Could Telemedicine Be a Game Changer for Workers’ Comp Claims?

Might the age-old question, “Is there a doctor in the house?” be rendered moot by the rise in telemedicine over the next few years? And if so, what claims management implications could there be for workers’ compensation carriers?

The use of telemedicine is on the rise, although it remains the exception rather than the rule, particularly in workers’ compensation. But given recent health care trends, it’s logical to assume that telemedicine will play a growing role over the next few years in diagnosing injured workers, monitoring their recoveries, and cutting down on fraudulent claims.

One major factor is the potential impact of the Patient Protection and Affordable Care Act. As noted in earlier columns, millions of currently uninsured Americans are expected to acquire health coverage thanks to the introduction of what is widely known as Obamacare. Some will sign up simply to avoid paying a penalty on their income tax forms for failing to comply with the law’s mandate to have insurance. Others will do so because coverage may be more accessible and/or affordable via the new federal and state health insurance exchanges. A number simply may buy because they are now eligible to do so, thanks to the law’s prohibition on pre-existing condition exclusions.

Whatever the reason, a flood of newly insured patients may very well pour into doctors’ offices as the reform law is fully implemented. As a result, it could be much more difficult to get a face-to-face appointment with a primary care physician or specialist. Any delay in diagnosis or treatment could raise claims costs for workers’ comp carriers, which depend on fast, aggressive delivery of care to get claimants back to work and off indemnity payments as quickly as possible.

But even if Obamacare had never become law, telemedicine still might make a lot of sense as a cost-control device in workers’ compensation claims, as it’s likely to be cheaper for an injured party to get an initial assessment and follow-up appointments over the Web or by phone than to see providers in person. For self-insured employers, those savings would go straight to their bottom lines. For those with third-party insurance, it could translate into more stable or even lower premiums.

Indeed, there are a number of operational advantages offered by telemedicine for workers’ compensation carriers, employers, and claimants.

For one, the use of telemedicine might expedite initial contact with a medical professional after a nonemergency workplace injury, with both a verbal and visual assessment possible over a computer monitor or smartphone at the worksite shortly after an accident takes place, while the details are still fresh in everyone’s minds.

Coordination among a number of providers also could be facilitated with this technology, allowing a medical team to confer and make sure that they are on the same page in terms of what the patient needs to do first, which doctor they should see, which diagnostic tests they might have to take, and what type of treatment or rehabilitation could benefit them. Second opinions, if requested or required, might also be quicker, more efficient, and less costly via telemedicine.

Once treatment is underway, follow-up doctor office visits may often be routine or even unnecessary to conduct in person. In such cases, telemedicine could save both time and money, particularly in situations where the insurer reimburses travel costs for medical consultations.

In cases where claimants return to work for light duty, the recovering employee could report his progress and receive further evaluation via a teleconference on his computer or smartphone right from his job site instead of having to take time off to travel to a doctor’s office for a face-to-face checkup. This could be a very valuable option in rural areas where doctor offices, particularly for specialists, might be few and far between.

Case workers also could use telemedicine platforms to stay in closer contact with claimants. They could video conference at virtually any time or place to make sure injured workers are keeping up with their treatment programs and getting prescribed health care medications and services. Telemedicine also could provide a record of an examination for follow-up and administrative purposes, as well as for potential fraud investigations.

Of course there are potential downsides for workers’ compensation insurers to take into account as well when considering the addition of telemedicine to their claims management tool kits. Telemedicine, after all, does have its limitations.

One is that doctors usually cannot perform many key functions over the phone or via a video conference, such a taking a biopsy, shooting an X-ray, or setting a broken bone. However, for initial assessments to determine whether a face-to-face consultation or an emergency room visit is recommended or if a prescription drug is called for, having a medical provider available on video or audio could be quite useful, even if it’s just to do triage online to determine the next steps.

Some may have privacy concerns over the security of video calls and medical information transmitted over the Web. And there may be those—doctors and patients alike—who are less technologically inclined (remember that many doctors still deal in paper records) and who just won’t feel comfortable communicating in this manner.

In addition, while there may be cost savings from video and audio interactions, the potential for fraud also might be higher if doctors can be fooled more easily by patients whom they don’t physically examine or if they are tempted into schemes to bill for rigged video consultations.

There also are legal and regulatory hurdles to clear. For example, not all states permit the practice of telemedicine in workers’ compensation. And while some carriers might like to have national comp specialists available for telemedicine referrals, state licensing issues could be a barrier blocking interstate consultations.

Medical malpractice liability is another concern if provider premiums are hiked by carriers worried about the possibility of higher error rates among doctors not examining patients in person. Until such fears are alleviated by hard data, any significant rise in medical malpractice prices could discourage doctors from participating in telemedicine programs.

Such obstacles are not to be dismissed lightly. Still, I have a feeling these kinks will be worked out over time. It seems that public attitudes and enabling laws are always playing catch-up with advances in technology, and I doubt telemedicine will be an exception.

Indeed, with video chats among people in general becoming so common on both computer monitors and smartphones, it’s only a matter of time before workers’ compensation claimants routinely ask if the doctor is “on” rather than “in.”