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Medical Management

Telemedicine Growing But Obstacles Remain

Diverse state regulations create hurdles that are impeding broader utilization of telemedicine.
By: | January 29, 2018 • 4 min read
Topics: Workers' Comp

As Concentra moves forward with an aggressive effort to provide telemedicine services for treating  occupational injuries nationwide, it is uncovering limits imposed by existing state workers’ compensation regulations.

Those limits raise due-diligence considerations for anyone weighing the implementation of telemedicine programs providing treatments, such as first doctor visits following a workplace injury and follow-up exams.

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Telemedicine holds great promise for providing such injured-worker care and is poised to expand significantly. But an array of established workers’ comp laws and regulations are slowing its advance into some jurisdictions, said Ann Schnure, VP of Concentra Telemedicine.

In some states, laws remain silent on treating worker injuries through telemedicine. But given a strong interest in telemedicine, the potential for laws to emerge in those states must be considered. That potentially creates risks for implementing telemedicine systems before knowing what parameters such regulations could bring, she added.

“You are making a risk decision going forward in a state that says ‘we are going to make regulations, we just haven’t written them yet,’ ” said Schnure, who is passionate about telemedicine’s potential.

Concentra, a national employee healthcare provider, currently offers telemedicine occupational injury treatment in California and will soon launch those services in Illinois, Michigan, and New Mexico. It expects to add many more states to its roster after that.

Ann Schnure, vice president, Concentra Telemedicine

In attempt to spread Concentra’s workers’ comp telemedicine offerings into additional jurisdictions, Schnure is methodically discussing each state’s existing regulatory environment with their workers’ comp regulators.

Despite existing impediments, Schnure expects state laws will evolve to favor telehealth. But it could be a few years for that to occur nationwide. Meanwhile, she believes moving forward requires careful due diligence, as she has found a few states where it is not yet a good idea to implement telemedicine.

“I think telemedicine is game changer,” she said. “ But you can’t [instantly] turn the switch on. You have to really think through what you are doing and what state you are in.”

Jill Allen, president and CEO of Consumer Health Connections, said that amid recent legal and regulatory advancements, every state now allows for telemedicine.

“Telemedicine in the last year and a half has been very widespread and very accepted,” Allen said. “There is nothing saying you can’t do this in workers’ compensation. It is very favorable.”

Actual implementation of workers’ comp telemedicine systems, however, has moved slowly. But it is expected to accelerate in 2018 and into 2019, said Allen, whose company provides telehealth solutions.

“I think 2018 we are going to see a massive uptick [in workers’ comp]. The interest is enormous with payers and employers asking how do I get it implemented.” — Ann Schnure, vice president, Concentra Telemedicine

Schnure also believes 2018 will be a year of rapid growth, especially with telehealth’s expanding adoption for non-occupational health care treatment.

“It really is exploding,” Schnure said. “I think 2018 we are going to see a massive uptick [in workers’ comp]. The interest is enormous with payers and employers asking how do I get it implemented.”

While state laws may not specifically prohibit telemedicine’s application in workers’ comp there are, however, other existing regulations that can be impediments in some states, Shnure said.

Some states, for example, require a “wet signature” for documents the injured worker and treating physician must complete . An electronic signature is not allowed, defeating telemedicine’s promise of eliminating employee travel for doctor visits.

While discussing the current regulatory environment with Washington officials, as another example, Schnure said she learned that the state’s workers’ comp code requires a medical report completed by a doctor who conducted a “hands-on” physical exam.

In other states, fee schedules have yet to include modifier codes for billing telemedicine services. Does that mean such treatments will be considered “unapproved care?”

There are other areas of uncertainty. California, for instance, does not currently have regulations stipulating whether specific requirements exist when using medical provider networks and telemedicine.

Regulators in states where such ambiguities exist are often helpful and will provide advice on what they think eventual regulations may say. But that is not the same as having regulations in hand.

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New regulations, meanwhile, may emerge in other areas of workers’ comp telehealth services.

So far, most states have been silent on the application of physical therapy services known as Telerehab, said Mary O’Donoghue, chief clinical and product officer at MedRisk, which offers the services nationwide, but currently provides them in six states.

Few limitations for telerehab’s application for workers’ comp treatments exist. But regulatory rigor will likely follow an increased used in the services, O’Donoghue added.

“I think over time that will change,” she said. “As the volume increases I think there will be more regulations making sure there are certain things in place, like making sure you have HIPAA-compliant technology.”

