The nation's largest organization of pediatricians has announced its support for telemedicine – but not on a first visit or for episodic care without the primary care provider's participation.
Taking a position similar to the Texas Medical Board - which is locked in a contentious battle with telemedicine provider Teladoc - the American Academy of Pediatrics published a policy statement that sharply criticizes virtual healthcare providers who focus on care from afar, and don't first meet with their patients in person.
That goes against the concept of the patient-centered medical home, which the AAP has endorsed since its unveiling.
"The use of telemedicine care by virtual providers, such as those linked to retail-based clinics, entrepreneurs or insurers whose business model is to provide healthcare 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 organization said in a July 1 article published in Pediatrics.
The authors argued that telemedicine, when used in isolation, is essentially the antithesis of the medical home model of quality care because virtual care often lacks the patients medical record and, instead, is incomplete or redundant waste.
"More importantly, virtual telemedicine care in isolation does not provide timely and comprehensive follow-up with the patient and the medical home. Finally, it does not provide the same level of care that would be provided in a hands-on visit (e.g., physical examination, necessary laboratory tests, etc.), and therefore the patient receives suboptimal care," AAP authors wrote. "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."
Aside from that first point of contact, the AAP favors telemedicine as a means of increasing access to healthcare services for patients, as well as allowing pediatricians to see more patients and consult with specialists. The organization also notes that while there is an initial investment in equipment, telecommunications and personnel, a telemedicine platform "can result in long-term overall cost savings," seen in reduced tests and exams, more efficient referrals and communications and less use of higher-cost tertiary care centers.
"Beyond these savings, there are many societal benefits, including the reduction in travel and patient transport, a reduction in the hours of missed work by the parent/guardian and a reduction in the frequency of missed school days," the AAP wrote.
Among the barriers to telemedicine use among the pediatrician community, the AAP cited a lack of research, high initial costs of implementation without financial incentives (such as loan forgiveness, technology investment grants and tax credits), a lack of coverage for malpractice insurance, and uneven state and federal policies with regard to licensure and reimbursement.
The AAP's stance on virtual visits isn't that much different from the Texas Medical Board, which tried to revise its rules to prevent doctors in that state from making certain diagnoses or issuing prescriptions based on a first visit via telephone, e-mail or text message. Teladoc filed a lawsuit against the board, charging that it was interfering with the company's right to do business; a state judge has put a hold on the board's ruling pending a trial.
The issue also has drawn concern from the American Medical Association, which recently tabled discussion on guidelines for virtual care.