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Telemedicine cuts costs, increases potential liabilities

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CHICAGO — Increased use of technology to treat injured workers remotely potentially could speed treatment, give injured workers access to more specialists and reduce workers compensation claims costs, but telemedicine also introduces new risks that must be addressed, a panel of experts said.

Licensing issues for medical providers, determining which conditions can be treated remotely and having a process for escalating treatment to an in-person setting all need to be considered, they added.

Given the huge costs associated with health care, “telemedicine has this great potential, but with all the potential there’s pitfalls and liabilities, and we have to keep that in mind,” said Debra Goldberg, chief underwriting officer at Sapphire Blue, a managing general underwriter unit of Ryan Specialty Group L.L.C. in Chicago.

She was speaking during a panel session on telemedicine at the 2017 Workers Compensation conference sponsored by the Claims and Litigation Management Alliance and Business Insurance in Chicago on Wednesday.

Telemedicine has been used for several years in radiology and pathology where physicians and other medical providers assess images and other reports remotely, said Mandi Karvis, a shareholder at law firm Sanders & Parks P.C. in Phoenix.

“That was not patient-based telemedicine … however, now it is emerging in different ways beyond just radiology and pathology, and where we are seeing it a lot is in rural areas that lack specialty coverage,” she said.

Telemedicine can allow a specialist to see a patient without the patient driving several hours to see the specialist, Ms. Karvis said.

Telemedicine can also help medical providers treat patients with mobility issues, said David T. Vanalek, Chicago-based director for U.S. professional liability claims at Markel Corp.

But as the practice of telemedicine expands, workers comp payers need to ensure that they are complying with state laws governing telemedicine.

One of the main concerns is licensing, said Ms. Karvis.

“If you are an Illinois provider who is treating a patient in Missouri, Arizona or Alaska, where are you practicing? Is it where you are, or are you practicing medicine where the patient is? Most of the statutes say it’s where the patient is as opposed to where the provider is,” she said. Therefore, providers need to be licensed in all the states where their patients are based, in addition to the provider’s state.

Some state medical boards will issue special telemedicine licenses, but the majority do not, Ms. Karvis said.

All providers involved in telemedicine also need to be aware of procedures and possible problems that may not arise with traditional in-person visits, the panelists said.

Common medical malpractice claims related to telemedicine often involve radiology, where there may be an image distortion or a failure or delay in communicating with a primary care physician, said Mr. Vanalek.

As telemedicine expands, more liability issues will arise, said Ms. Goldberg of Sapphire Blue.

In particular, payers and providers need to assess what type of technology is used and whether the provider needs to use video or just speak to the patient, she said.

“In some scenarios, a phone call is fine, but in other scenarios, such as (psychological claims), you really want to have an interaction where the provider can see the patient to see whether there is something to be concerned about above and beyond what they are saying,” Ms. Goldberg said.

And procedures need to be in place to determine whether telemedicine is appropriate for the care being provided, she said. For example, a severe injury should require an in-person assessment.

“You really have to ask yourself whether the platform you are using is appropriate to the type of injury or course of care,” Ms. Goldberg said.

In addition, triage nurses using telemedicine should know the policies and procedure for contacting a doctor “if it’s apparent during the triage process that there’s something bigger going on and it’s not just a sprain,” she said.

In addition, with potentially thousands of physicians available to see a patient via telemedicine, procedures need to be in place to ensure that patients are seeing the appropriate physician, Ms. Goldberg said.