United States

Children's hospital executives offer perspectives on telehealth

INSIGHT ARTICLE  | 

RSM US LLP recently hosted a virtual roundtable of industry executives from children’s hospitals across the country to discuss their virtual care strategies prior to COVID-19 and how that strategy has evolved since the onset of the pandemic. The discussion traversed a number of familiar paths, but also revealed some unexpected discoveries as virtual care models and telehealth have transformed health care delivery and patient experiences everywhere.

Each of the executives noted positive surprises for their patient populations; top of that list is significantly higher telehealth and virtual care delivery than before the pandemic. Like many health systems, children’s hospitals have experienced their most disruptive and severe volume declines in memory and are inching their way back to volumes each had become accustomed to; telehealth is part of that story.

The following are perspectives that highlighted the opportunities and challenges present in the minds of the executives who participated.

Digital health’s immersion experiment

A care model has never transitioned so quickly from its historical modality to its future state. This breathtaking change led to pleasant surprises on the part of our executives. Prior to COVID-19, telehealth and virtual care delivery options existed, but families weren’t all that familiar with them and were only at the outset of the technology adoption cycle. Utilization wasn’t widespread because they hadn’t seen and felt the care delivered using this medium and this accelerated that adoption cycle in profound ways. One executive, whose organization had not provided any form of telehealth prior to COVID-19, noted their organization’s hesitancy was rooted in a belief that not all their families would have appropriate access to devices that would enable widespread telehealth usage. This organization implemented an emergency telehealth initiative in three business days and saw capacity skyrocket to 80% of their capacity with 90% of services being delivered virtually.

Regulatory support of virtual care

With all of the positive observations from children’s hospital executives on the care delivered using telehealth platforms and the effectiveness of this care, executives also applauded the unintended demonstration given to legislators who were able to see the tremendous economic value created. This resulted in sweeping regulatory changes in recognition of the fact that this modality of care delivery creates value with restrictive legislation only hindering its growth. The speed at which these changes have occurred is impressive; the boundaries of how the digital experience is reshaped will test new challenges in the areas of e-consent and site of service in the near term.

Access and utilization in virtual care delivery

As delivery of telehealth and virtual care has peaked and since tapered over recent months, our executive participants outlined a consistent concern for the future of the reimbursement model for virtual care delivery. The increased access for telehealth models allowed restoration of volumes in certain areas of clinical operations, but resulted in measurable declines in other areas with ancillary procedures experiencing the most pain. As organizations evaluate and map out their digital and physical footprints, these changing patterns of clinical care habits could create very different capital plans for many children’s hospitals as well as other participants in the delivery system.

Digital transformation and its impact outside of clinical care

Our conversation led us to discuss even broader applications of digital means to affect the patient and their family’s care experience. Digital is also is being used to transform the way employees interact and access flexibility in their relationships with fellow employees and their employers. Some exciting developments were occurring in many of the participants’ organizations, from virtual dog therapy visits with children confined to their rooms to families being able to virtually enter the room of a patient under visitor restrictions. Care is clinical, but its effectiveness is also determined by the experience and this is being reshaped at unparalleled speeds. One organization has used new technology to centralize and change its communication methods with its patients and their families as many of these families represent life-long patients subject to research studies. The organization has also leveraged technology tools to allow children to maintain participation in their education at school. Employees have also benefitted from tools implemented to serve as a social network for each other and allow employees to post their needs for tutors, childcare or other tasks on a forum for fellow employees to view and aid in supporting each other.

Financial outlook

Despite the challenges recently encountered and the tests to the resilience of each executive’s organizations, we noted a generally positive outlook on the future of their organization’s ability to succeed and thrive through these challenges. These tests taught them a great deal; the employees and leadership of each organization adapted to see their way through to the current day. The executives continued to have hope that reimbursement models will allow for this transformative shift from the physical investments in our current system to the digital investments needed for tomorrow. The executives had optimism in the future of regulatory changes that will not only allow virtual care to remain present, but extend it. Having seen the benefits, we might now anticipate further legislation to remove impediments to widespread adoption of telehealth and more effective use of the extremely specialized resources that exist in our children’s health care systems.

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