Why pediatric leaders are embracing virtual care


The pediatric healthcare landscape is undergoing a period of significant transformation. Children's hospitals and other pediatric providers are becoming more strategic about how they're delivering care in response to declining Medicaid reimbursements and a heightened emphasis on patient convenience.

During an advisory call hosted by Becker's Hospital Review, two pediatric leaders discussed how they're tapping into virtual care services to offer patients more convenience and access to care amid an increasingly competitive pediatric environment.

The pediatric leaders were:

  • Kathleen Conway, director of pediatrics at Henry Ford Health System in Detroit
  • Christine Darr, MD, medical director of pediatric emergency medicine at Rocky Mountain Hospital for Children in Denver

The current pediatric healthcare landscape

Pediatric leaders' strategic priorities in 2020 are largely shaped by two major trends: declining reimbursements and rising consumer demands.

1. Medicaid reimbursement is a continuous challenge. Reimbursement is a challenge on every healthcare leader's mind, but particularly for those in the pediatric space.

In 2018, Medicaid covered 38 percent of all children in the U.S., according to an analysis from the Kaiser Family Foundation. Children's hospitals and other pediatric providers care for a disproportionately high volume of these kids, who often have severe health needs that are more complex and costly to treat.

"We see a large number of Medicaid patients, and the reimbursement doesn't cover the cost for providing that care," said Dr. Darr.

In December 2019, Congress delayed a nearly $4 billion cut to Medicaid Disproportionate Share Hospital payments, which would have an outsized effect on children's hospitals and other pediatric providers. Hospital groups are still pushing for a more permanent solution to the cuts, slated to take effect this May.

Low Medicaid reimbursements — coupled with rising drug and supply costs — often leave slim margins for pediatric providers.

"A lot of private pediatricians are getting out of the Medicaid business because it's not a good payer," said Ms. Conway. As a well-known health system that employs its own physicians, this trend hasn't posed an issue for Henry Ford. However, the system still struggles to remain profitable in the pediatric space, Ms. Conway said.

2. The rise of consumerism welcomes new competition. Another threat to pediatric providers' margins is increased competition, largely driven by the evolution of healthcare consumerism and subsequent shift to outpatient care.

Today, parents have a plethora of options when it comes to choosing where to take their children for care.

"A lot of parents are taking their children to urgent care sites that don't necessarily have pediatric physicians or advanced practice providers," Dr. Darr said. "It's often a financial decision and a convenience decision."

 Urgent care centers and retail clinics have flexible hours, accept walk-in appointments and offer low out-of-pocket costs, all of which are attractive amenities for parents. As such, hospitals and health systems are increasingly recognizing the importance of offering similar levels of convenience to remain competitive in pediatric care and protect their bottom lines.

The quest for convenience

The most obvious way pediatric providers are responding to these market trends is by offering patients more flexible hours and convenient care locations. But many providers are taking this a step further and adopting virtual care services to improve care access even more.

"We're seeing we have to focus more of our time and energy in the ambulatory space and in telemedicine, because that's where things are going," Ms. Conway said. "We have a whole department that is pushing different options for virtual care as a way to expand services without necessarily having to open up new sites."

 Many of Henry Ford's younger patients have expressed interest in using virtual care solutions, the expansion of which is a big strategic priority for the system right now, according to Ms. Conway. The health system offers several virtual care services through its MyChart patient portal, including online appointment scheduling, telemedicine visits and a communication platform to connect with physicians on follow-up care.

Henry Ford's physician offices are also equipped with technology to offer virtual behavioral services for children, and the system's autism center offers virtual coaching to parents of children with special needs. 

"Some of the younger physicians are all fine with this. The older physicians, they still kind of like to see the patient," Ms. Conway said of the system's shift to more virtual care services. "Acceptance varies from one place to the next and from one doctor to the next. But I think more and more, as they're seeing that this is the wave of the future, they're getting on board with it."

Dr. Darr said she's also seeing virtual care become more accepted in her market, adding that Rocky Mountain Hospital for Children is now looking to provide telemedicine consults in its emergency department.

Most children who seek emergency care are not seen in children's hospitals, meaning general acute care hospitals must ensure they have the right equipment, processes and education in place to care for this patient population. Telemedicine offers yet another way to provide specialized pediatric care to these patients.

"I think throughout the country a lot of programs are starting to explore the use of virtual care or telemedicine to reach more patients, especially in rural areas where there may not be pediatric coverage," Dr. Darr said.

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