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Nurse triage services expand into telehealth

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As companies weigh whether to expand their workers compensation strategies to include telemedicine, many are maintaining or expanding the use of more traditional 24/7 nurse triage phone centers and on-site clinics to quickly evaluate injured workers.

Nurse phone triage and on-site clinics have been around for two decades or longer, but have grown substantially in the past decade — growth that continues, according to service providers.

Nurse triage calls are the first step in evaluating an injured worker and determining whether self-care, treatment by a doctor or a trip to the emergency room is in order. That immediate attention can prevent unnecessary medical tests and trips to the ER, while saving time and keeping some workers on the job, experts say.

Third-party administrator Gallagher Bassett Services Inc. “has seen no slowing of interest in our nurse triage program. Customers often call it the most important part of their workers comp program,” said Niel Simon, senior vice president of vendor solutions and medical operations for the Itasca, Illinois-based firm.

More than 80% of its larger clients use nurse triage, he said.

At McHenry, Illinois-based Medcor Inc., a provider of on-site clinics and nurse triage phone services, there’s still “strong interest” in nurse triage, with a “better than 98% retention rate,” said Executive Vice President Curtis H. Smith.

Medcor opened its first on-site clinics in 1984 and now operates 200 of them for 80 public- and private-sector entities. Clients choose whether to include occupational health and workers comp services along with primary care.

Medcor began its nurse triage phone line for worker injuries in 1997. It employs 104 nurses trained on Medcor triage software that uses algorithms to determine best treatments. The company contracts mostly with large, self-insured companies, although some insurers include it in benefits packages to midsize companies, he said.

Medcor provides injury triage at about 250,000 work sites and fields about 1,000 calls a day, with 40% of injured workers recommended for self-care, 60% told to see a doctor, and 1% directed to call 911.

While nurse triage lines have been popular among large employers, many companies are now considering whether to move into telemedicine that provides video conferencing with a doctor who can treat or advise on visual injuries such as lacerations, contusions and mild burns.

Nurse triage is “the gateway” to telemedicine, as about a third of clients with nurse triage services inquire about expanding into telehealth, Mr. Simon said.

Over the summer, Gallagher Bassett piloted a telemedicine program and has just made it available broadly to its clients, he said.

“A lot of clients are asking about it but are waiting to see the data” on cost-effectiveness, Mr. Simon said. Still, he expects interest to grow over the next six months.

Third-party administrator Sedgwick Claims Management Services Inc., based in Memphis, Tennessee, has offered a 24/7 nurse triage service since 2008 that is used by more than 100 Fortune 500 companies, said Jim Harney, vice president of client services.

In June, Sedgwick began a pilot program in telemedicine for workers comp injuries and made it available in July to all clients that use the nurse triage service, which Sedgwick calls a clinical consultation service. A “handful” of clients have opted not to have telemedicine as an option, Mr. Harney said.

For an employee whose injury can be treated through a video call, “the benefit really comes from that continued productivity — the ability to eliminate travel and save time,” Mr. Harney said.

While employers decide whether to move ahead with telemedicine, others are seeing that the existing nurse triage service can have value beyond saving medical costs.

That was the case for Ray Hansen, safety director for South Weber, Utah-based Sure Steel Inc., which employs about 200 people.

Sure Steel has had a Medcor nurse triage phone service for worker injuries for nearly three years — part of the benefit package offered by his insurance company, he said. The steel erector company has had few worker injuries in the past three years, but the company and employees have been happy with the results from its phone calls to the nurse, Mr. Hansen said.

But one call may have saved an employee’s life, he said.

It happened when a worker at a mine site in Nevada complained to his supervisor that he’d had pain in his neck radiating down his arm for three days but had refused to go to a doctor.

The supervisor put the worker, who spoke Spanish, on the triage phone line with a bilingual nurse. She convinced the man to go to a clinic near the mine, where he was helicoptered to a hospital.

“He underwent an emergency procedure for his heart,” Mr. Hansen said. “He made a full recovery and returned to work. It all worked out beautifully.”