Smartphones, tablets, and laptop computers are commonplace in today’s world. Such technology allows easy and instantaneous access to many types of information and can instantly connect people from across the world. It is this same technology that has allowed for the introduction of telemedicine as an alternative to on-site medical care.
Growth of Telemedicine
Telemedicine is the use of electronic communication technologies to provide clinical services to patients without an in-person visit, with the goal of improving the patient’s health status. The electronic communications or monitoring may be used for follow-up visits, management of chronic conditions, medication management, consultation with specialists, or other clinical services that can be provided remotely via secure video and audio connections.1
According to a representative from Kaiser Permanente (KP), a leader in telemedicine services, the number of telemedicine customers is expected to increase to roughly 7 million by 2018 (up from 350,000 in 2013). In 2015, of KP’s 110 million interactions between physicians and members, 56% were virtual, surpassing physical visits for the first time.2
The Department of Veterans Affairs (VA), which operates the nation’s largest healthcare system and is recognized as a world leader in the development and use of telehealth services, has achieved better results through telemedicine. According to the VA, telemedicine has increased access to high-quality healthcare services and has proven to be an effective and convenient way for patients to receive—and medical providers to provide—medical care.3
Given the increased use of telemedicine in general healthcare, can it help provide access to prompt, high-quality medical care, timely return to employment, and better outcomes for injured workers and their employers in workers compensation?
Telemedicine in Workers Compensation
As telemedicine regulations slowly become adopted in the workers compensation (WC) insurance industry, some companies are beginning to take advantage of this technology to improve efficiencies and outcomes. Types of telemedicine services that can be used in WC include:
- Virtual face-to-face interactions
- Remote measurement of vital signs
- Prescription drug reviews
- Text alerts/reminders and other messaging of health information4
In certain situations, where accessibility to immediate medical care may be limited, one type of telemedicine service—24/7 tele-triage—may be an invaluable resource for initial assessment and evaluation. Examples include when employees are injured:
- During overnight shifts, when emergency rooms would typically be the only available option for evaluation
- While traveling or working in rural/remote locations, when there are no healthcare or urgent-care facilities nearby5
Benefits of Telemedicine
Aside from immediate assessment and evaluation, telemedicine could be used for follow-up appointments such as post-operative visits and second surgical opinions. It can also provide access to specialists who may not be available locally. Video consultations, along with remote patient monitoring technologies, can allow healthcare providers to monitor high-risk conditions (e.g., obesity and diabetes), monitor a patient’s progress, and help prevent or minimize complications or delays in treatment.6 They can do all this while eliminating travel for the patient, associated expenses (including food and lodging), and missed time from work.
In summary, telemedicine has the potential to:
- Save both time and money for patients and employers
- Provide quicker, more efficient access to high-quality medical care
- Make specialists more easily accessible
Successful use of such services could lead to more efficient care, a quicker return to work, and better outcomes overall. While not every injured worker would be an ideal candidate for telemedicine, many could experience fewer obstacles to exceptional care.
Risks/Limitations of Telemedicine
As with any emerging technology, there are related challenges. Signal disruption or equipment failure could cause missed appointments or delays in receiving care. In addition, some patients may not be receptive or comfortable with the virtual healthcare concept.
Some other risks and limitations associated with telemedicine include:7
- Lack of physician fee schedules for telemedicine services
- Lack of regulations and policies for licensing and privacy
- Jeopardized quality of care with potential for misdiagnosis
- Possible high start-up technology costs
- Cybersecurity threats; security of data
While increased use of technology can lead to more efficient, and possibly better, outcomes in WC, medical practitioners and claims adjusters need to strike a balance between the use of telemedicine and face-to-face interactions in order to meet the needs of the injured worker.
Recent Telemedicine Legislation
When it comes to legislation and rule changes to advance the use of telemedicine, some states are moving more quickly than others. In early 2018, Texas proposed a rule that would expand injured workers’ access to telemedicine services by lifting a restriction in the Medicare-based reimbursement policy that limits the use of telemedicine to underserved areas—typically rural regions with few healthcare providers.
Additional restrictions included the fact that telemedicine could only be provided to a patient in a doctor’s office, hospital, or clinic, but not at a patient’s home. The proposal would allow healthcare providers to charge and be reimbursed for telemedicine services regardless of where the injured worker is located when the services are delivered. In April 2018, the Texas Department of Insurance, Division of Workers’ Compensation, announced a new fee schedule applicable to telemedicine and telehealth services provided on or after September 1, 2018.
Also in 2018, legislators in Florida proposed two telehealth-related bills, House Bill 793 and Senate Bill 280. Among other provisions, these bills attempted to establish a standard of care for telehealth providers and authorize them to use telehealth to perform patient evaluations and prescribe certain controlled substances. However, neither bill advanced.
It is worth noting that the types of telemedicine services covered, provider requirements, and reimbursements may vary across states. For example, some states require physicians to have a special telemedicine license, while others do not. As with emerging insurance issues in the past, model legislation and regulation that address licensing, definitions, limitations, and reimbursements may assist with implementing telemedicine plans more widely.
Telemedicine has the potential to be another tool in the claims adjuster’s toolbox, which might help contain costs and improve outcomes in workers compensation. However, it’s still too early to tell what impact it will have, injured workers’ acceptance of it, and which claims would be most appropriate for its application. Given the increased interest in the use of telemedicine in workers compensation, NCCI will look for opportunities to evaluate its impact on WC costs. As telemedicine evolves, and participants become more comfortable with the technology, its use in WC could become as commonplace as the devices that help enable it.
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