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Wait Times, State Regulations Among Telemedicine Concerns

By Elaine Goodman (medical/business Reporter)

Thursday, February 2, 2017 | 826 | 0 | 47 min read

Telemedicine might sound like a service where a doctor instantly appears on a smartphone screen to provide medical treatment at the push of a button.

Teresa Bartlett

Teresa Bartlett

But in reality, wait times can be long to see a telemedicine provider, and that is one of the challenges to designing an effective telemedicine system in workers’ compensation, said Dr. Teresa Bartlett, senior vice president for medical quality at Sedgwick.

“As Sedgwick evaluated approaches in using telemedicine, we knew the right solution must provide convenience and time savings for all,” Bartlett said in an email on Wednesday. “What shouldn’t happen is trading the inconvenience of waiting for an appointment in a real doctor’s office for waiting in a virtual one.”

Telemedicine is a concept that has been much talked about in workers’ compensation but has yet to be widely implemented. The concerns about wait time come as more workers’ comp companies dip their toes in the telemedicine waters.

Coventry said in November that it will begin offering workers’ compensation telemedicine services through its around-the-clock nurse triage program. When treatment is recommended, Coventry triage nurses will determine if telemedicine is appropriate for the injured worker and offer the employee the option to participate in a virtual visit.

“While telemedicine is underutilized in workers’ comp presently, Coventry sees it as a benefit to both the employer and employee — quick, convenient access to a physician at the time of injury without leaving the work site being the primary benefit,” the company said in a news release.

Concentra announced in December that it will begin offering telemedicine services early this year through a partnership with telehealth company American Well. The goal is to give injured workers access to medical care around the clock, seven days a week, through computers, kiosks or smart mobile devices.

Greg Gilbert, senior vice president of reimbursement and government relations at Concentra, said Wednesday that wait times are one issue the occupational medicine provider will monitor as it rolls out telemedicine services. Wait times will depend in part on demand for the new service, he said.

“You just don’t know until you get it up and running and see what the volume is,” Gilbert said.

Gilbert said American Well is fine-tuning its telehealth platform to accommodate workers’ comp claims. He said California will likely be one of the first states where Concentra offers telemedicine, due in part to its lack of regulatory barriers. The state Division of Workers’ Compensation regulations are essentially silent on telemedicine, he said.

In contrast, Texas ties its telemedicine requirements to Medicare rules, which say that telemedicine is an option for patients only in rural areas, where medical providers are scarce.

A Coventry spokeswoman said its telemedicine system isn’t being implemented in Texas or Arkansas due to regulations in those states.

States that address telemedicine in their workers’ compensation regulations include Colorado, where telehealth requirements are spelled out in the Division of Workers’ Compensation fee schedule. Telehealth procedures are required to be at an originating site that has appropriate health-care privacy and electronic-security standards in place.

The originating site, which is responsible for verifying injured worker and provider identity, may be a doctor’s office, hospital, clinic, skilled nursing facility or a community mental health center.

Bartlett at Sedgwick said that a telemedicine system has the potential to offer several benefits, including easier access to high-quality providers and shorter wait times.

But in researching telemedicine, Sedgwick found many industry examples where patients were not correctly triaged or pre-qualified for a virtual doctor visit, Bartlett said. 

“If an injured worker is misdirected to telemedicine, this could result in frustration for them and increased cost for the employer due to additional in-person visits or, in the worst case, misdirection and an unsafe return to work,” Bartlett said.

In addition to clinical factors, Bartlett said, other issues need to be considered before referring an injured worker to telemedicine, including whether the worker will be comfortable with the approach, is the proper technology is available and will the worker have privacy during the visit.

Doctors providing telemedicine services also need specific training to make sure the injured worker has a good experience and the medical examination is successful, she said.

Bartlett further discusses the challenges and potential benefits of telemedicine in the most recent edition of Sedgwick’s quarterly online publication, Edge.

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