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Virtual House Calls

Using telemedicine tools for enhanced clinical support in workers compensation

February 27, 2020 Photo

Once upon a time, doctors arrived at one’s doorstep carrying a black bag packed with a thermometer, a stethoscope, and other tools. Today, millennials and others can benefit from virtual house calls and other technologies that increase access to clinicians, facilitate appropriate care, and support better outcomes.

While telemedicine and telehealth aren’t new, the emergence of wireless technology and the need to improve access have combined to form a perfect opportunity for new tele-services—making this the perfect time to apply them in workers compensation.

Telemedicine and Workers Compensation

Virtual connections offer many benefits in workers compensation. The Official Disability Guidelines (ODG) currently recognize their use for treating pain, diabetes, back pain, and mental health disorders. The availability of video consultations with a board-certified occupational medicine physician offers injured employees and employers a number of benefits, including:

  • Rapid access when treatment is needed, with 24/7/365 availability.
  • Cost savings by reducing unnecessary emergency room and urgent care visits.
  • Less time away from work, decreased absenteeism, and improved productivity.
  • Greater employee satisfaction.

Telemedicine video visits can effectively manage many non-emergency diagnoses, including the most common occupational injury diagnoses:

  • Ankle sprain.
  • Knee / leg sprain.
  • Knee contusion.
  • Lumbar groin sprain.
  • Lumbosacral sprain.
  • Neck sprain.
  • Open wound on finger.
  • Shoulder/arm sprain.
  • Thoracic region sprain.
  • Wrist sprain.

Consider telemedicine as an option when an employee is at a remote location and a clinic might not be immediately available, or when an injury occurs on an overnight shift and the only other option is to visit the emergency room for evaluation. Looking beyond the initial injury, telemedicine also has the potential to provide follow-up care, including post-operative visits or even second surgical opinions.

Integrating Telemedicine with Nurse Triage

Another option for integrating telemedicine into workers compensation is to make it available during the nurse triage process. It is particularly useful for employees with minor injuries or those who are ambivalent about self care vs. seeking treatment.

Virtual Triage and Video-Telephonic Case Management are two types of virtual connections designed to support clinical staff. Virtual Triage allows triage nurses to connect via secure video to enhance their ability to assess the extent of the injury accurately. Virtual Triage also provides the most appropriate recommendation for the level of care needed and targets:

  • Burns.
  • Lacerations.
  • Scrapes/scratches.
  • Bruising.
  • Rashes.
  • Insect bites.

Video-Telephonic Case Management allows the telephonic case manager and individual to connect via video conference. This method enables the nurse to more closely mirror a face-to-face visit and quickly establish an element of trust and rapport with the injured or ill person. Utilizing the video connection allows the telephonic nurse to:

  • Pick up on non-verbal cues such as body language, which is essential in engaging with patients.
  • Appeal to a younger generation or anyone comfortable using video technology to communicate.
  • View the injured body part and the healing process.

Telehealth Use for Chronic Health Problems

Telehealth has primarily been used to improve the management of chronic health problems—the kinds of conditions that can jeopardize recovery and return-to-work following an injury, or that could lead to injury, particularly in an older workforce. Both chronic conditions and age can have a significant impact on outcomes and costs.

Illness rates in the general population are increasing, and this trend is also reflected in workers compensation. The number of workers comp claims identified as also having a comorbid diagnosis within the first 12 months of a claim is increasing, with hypertension, drug abuse, and diabetes being the most prevalent causes. Comorbid conditions in workers comp are highly underreported, however claims with one or more comorbid conditions are more costly than other claims.

Remote Patient Monitoring for High-Risk Claims

Remote patient monitoring (RPM) can play a key role in managing high-risk claims and reduce re-admission rates. Consider the patient who has insulin-dependent diabetes and an open wound after surgery. Monitoring insulin levels is critical to proper healing and preventing infection. With RPM, the patient can check her insulin levels and transmit the information to the case manager. The case manager can then advise the employee to contact the primary care provider, if necessary, for additional treatment.

The first step is identifying the right candidates for remote patient monitoring—those at higher risk for complications and prolonged recoveries. Key questions to consider include:

  • Are comorbid conditions delaying or preventing the injured employee from receiving the recommended care and prolonging recovery?
  • Do the conditions pose a higher risk of re-admission post surgery?
  • Are there other risk factors, such as functional limitations, lack of caregiver, poor living conditions, low health literacy, narcotic use for more than 30 days, or other psycho-social issues?

RPM is only applicable to a small population of high-risk workers compensation claims. However, paired with case management to monitor, educate, and coach the individual, it can make a powerful impact. This combination of technology and clinical service could help reduce medical spend on high-dollar claims.

Telemedicine and Telehealth Adoption

As with all new technology, some people will be hesitant to take part, so participation in these programs is entirely voluntary. It is also not expected for adoption to occur overnight. Like telemedicine, it takes time for people to get accustomed to a new idea and embrace it.

The legislative landscape is also still evolving. Several states have enacted workers compensation regulations allowing telemedicine video consultations with a physician. Each state has different telemedicine policies, and the types of services covered, provider requirements, and reimbursements differ for each, as does medical licensure. Some states require physicians to have a special telemedicine license.

As the telemedicine industry continues to boom, we’re seeing an increasing number of new forms of telehealth emerge in the marketplace. Telehealth variations include tele-rehab, new forms of remote patient monitoring, and even utilization of “avatar-like” nurses by hospital systems and providers.

Offering telemedicine as an option at the time of injury allows for quick and convenient access to a physician around the clock, every day of the year. These “virtual house calls” can go a long way toward reducing or eliminating unnecessary absence from the workplace, lowering medical costs, improving productivity and increasing employee satisfaction. Remote patient monitoring can prevent delays in treatment, complications, and re-hospitalization. In this new world of telehealth, we must continually be looking for innovative modes by which triage nurses and case managers can connect with the individuals they serve and engage them on their road to recovery.

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About The Authors
Tammy Bradly

Tammy Bradly is vice president of clinical product development for Coventry. Bradly is a certified case manager with more than 25 years of comprehensive industry experience. 

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