Workers’ Compensation Eyes Telemedicine As Treatment Option
By: Denise Johnson, Insurance Journal, June 2015
Cost savings, better access to care, immediate triaging of injuries and faster claims closings are just some of the benefits of telemedicine, according to workers’ compensation experts, who also say its use is growing.
Telemedicine could potentially deliver more than $6 billion a year in health care savings to U.S. companies, but only if the technology is widely-adopted, according to a 2014 report by Towers Watson.
The Towers Watson analysis points to a maximum potential savings, but even a significantly lower level of use could save hundreds of millions of dollars, according to Dr. Allan Khoury, a senior consultant at Towers Watson.
“Achieving this savings requires a shift in patient and physician mindsets, health plan willingness to integrate and reimburse such services, and regulatory support in all states,” Khoury said.
Texas Study
A recent Texas Department of Insurance Workers’ Compensation Research Division study shed light on how it might work. The study, which defines telemedicine as the delivery of medical care and information via telecommunications network, found two areas of the Texas workers’ compensation system that could benefit from telemedicine: the designated doctor and the spinal surgery second opinion processes.
In both cases, injured workers must go to doctors other than their treating doctor for second opinion examinations. But using telemedicine, an injured worker could have access to a designated doctor or second opinion spinal specialist already familiar with the workers’ compensation system.
The report indicated some of the benefits could include “greater conformity among second opinions, increased injured worker satisfaction with the process, fewer disputes, and an electronic record of procedures followed.”
Another benefit of telemedicine is that employees working in remote locations could still seek treatment guidance. The TDI report noted that Texas especially could benefit since it is a state that is 80 percent rural and more than half of all Texas claims are filed in counties officially designated as rural.
One drawback of the rural concentration, according to the report, is that these regions may have telecommunications infrastructure limitations.
Kim Haugaard, vice president of network and medical operations at Texas Mutual Insurance Co., said earlier this year her company is considering the use of telemedicine.
“Texas is a very expansive geographical area, and in many rural areas there are very few or no medical providers to administer medical care,” said Haugaard. “Injured workers may have to travel a significant distance to obtain medical care…telemedicine is an option that we are exploring.”
Jodi Mathy, senior claims consultant at Wisconsin-based HNI, said that while she sees telemedcine being used in general other situations, she doesn’t currently have any clients utilizing telemedicine for workers’ compensation treatment.
“I do have many more clients that are engaging 24/7 nurse triage which I think is the baby step before telemedicine. Companies like TriageNow have a smartphone app that allows the injured worker to take pictures and send them to the nurse real-time. We do see telemedicine becoming more popular on the general health side of things. In fact, HNI makes Anthem’s LiveHealthOnline available for its employees,” said Mathy.
Benefits of Online Care
According to Haugaard, the benefits of telemedicine include improved access to care in rural areas; fast non-emergency care; improved cost efficiency by reducing non-emergency care delivered by hospitals and a reduction in travel time by triaging an injury for medical severity and referral to the most appropriate level of care.
Mathy believes that based on current estimates, there will be a physician shortage in the near future, which could mean more of a role for telemedicine.
“Telemedicine will allow for early intervention and triage of less complex claims. It will decrease wait times that will lend itself to shorter claim durations,” said Mathy. “The initial interactions will also be less costly than an ER or urgent care visit.”
Patient Acceptance
While the industry may be welcoming, it remains to be seen if patients will be accepting of telemedicine.
Haugaard said that although telemedicine is not a new concept, it is relatively new to the workers’ compensation market.
“We believe it will eventually be widely adopted in workers’ compensation but until then there are concerns about how the concept of telemedicine will be received by injured workers,” said Haugaard.
Mathy thinks the main drawback will be in the patient’s experience.
“The lack of ‘face-to-face’ care may feel cold and impersonal and the employee may become put off by the experience. Also the lack of in-person examination could lend itself to additional diagnostics tests being ordered by MDs to confirm/rule out possible diagnosis,” Mathy said.
Low Hazard Industries
Certain industries may be able to embrace telemedicine more easily than others.
For example, low hazard industries, such as retail and office workers that typically generate low severity claims, may be better suited for telemedicine because they typically result in minor medical injuries, Haugaard said.
High hazard industries that generate high severity injuries, such as the oil and gas and transportation industries, may not be good candidates for telemedicine because they more often result in emergency room type injuries, said the Texas Mutual vice president.
On the other hand, Mathy said that the transportation industry may benefit the most from telemedicine since truck drivers are on the road all over the country and sometimes getting medical treatment at a certain time or location can be difficult.
“Telemedicine will break down some of those barriers,” said Mathy. “This industry will also benefit from the ability to keep freight moving instead of having unnecessary downtime while drivers are waiting for medical clearance or worse yet, having a driver taken off a freight load.”
According to Mathy, telemedicine is the future.
“I think that telemedicine will be an integral part of future medical care and treatment,” said the Wisc.-based senior claims consultant. “We are in the experimental phase with this medical model and looking for its best application in workers’ compensation.”
In April the Texas Medical Board began requiring doctors to meet patients face-to-face before prescribing drugs. However, Teladoc, a large telemedicine provider, went to court to block the rule. On June 1, it won a preliminary injunction against enforcement of the rule pending its court challenge that the “face-to-face” rule is an unreasonable restraint of trade.
