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COVID-19 puts telemedicine in comp on fast track

COVID-19 puts telemedicine in comp on fast track

Telemedicine is catching on in workers comp amid the COVID-19 pandemic, as patients and providers grow more comfortable with the technology and state regulators eliminate barriers to its adoption.

The industry has been ripe for years for implementing the telemedicine approach to such tasks as triaging injuries, conducting follow-up appointments and providing rehabilitation services, experts say. And numerous providers and programs that help coordinate care over the Internet have entered the market.

The spread of coronavirus, which has led to government-ordered shutdowns to stem its spread, is making telemedicine less of an option and more of a required offering, experts say.

“We’ve just seen a massive uptake to the tele-rehab process,” said Michelle Despres, vice president and national product leader at Jacksonville, Florida-based One Call Care Management Inc., a managed care organization that has included physical therapy sessions over the internet for injured workers in its offerings since 2017. “It’s been low adoption until this crisis. … Now it has gone through the roof.”

One Call CEO Thomas Warsop spoke during a recent webinar sponsored by Sedgwick Claims Management Inc. and Safety National Casualty Corp. of a “2,500% increase in supply and utilization” of services that link remote physical therapy providers to patients. “There was a clear reluctance … that I think is dead,” he said. “This experience (with COVID-19) means telemedicine will just keep growing.”

Behind the trend is the “injured worker’s willingness to get treatment now” with the dangers posed by the virus, he said.

In addition, regulators are changing rules to help widen the availability of telemedicine services for injured workers. Today is the first day that California doctors can use a new fee schedule for telehealth. Texas on Monday also upped its fee schedule. 

“We have been so excited to see some of the states that had such restrictions lift them,” said Ann Schnure, Cincinnati, Ohio-based vice president of telemedicine operations for Concentra Inc., a provider of occupational health to injured workers.

Washington had the “strictest regulations,” she said, adding that the state didn’t allow for telehealth unless both the patient and the provider were in a medical facility at the time of care.  It lifted those requirements in March, she said, enabling home appointments.

“Now many of the states say in their (workers compensation) regs that you must have a telemedicine solution,” Ms. Schnure said.

Many states have also loosened the requirement, temporarily in most cases, that a doctor be licensed in the state he or she is practicing in, according to Dr. Teresa Bartlett, Troy, Michigan-based senior vice president of medical quality for third-party administrator Sedgwick Claims Management Services Inc.

Some states have also eliminated the requirement under federal HIPAA rules that remote medical care be conducted over encrypted software programs, Dr. Bartlett said, adding that sessions over such platforms as Skype, WhatsApp and Facetime are helping to open doors. That change helped clear another hurdle for some: technological capabilities, she said.

Coronavirus shelter-in-place rules “just happened so suddenly that for everybody, access to care became complicated,” she said. “Necessity is the mother of invention.”

Can all workers comp care be conducted this way? That’s a common question, said Dr. Lisa Figueroa, Raleigh, North Carolina-based vice president of medical operations and national medical director of telemedicine for Concentra.

“We certainly understand that not all workers comp injuries are appropriate for telemedicine,” she said. “It is all based on the mechanism of injury. Somebody who falls 15 feet from a ladder? That would not be appropriate for telemedicine. But the sprains and strains of the upper extremities, your abrasions, dermatitis … there are many to list. Many workers comp injuries that can be seen over telemedicine.” 

Dr. Figueroa said doctors can examine such things as range of motion, bruising and swelling to begin treatment. For existing patients switching to telemedicine, the “transfer of care” has been in Concentra’s operations since it introduced telemedicine in 2017.

Whether the current medical climate will permanently help usher in telemedicine remains to be seen, experts say. “The regulations are changing daily,” Ms. Schnure said.

Dr. Bartlett and others are optimistic. “This is a big wakeup call to all of society that telehealth is here to stay, and it is a very helpful way to practice,” she said.

“Health care is going to be forever changed by this event,” said David Lupinsky, Sacramento, California-based vice president of medical review services for Corvel Corp., which provides nurse triage and telehealth services for employers. “What was once novel will start to become the usual,” he said in a Corvel webinar Tuesday on virtual care.

More insurance and risk management news on the coronavirus crisis here