American Academy of Pediatrics Targets Parity in Telehealth Policy Statement

September 02, 2021 - The American Academy of Pediatrics has issued a policy statement on telehealth that calls for, among other things, payment parity and more efforts to address the social determinants of health.   

“All children and adolescents deserve access to quality healthcare regardless of their race/ethnicity, health conditions, financial resources, or geographic location,” the policy statement, published in the September issue of Pediatrics, states. “Despite improvements over the past decades, severe disparities in the availability and access to high-quality healthcare for children and adolescents continue to exist throughout the United States. Economic and racial factors, geographic maldistribution of primary care pediatricians, and limited availability of pediatric medical subspecialists and pediatric surgical specialists all contribute to inequitable access to pediatric care. Robust, comprehensive telehealth coverage is critical to improving pediatric access and quality of care and services, particularly for under-resourced populations.”

The document, titled “Telehealth: Improving Access to and Quality of Pediatric Health Care,” contains eight recommendations, focusing primarily on ensuring equitable, quality care, payment reform and addressing barriers to access.

On payment reform, the AAP calls for parity in reimbursement, so that care providers are paid at the same rate that they are paid by insurers for in-person services. The policy statement points out that telehealth services often require time and resources that match or even exceed the effort put into office visits.

“Payment for telehealth services at parity with the equivalent services provided in person by private insurers, Medicare, and Medicaid and/or Children’s Health Insurance Program, including managed care arrangements, will allow the use of the most appropriate place of service for each encounter, as will inclusion of telehealth among the medically necessary services covered under the treatment provisions of Medicaid’s Early and Periodic Screening, Diagnostic and Treatment law,” the document states.

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“Technology can, in many situations, remove perceptions of a difference in value between services provided remotely and those provided in person and can provide greater value with the use of remote patient monitoring by preventing unnecessary emergency department and hospital use, especially in children and youth with special health care needs,” it adds.

In calling for parity, the AAP points out that increased coverage will prompt more care providers to use connected health tools and platforms, thereby expanding adoption and creating new opportunities to use these services and reach more children.

“Children and youth with special healthcare needs, including those with mental and/or behavioral conditions and medical complexity, will require additional consideration for developing innovative payment structures that promote care integrated across settings that maximize value,” the AAP continues. “Investment in telehealth and remote monitoring infrastructure, including devices and connectivity, for such populations is critical to providing equity in access to pediatric services. Medicaid payment structures (such as waivers and Health Homes), which are used to pay for services for specific populations, can also cover telehealth services in these populations.”

Among other recommendations, the AAP supports using telehealth to address barriers to healthcare access – be they geographic, societal or cultural – as well as health inequity.

“Inequity in access to health care services for children is discriminatory and unacceptable because it results in unequal care and worse outcomes for children without access,” the document states. “Telehealth can decrease disparities in access to care by extending pediatric expertise and best practices to children no matter where they are located. Addressing barriers, such as language, digital literacy, disability, and access to and payment for technology infrastructure, is required to avoid furthering disparities.”

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The organization also notes that interstate licensure issues often throw up roadblocks to healthcare access for children, as does a lack of access to broadband connectivity or the resources to acquire or use telehealth technology.

“Every individual, especially those in under-resourced areas of the country, both urban and rural, deserves availability of and support for a reliable technology and telecommunications infrastructure … to avoid furthering health care disparities,” the document states.

Other recommendations call for an emphasis on access to primary and specialty care services, support for the use of telehealth in the medical home, the development of standards of quality care, and more support for federal research on the value of telehealth.

“Creation of an evidence base to address best practices, workforce needs, patient access to care, quality of care, reduction of health care costs, and patient and/or family and clinician satisfaction will enable future research to improve the function of and access to pediatric care via telehealth, including the impact of alternative payment and care delivery models that use telehealth and remote monitoring for children with special needs to integrate care across settings most effectively,” the document concludes.