency of care, thereby allowing pediatricians to see more patients and addressing physician shortages. It lays out myriad other benefits of the technology.

“[B]y increasing health care access for children, particularly for children living in rural communities, the use of telemedicine technologies can help reduce missed appointment rates, increase adherence to recommended therapies, and help ensure the appropriate frequency of recommended physician visits,” the AAP writes. “...Previous research has revealed that the appropriateness of referrals to medical subspecialists/surgical specialists is increased and redundancies in evaluative and diagnostic studies are reduced when telemedicine is used. This situation may be particularly true for children, and especially children with special health care needs.”

The policy note even weighs in on the state of telemedicine research, urging those studying telemedicine interventions to make use of randomized control trials with real control groups, rather than relying on historical data for the control condition.