In the past few years, a great deal of appropriate attention has been spent pondering various ways in which access to medical care could be improved for injured workers. Various constituencies argue that in spite of significant improvements in information technology, medical care is all too often still delivered in an old-fashioned, inefficient manner. They ponder whether improvements might flow from increased use of telemedicine. In a recent breakout session at the 25th Annual National Workers’ Compensation Conference & Expo [November 30 – December 2, 2016, in New Orleans’ Morial Convention Center], three prominent experts—Ann Schnure (former VP, Risk Management – Claims, Macy’s), Jill Allen (President & CEO, Consumer Health Connections, LLC), and Paul Morizzo, Provider Networks Manager, Missouri Employers Mutual) presented a lively and optimistic discussion of the subject. Important New Insights
The session, “Telemedicine’s Role in Workers’ Comp Care,” offered me a number of new insights. I did not realize, for example, that telemedicine has been around for more than 40 years. According to the speakers, telehealth is the second fastest growing industry in the United States. They posited that by 2020, some $34 billion would be spent each year in the telehealth industry. Obviously, that projected spend is much broader than just the workers’ comp world. Yet, the speakers predicted that by 2018, as many as 80 percent of all U.S. employers would offer some form of telehealth benefits for employees.
Why Isn’t Telemedicine Currently Being Used in Workers’ Comp?
In order for the jump to telemedicine to take place, the workers’ comp world is going to have to clear a number of hurdles. They include:
- Many employees say they don’t want it
- Anxiety over the acceptance of telemedicine by hearing officers, judges, and the judicial system
- Perception—partially true—that some employers cannot afford the cost of necessary equipment and/or facilities
The speakers also stressed that if telemedicine it to be widely utilized in the next few years, we’ll need to rely upon it form more than just triage.
From the Employer’s Perspective
Ms. Schnure outlined how Macy’s became interested in telemedicine. Her office determined that in too many cases, injured workers were avoiding follow-up visits with healthcare providers, offering a plethora of excuses: lack of transportation, desire to save employer dollars, and a feeling that such visits were unnecessary since their conditions had improved.
Macy’s considered a number of alternatives, including the development of onsite clinics and the creation of partnership with other employers,, but Macy’s was intrigued by the possibilities offered by telemedicine. Schnure suggests that telemedicine is particularly suitable for the treatment of the following injuries and condition:
- Allergic reactions and rashes
- Burns, bites, and stings
- Sprains and strains of any body part
- Bruises, cuts, and scrapes
- Corneal abrasions
- Medication management
- Post operative checkups
From the Vendor’s Perspective
Ms. Allen shared sights from vendors. She noted that there were a number of market forces pushing the comp world toward greater use of telemedicine. In particular, she pointed to the much-discussed issue of our nation’s shortage of physicians. At a time when many “baby boomer” physicians are leaving their practices, the population continues to grow, and yet there is a growing expectation that quality medical care should be available to all. She added that physicians perceive the profession to be less remunerative following the passage of the Affordable Care Act. By 2020, there will be an estimated shortage of between 90,000 and 135,000 physicians in the country. Broader use of telemedicine is one way to alleviate the strains.
I thought Ms. Allen’s description of the average physician office visit particularly informative. On average, it consumes 121 minutes—37 minutes in total travel time and 84 minutes in the clinic (check-in, wait time, meeting with the physician, etc.). According to these computations, adults in the U.S. spent 1.1 billion (that’s with a “b”) hours of unnecessary time traveling to the doctor and waiting in the clinic. That is an expensive loss of opportunity. Allen allowed that by offering convenient access to health professionals, employees are less likely to miss work, or take time off to get the care they need. According to the speaker, telemedicine can serve as a genuine catalyst for employees to take a more active role in improving and maintaining their own health.
From the Carrier’s Perspective
Mr. Morizzo spoke on behalf of carriers, noting a number of benefits that could flow from a broad use of telemedicine in the workers’ compensation arena. According to Morizzo, telemedicine:
- Transfers the responsibility of making initial medical decisions from the employer to a trained medical professional
- Reduces unnecessary utilization of expensive treatment options like ER and Urgent Care
- Keeps employees on site, thus eliminating costly travel and lost productivity for both supervisors and staff
- Improves communication between employees, employers and physicians, ensuring everyone is on the same page
Morizzo outlined how the telemedicine process worked with Missouri Employers Mutual, noting that 95 percent of those treated returned to work the same day. Indeed, 99 percent returned to work within three days.
Some of My Skepticism Left Me
It is likely a function of my age, but I’ve been a skeptic when it comes to telemedicine, both within and without the world of workers’ compensation law. I think I’ve given short shrift to its potential, thinking that the loss of face-to-face contact with the healthcare provider was an insurmountable obstacle. Not that it really matters, but I came away from the New Orleans conference with a new level of appreciation for what may be accomplished through telehealth and telemedicine.
Telemedicine is no silver bullet for the problems that inflect the comp world. There is no such bullet. I’m beginning to agree, however, that telemedicine can be an effective tool for providing much needed care on an efficient, cost-saving basis. I want to thank the panel for an excellent program.