Challenges of Telemedicine

At the 2019 WCRI Annual Conference, a session discussed the challenges and opportunities of telemedicine. The panel was:

Moderator: Dr. David Deitz, David Deitz & Associates

Speakers:

Ms. Amy Lee, Texas Department of Insurance

Mr. Kurt Leisure, The Cheesecake Factory

Mr. Dan Allen, Construction Industry Service Corporation (CISCO)

Dr. Stephen Dawkins, Caduceus USA

Telemedicine is growing rapidly in the group health setting but we have only begun to scratch the surface on it’s potential. It is estimated that up to 40% of medical visits could be done by telemedicine, while currently less than 1/100% actually are.

There is almost no quantitive data on the use of telemedicine in workers’ compensation. Adoption has been very slow and the regulatory environment is an impediment to this. Reimbursement has also been a challenge.

The potential benefits for employees and employers with telemedicine include:

• Ability to get immediate medical care with no waiting.
• It is available 24 hours a day, 7 days a week.
• More focused attention from the doctor.
• Do not have to go into a doctors office with a bunch of sick people.
• Bi-lingual doctors available.
• Prescriptions can be given.
• Return to work can be done with minimal disruption, often during the current shift.
• No transportation issues.
• Immediate care for the employee.
• Injury notes can feed directly into claims intake system.
• Medical care more consistent with employee experience in group health.

Challenges Include:

• Too many claims referred by telemedicine to urgent care or emergency room means you end up paying double medical costs.
• Privacy concerns.
• Adoption by injured staff. This is by far the largest obstacle.

Overall, most injured workers who have utilized telemedicine found it to be a positive experience. The more people have a good experience with this, the more adoption will be seen as the positive feedback spreads by word of mouth.

Regulatory Challenges

Many states require a face-to-face visit to establish the patient/physician relationship and trigger something billable. Laws must be changed to allow for the use of telemedicine as an acceptable alternative. Once the treatment is allowed, states have to look at their workers’ compensation fee schedules and treatment guidelines to ensure they allow for reimbursement of telemedicine services. Most states do not currently have this. Telemedicine services need to comply with state data reporting requirements and must maintain the same standard of care received in face-to-face visits. In addition, state licensing boards must make decisions around the scope of care allowed under telemedicine. Finally, regulators need to look at making exceptions to geographic restrictions as it should not matter where the physician providing the telemedicine visit is physically located.