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Walls: Is Telemedicine the Last Frontier for WC?

By Mark Walls

Friday, May 31, 2019 | 578 | 0 | min read

Telemedicine makes it possible for injured employees to reach a qualified clinician from home or the work site, providing a promising alternative that ensures early treatment.

Mark Walls

Mark Walls

In a session at the recent RIMS 2019 Conference and Exhibition, panelists discussed how technology can improve efforts to manage an injured employee’s health care experience.

Speakers included Ann Schnure, vice president of telemedicine operations at Concentra, and Janine Kral, vice president of risk management at Nordstrom.

Every state has adopted telemedicine in some form, with an increasing number accepting telemedicine for workers’ compensation, but many companies and individuals have been slow to adopt. In the past few years, however, adoption and usage have grown significantly.

In addition, more than 75% of health delivery organizations, like physician groups and hospitals, use or plan to use telemedicine soon. Eighty percent of larger employers use telemedicine, and that number is expected to jump to more than 90% in 2019.

Telemedicine for workers’ compensation

The first thing to remember where workers’ compensation is concerned is that there are no federal regulations for telemedicine. Each state has its own medical board that regulates medical rules. For workers’ compensation claims, wherever the patient is when the person needs to see a doctor, that state’s medical rules will apply, regardless of where the patient lives or where the accident took place.

There are some differences between telemedicine for group health and telemedicine for workers’ compensation. State workers’ compensation divisions provide additional oversight. Billing and reimbursement are also different. Rates vary widely among group health programs but follow standard billing and reimbursement procedures for workers’ comp.

Despite these differences, patients report high satisfaction with their telemedicine experience. A robust communication and rollout plan is required to facilitate awareness and use.

Use cases for telemedicine in workers’ compensation

Telemedicine is not right for all workplace injuries but can be effective for certain situations. It can be used for minor injury visits, recheck visits, telerehab, specialty visits (dermatology, behavioral health) and pathogen exposure counseling/treatment. For these situations, telemedicine can eliminate travel to a provider, bring care to geographically dispersed workforces in remote locations and provide after-hours injury care.

Injuries appropriate for a telemedicine visit could include strains, sprains, contusions, abrasions, simple burns or occupational dermatitis. Telemedicine can be a option for up to 60% of rechecks, regardless of the initial injury type.

Implementing a successful program

One of the first things to consider in implementing a telemedicine program is choosing a model to use. There are several options to choose from, including Triage Only, Recheck Only, One-and-Done, and Comprehensive. These models all vary in their use of occupational medical experts/generalists, phone/video and scope/continuity of care.

Triage Only is widely accepted, limited in scope and uses either phone or video. Recheck Only requires the patient to first get in-person care. This model may or may not maintain continuity of care and typically uses video.

One-and-Done is typically staffed by a generalist, provides no continuity for follow-up care, and could use phone or video.

Comprehensive models offer occupational medical experts. The patient can begin and continue with telemedicine, and these models use video for full treatment.

Other items to consider include the technology and equipment needed, what the workflow will look like, the experience of the provider, and communication among the employer and other stakeholders.

Telemedicine may not be right for every situation and will not affect spending on catastrophic claims but can provide several benefits for employers handling smaller workers’ compensation injuries.

Mark Walls is vice president of communications and strategic analysis at Safety National. This blog post is reprinted by permission from InsuranceThoughtLeadership.com.

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