Conversion of a Traditional In-Person Feeding Clinic to a Telehealth-Only Model of Care

In March 2020, many state, local, and national governments declared various states of emergencies in response to the COVID-19 pandemic. In Massachusetts, where our multidisciplinary pediatric feeding clinic is located, the governor declared of a state of emergency encouraging social distancing, and simultaneously signed an order establishing reimbursement parity for telehealth visits to in-office traditional visits by both commercial and state health insurers. This presented a challenge and an opportunity for our multidisciplinary program for children with pediatric feeding disorders embedded in a large academic children's hospital. In this paper we aim to provide a roadmap for rapid implementation of telehealth practice without a reliance on in-person care in a multidisciplinary pediatric feeding clinic. Description: Within a week, the program pivoted from solely in-person care to 100% telehealth services for both new and established patients. Through this transition, the program encountered several challenges with technology, scheduling, licensing, and concerns for reinforcing pre-existing healthcare disparities.

The program quickly overcame many of these challenges and found telehealth to offer benefits to patients such as improved coordination of care with other agencies, reduced appointment times, and reduced travel time and travel cost. Even with a reduction in the number of patients seen per clinic due to the manner in which telehealth was implemented, there was an increase in the number of visits completed with a slight reduction in the no-show rate. Additionally, providers in the program are better able to evaluate feeding practices in the home and understand many of the barriers families may face in implementing interventions. While telehealth does have some challenges, it can help to improve access, communication, and may increase patient satisfaction for children who require multidisciplinary care for their pediatric feeding disorder.

Our hope is that billing parity for telehealth will continue to be supported by insurance companies and state governments throughout the remainder of this pandemic, and far beyond.