Pediatrix Medical Group

Christina Bell

Telehealth services became standard practice during the pandemic out of necessity and has permanently modified patient expectations for convenient access to care. From a patient and clinical perspective,telehealth has shown its value in many situations, and organizationscontinue to evaluate how to sustain and evolve the use of this modality. It is widely recognized that telehealth is here to stay andcan continue to as a mechanism to expand access to subspecialty care in both hospital and ambulatory settings. 

For Pediatrix Medical Group, the pediatric TeleNeurology Program was developed to meet the growing demand for pediatric Neurology services in communities with limited coverage.  Focus was initially on designing our clinical program to support neonatal intensive care units (NICUs).In partnership with Teladoc, Pediatrix created a scalable sustainable, TeleSpecialty Program Structure. that has grown beyond supporting NICU services in the state of Florida, to provide access to hospital systems across the US in various units and capacities.

There is a finite number of pediatric neurologists across the country, and more and more providers are shifting their focus of care and/or retiring from patient care in search of better work/life balance. This results in a mass strain on access to specialty services across the country, especially in rural areas.

Telehealth lends seamlessly to this perfect storm of limited staff and large coverage areas nationally. It also helps support keeping patients closer to home, reduces transfer rates out of hospitals and creates a more comprehensive care model, meeting patients and clinicians where they are.

Our approach in developing our TeleNeurology program was to create easy, efficient workflows to prioritize the provider and clinical experience in a virtual environment. We acknowledged that with a new program we would need to have a lean methodology to the approach and ensure we had active engagement between the hospital and our partners to create rapid iterative improvements as needed.

Operational considerations for the program are:

1. Partnerships with hospitals require agnostic technology.

2. Many hospitals created virtual care solutions – we don’t want to add burden but rather provide economical hardware and software choices in the event its needed.

3. Providers spanning multiple hospitals cannot sustain multiple access points in various electronic health records for documentation purposes.

4. Management of financial reimbursement is difficult for low volumes. Dealing with payors in different states requires a varying amount of work and is a heavy administrative burden.

How we balance the considerations:

1. Selected a hardware and software platform that has flexibility in cost and configuration.

2. Leverage Teladoc for receipt of intake (hospital referral request for consult) and documentation for specialty care provider consistency

3. Create a model that is a flat rate stipend for specialty provider availability and then include an additional charge for stat/emergent needs and per unit of service.

Lessons learned and iterative improvements:

Analytics area key component of any program. We needed to ensure we have price transparency for billing and hospital partners, capturing key operational and clinical insights. Based on the initial design, we received data that had a bit of noise that needed to be addressed. We modified the documentation templates to clearly show the metrics we were seeking and are currently working with our internal analytics team to automate data into business intelligence. This will allow us to create dashboards for items ranging from billing, coding, diagnosis, volume per type of service per location and key clinical outcome measures such as patients kept in system (i.e., not transferred out) and more.

Overall, we have had great success in the implementation of our scalable program and plan to replicate the structure for other specialty services.