Purpose: The Heart Institute at Cincinnati Children's Hospital Medical Center (CCHMC) hosts a Preventive Cardiology Program to assess and manage cardiovascular risk factors for pediatric patients. The lipid and hypertension clinics are staffed by providers from either: cardiology, endocrinology, or nephrology, and include registered nurses and dietitians. Prior to the COVID-19 pandemic, the clinics did not offer a virtual care option and required patients and families to attend all visits in-person. Born from access challenges due to in-person clinic restrictions during the pandemic, telehealth was adopted as a service modality to deliver immediate and billable care to patients with abnormal cholesterol levels. Best practices and learnings have been captured to guide decision making, while also considering the viability for continued utilization of telehealth in Preventive Cardiology programs.

Project Design: A systematic analysis was completed to incorporate data and commentary from financial reporting, schedule utilization, patient demographics, patient and family experience scores, and provider interviews. Our examination focused specifically on the visits held by the cardiologists in the program as these were the primary providers to offer telehealth services in addition to in person.

Results: The retrospective analysis (April 1, 2020 through March 31, 2022) identified 678 unique patients that accessed telemedicine care by the provider subset for 1,019 visits over two years. The same providers also completed 680 in-person visits over the study timeframe. Approximately 29% of the telehealth visits were completed for a new appointment as opposed to a follow up. By comparison, in-person visits saw approximately 40% new visits. For encounters with available billing data, average reimbursement rate for telehealth professional billing across all payors was 48.3%. In-person visits experienced a lower reimbursement rate (38.8%) during the same timeframe. The vast majority of patients that utilized telehealth were from CCHMC’s primary service area. Patient and family experience data on average demonstrated favorable satisfaction scores for telehealth in comparison to in-person visit evaluations (telehealth n=82, in-person n=100). Provider interviews highlighted that implementation of telehealth increased ease of care for providers and their patients. It allowed families to decrease time spent away from school and work and enhanced flexibility for providers to conduct telehealth from various secure locations. Primary threats to telehealth viability include uncertainty for continued telehealth reimbursement by payors and patients’ access to reliable internet infrastructure. 

Conclusion: The Heart Institute at CCHMC adopted telehealth visits for the Preventive Cardiology Program during the COVID-19 pandemic. Over a year later, telehealth visits have shown benefit to patients through increased access to care and positive experience. Furthermore, the program realized favorable reimbursement relative to comparable in-person visits. Telehealth services lines may be viable for the long-term, but will greatly rely on continued payor support and patient access to resources. Additional research is warranted to analyze patient outcomes and treatment plan adherence in telehealth versus in-person care for Preventive Cardiology.