That assessment, though, implies that the telerehab use will expand. &

Roberto Ceniceros is senior editor at Risk & Insurance® and chair of the National Workers' Compensation and Disability Conference® & Expo. He can be reached at [email protected] Read more of his columns and features.

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Risk Management

The Profession: Curt Gross

This director of risk management sees cyber, IP and reputation risks as evolving threats, but more formal education may make emerging risk professionals better prepared.
By: | June 1, 2018 • 4 min read

R&I: What was your first job?

My first non-professional job was working at Burger King in high school. I learned some valuable life lessons there.

R&I: How did you come to work in risk management?

After taking some accounting classes in high school, I originally thought I wanted to be an accountant. After working on a few Widgets Inc. projects in college, I figured out that wasn’t what I really wanted to do. Risk management found me. The rest is history. Looking back, I am pleased with how things worked out.

R&I: What is the risk management community doing right?

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I think we do a nice job on post graduate education. I think the ARM and CPCU designations give credibility to the profession. Plus, formal college risk management degrees are becoming more popular these days. I know The University of Akron just launched a new risk management bachelor’s program in the fall of 2017 within the business school.

R&I: What could the risk management community be doing a better job of?

I think we could do a better job with streamlining certificates of insurance or, better yet, evaluating if they are even necessary. It just seems to me that there is a significant amount of time and expense around generating certificates. There has to be a more efficient way.

R&I: What was the best location and year for the RIMS conference and why?

Selfishly, I prefer a destination with a direct flight when possible. RIMS does a nice job of selecting various locations throughout the country. It is a big job to successfully pull off a conference of that size.

Curt Gross, Director of Risk Management, Parker Hannifin Corp.

R&I: What’s been the biggest change in the risk management and insurance industry since you’ve been in it?

Definitely the change in nontraditional property & casualty exposures such as intellectual property and reputational risk. Those exposures existed way back when but in different ways. As computer networks become more and more connected and news travels at a more rapid pace, it just amplifies these types of exposures. Sometimes we have to think like the perpetrator, which can be difficult to do.

R&I: What emerging commercial risk most concerns you?

I hate to sound cliché — it’s quite the buzz these days — but I would have to say cyber. It’s such a complex risk involving nontraditional players and motives. Definitely a challenging exposure to get your arms around. Unfortunately, I don’t think we’ll really know the true exposure until there is more claim development.

R&I: What insurance carrier do you have the highest opinion of?

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Our captive insurance company. I’ve been fortunate to work for several companies with a captive, each one with a different operating objective. I view a captive as an essential tool for a successful risk management program.

R&I: Who is your mentor and why?

I can’t point to just one. I have and continue to be lucky to work for really good managers throughout my career. Each one has taken the time and interest to develop me as a professional. I certainly haven’t arrived yet and welcome feedback to continue to try to be the best I can be every day.

R&I: What have you accomplished that you are proudest of?

I would like to think I have and continue to bring meaningful value to my company. However, I would have to say my family is my proudest accomplishment.

R&I: What is your favorite book or movie?

Favorite movie is definitely “Good Will Hunting.”

R&I: What’s the best restaurant you’ve ever eaten at?

Tough question to narrow down. If my wife ran a restaurant, it would be hers. We try to have dinner as a family as much as possible. If I had to pick one restaurant though, I would say Fire Food & Drink in Cleveland, Ohio. Chef Katz is a culinary genius.

R&I: What is the most unusual/interesting place you have ever visited?

The Grand Canyon. It is just so vast. A close second is Stonehenge.

R&I: What is the riskiest activity you ever engaged in?

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A few, actually. Up until a few years ago, I owned a sport bike (motorcycle). Of course, I wore the proper gear, took a safety course and read a motorcycle safety book. Also, I have taken a few laps in a NASCAR [race car] around Daytona International Speedway at 180 mph. Most recently, trying to ride my daughter’s skateboard.

R&I: If the world has a modern hero, who is it and why?

The Dalai Lama. A world full of compassion, tolerance and patience and free of discrimination, racism and violence, while perhaps idealistic, sounds like a wonderful place to me.

R&I: What about this work do you find the most fulfilling or rewarding?

I really enjoy the company I work for and my role, because I get the opportunity to work with various functions. For example, while mostly finance, I get to interact with legal, human resources, employee health and safety, to name a few.

R&I: What do your friends and family think you do?

I asked my son. He said, “Risk management and insurance.” (He’s had the benefit of bring-your-kid-to-work day.)

Katie Dwyer is an associate editor at Risk & Insurance®. She can be reached at [email protected]