Telemedicine Gaining Ground in Comp Arena

Telemedicine – the use of phone or online video conferences to connect physicians with patients as opposed to traditional office visits – is a growing trend in workers’ comp, with supporters that cite extensive benefits for both payers and claimants.

Denise Wrenn, Occupational Health Consultant at Cleco Corporation, sees major value in increasing workers’ comp claimant access to a service that has long been utilized in alternative settings. “Telemedicine is not a new concept for health care in general,” she said. “It plays an integral role in how patients in rural settings and at offshore clinics receive access to services where physician supply is limited.”

Wrenn, who is a certified occupational health nurse, sees the potential for telemed as an “integrated resource” on large job sites or factories. “Simple put, it provides injured or ill employees with early evaluations and diagnoses, and it makes it easier to monitor recovery and keep employees working,” she explained.

Teladoc takes on the Texas Medical Board, patient acceptance a potential issue

However, the increase in the general use of the technology is not without controversy. An ongoing court case in Texas between the Texas Medical Board and Teladoc Inc., the largest telemedicine provider in the U.S., could have significance for telemed operations and how they are regulated.

The Texas Medical Board attempted to promulgate rules that would prevent telemedicine doctors from treating patients (diagnosing and prescribing medication) remotely, unless the doctor and patient in question had already seen each other in person and established a relationship regarding ongoing care. In response to the rules, Teladoc sued the Texas Medical Board, accusing them of violations under the federal Sherman Act, an anti-trust law.

Teladoc’s argument stems from the company’s interpretation of the rules, which it claims is an attempt to artificially reduce physician supply, thus decreasing competition. Although the rules do contain certain exceptions that would allow remote diagnosis and prescriptions if the patient could undergo a surrogate exam and allow mental health visits to occur remotely, Teladoc won a preliminary court order earlier this month blocking the rules from going into effect as planned. U.S. District Judge Robert Pitman in Austin signaled in the order that Teladoc was likely to succeed in the suit.

John Kocke, a nurse and owner of AMC Resources, a bill review company, sees why the Medical Board would seek to restrict telemedicine doctors’ abilities. He said that the conflict is at least partially about poaching patients from traditional clinics and the speed and efficiency with which telemed doctors can see patients. The competition, Kocke said, is “just like Wal-Mart hating Amazon.”

As for the application to Louisiana’s system in the near future, Kocke cautions against expectations of immediate claimant acceptance. “The first thing that comes to mind is all of the potential litigation [associated with telemedicine] because of the idea of ‘company doctors,’” Kocke explained. “I see some value in it, but not as a replacement for office visits – strictly as an adjunct for quick, visual diagnoses.”

Whether or not telemedicine emerges as a significant piece of Louisiana’s comp medical services across carriers, Kocke believes there is always going to be a prominent place for hospitals and clinics in comp claims. “For basically everything, they’re going to need to be seen,” he said. “But for almost all follow-up visits for minor injuries and those claims where you’ve only got two to four weeks of lost time, telemedicine is a great resource and it has the potential to save a lot of time and money.”

Telemedicine provides massive potential savings

Indeed, the likely outcome of the Teladoc case and the continuous climb of technological advancement at American offices and worksites appears to make telemedicine an inevitable addition to health care in workers’ comp as the law catches up with the services’ intricacies and savings potential.

A Towers Watson report published last year estimated that telemedicine could save U.S. companies as a whole $6 billion per year on health care if it were widely adopted, and the research firm expects a 68 percent increase in employer use of the technology by the end of 2015. Additionally, a recent study performed by the Texas Department of Insurance Workers’ Compensation Research Division offered recommendations to save on reimbursements and provider confusion by utilizing telemedicine doctors already familiar with workers’ comp for second opinions.

CorVel gets in on the action with claimant telemed app

CorVel Corporation, a national provider of “risk management solutions” including workers’ comp, with a local office in Metairie, is already seeking to expand telemedicine as a part of its programs.

David Lupinsky, Vice President of Medical Review Services at CorVel, spoke with Louisiana Comp Blog about the rise of telemedicine and the company’s initiative to incorporate more telemed in its claims management program – including through the use of a claimant smartphone app.

The company, which is looking to launch the project with its current customer base by August 2015, believes the offering will only enhance the claimant experience, while also improving efficiency. “There are a lot of places for the use of telemedicine,” Lupinsky said. “We’re planning on offering it for those musculoskeletal injuries where we can say, ‘You can either go to a brick and mortar clinic and here’s the name of that and directions, or, we can connect you to a physician right now.’”

Part of the challenge CorVel’s team has faced in the development of the program and associated app is the differing state laws and regulations surrounding the telemedicine industry, as evidenced by the Teladoc case.

For his part, Lupinsky believes that prescribing practices through telemedicine are acceptable where they are, explaining, “We have to look at the medical necessity for this medium. It’s illegal under federal law for doctors to prescribe controlled substances over telemedicine, but as long as there is low potential for abuse, [for the drugs they can prescribe] I think having them prescribe easily is a good thing.”

Overall, Lupinsky expects the introduction of telemed into CorVel’s range of services to be a valuable endeavor, and “a logical progression” from the company’s current 24/7 nurse triage program. “Right now, we’re estimating that these telemedicine visits are going to cost 30 to 40 percent less than a brick and mortar visit, not included in that is the other expenses too, like mileage,” he said. “We also expect faster treatment, less disability durations, and a higher level of patient satisfaction through this new avenue for treatment.”


Editor’s Note: Access the court documents granting injunctive relief in the Teladoc case, plus Teladoc’s complaint in full below:

Teladoc v. Texas Medical Board order 5.29.15

Teladoc complaint as filed 4.29.15

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