Parent experience and cost savings associated with a novel tele-physiatry program for children living in rural and underserved communities: Tele-physiatry for underserved communities

Abstract Objective The aim of this study was to investigate parent and therapist experience and cost savings from the payer perspective associated with a novel tele-physiatry program for children living in rural and underserved communities. Design We designed a non-inferiority, cluster-randomized crossover study at four school-based clinics to evaluate parent experience and perceived quality of care between a telemedicine-based approach in which the physiatrist conducts the visit remotely with an in-person therapist and a traditional in-person physiatrist clinic. Results A total of 268 encounters (124 telemedicine and 144 in-person) were completed by 200 unique patients. For parents and therapists, experience and perceived quality of care were high with no significant differences between telemedicine and in-person encounters. For parents whose children received a telemedicine encounter, 54.8% reported no preference for their child's subsequent encounter, 28.8% preferred a physiatrist telemedicine visit, and 16.4% preferred a physiatrist in-person visit. From the payer perspective, costs were $100 higher for in-person clinics owing to physician mileage reimbursement. Conclusions We found that school-based tele-physiatry for children with special healthcare needs is not inferior to in-person encounters with regard to parent and provider experience and perceived quality of care. Tele-physiatry was also associated with an average cost savings of $100 per clinic to the payer.