Nicklaus Children’s Health System

Saima Aftab

The COVID-19 pandemic has proven to be the single biggest disruptor mankind has experienced in over a century. It has wreaked havoc on the lives and livelihoods of many. It has threatened the very core of what makes us human; our ability to connect and interact with one another. It has also challenged us to find creative solutions, overcome barriers, and transform the very way we function in a world that has changed forever. The Healthcare industry was most significantly impacted by the pandemic and the pediatric healthcare space was no exception.

Telemedicine proved to be a Godsend in these tumultuous times. While the technology for telemedicine was in existence for over a decade prior to the pandemic it was never widely adopted. One of the major barriers to widespread telemedicine use was the lack of reimbursement by payors. There was also an overall sense of inertia or skepticism from the medical community. Medical malpractice and concerns for HIPAA security also loomed over this novel approach to healthcare. In all reality, telemedicine was in need of a hero and the pandemic proved to be one. When CMS enacted the telemedicine waivers and enforced equal payment for telemedicine services (in early March of 2020) the number of telemedicine encounters recorded increased by over 150 percent just in a short span of three weeks. This trend only continued with over a billion telehealth visits recorded in the US in 2020 alone.

At Nicklaus Children’s Health System, we saw a staggering 3000 percent increase in telehealth visits during 2020. We rolled out telemedicine to all our primary care and subspecialty practices very rapidly to guarantee our children could see their specialists without skipping a beat. We also deployed telemedicine in our intensive care units specifically in our COVID-19 unit to minimize out staff’s exposure and to conserve PPE. In our psychiatry and psychology department, the telemedicine experiment was a roaring success. Based on our Press Ganey surveys our behavioral health patients felt that the telemedicine experience was superior to an in-person visit.

“There is a lot of compelling data that shows that telemedicine can improve access, lower the cost of healthcare and also help overcome healthcare disparities in pediatric populations.”

We also discovered some interesting new use-cases in our pediatric populations. We deployed a NICU follow-up telemedicine pilot for post-discharge care of our complex NICU graduates. Through this program, a seasoned NICU nurse would check in to review feeding, assess and reinforce safe sleep practices, and reassure the parents. This program led to a dramatic reduction in the number of ER visits and readmissions for our NICU graduates. Our physical therapy and rehabilitation teams also jumped right in to provide therapy sessions preventing our at-risk children from losing ground but also reinforcing therapies in the child’s home environment. As the largest free-standing hospital in the state of Florida serving a predominantly low-income population, the one thing that we were interested in was determining the true cost of accessing care. We developed a novel tool that helped us compute the miles each family traveled to receive care at any one of our facilities. Once we computed the cost of travel, we added in the cost to take a day off from work to take a child to the doctor. This sophisticated economic analysis tool helped us get the true picture of the cost-saving that telemedicine had to offer to each of our families. The data gathered from this tool will help inform our value-based care strategy. In serving our low-income families through the pandemic we also became acutely aware of the digital divide. Many of our highest-risk patients were unable to access telemedicine due to lack of internet or due to lack of digital devices. In the future we foresee digital connectivity will be a social determinant of health and health systems will need strategies to address this specifically.

In short, there is a lot of compelling data that shows that telemedicine can improve access, lower the cost of healthcare and also help overcome healthcare disparities in pediatric populations. We will achieve this only from ongoing investment in digital infrastructure, by simplifying the system for medical licensure with better interstate reciprocity, ongoing reimbursement for telemedicine services, and most importantly through community partnership and capacity building. This will ensure that access to telemedicine becomes a right not just a privilege for our children.

As CMS administrator Seema Verma said, “I think the genie’s out of the bottle on this one, I think it’s fair to say that the advent of telehealth has been just completely accelerated, that it’s taken this crisis to push us to a new frontier, but there’s absolutely no going back.”