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Modernizing Healthcare by Embracing Telemedicine

Telemedicine may be the healthcare delivery model of the future, but in exchange for convenience and efficiency, patients and providers could sacrifice quality of care.
By: | October 3, 2017 • 5 min read

Today, we can request a ride, order groceries, and stream a television show with just a simple click. And increasingly, we can also access healthcare. According to the American Telemedicine Association, more than 20 million Americans will have access to a remote healthcare service by the end of 2017.

Whether receiving or administering care, telemedicine can have advantages. For patients, telemedicine offers convenience and speed, and for healthcare providers, it allows medical professionals to see more patients.

With these advantages come new challenges, such as technical requirements, compliance, and licensing of personnel. By taking a holistic, cross-team approach to implementation and working closely with their insurance partners, healthcare providers can successfully embrace telemedicine and also protect patients, medical professionals, and their own operations from the potential downsides.

A New Model to Meet Patient Needs

A variety of factors drive the need for telemedicine. Many people live in areas where getting to a healthcare facility is challenging, or where there’s a shortage of physicians and specialists. And, those who benefit most is also growing: the number of elderly Americans has increased from 35 million to 49 million1 in the past 16 years. This group typically needs more care, but often has difficulty getting to a doctor’s office.

“Many senior care facilities are using videoconferencing to access telemedicine. Physicians see the senior citizens at the facility, diagnose ailments, and prescribe treatments remotely,” said Kristin McMahon, President, U.S. Liability and Regulatory Healthcare Products, IronHealth.

Cutting out the need for transportation means faster care for patients, which could also translate to fewer hospital readmissions.

“Faster diagnosis and treatment could translate into fewer professional liability claims. For example, you could more quickly address pressure sore ulcers or recommend appropriate fall precautions to minimize the risk of resident bodily injuries,” said Jeff Duncan, Chief Underwriting Officer, Healthcare Practice, Liberty Mutual Insurance.

Healthcare providers can also potentially see more patients in a day by addressing more minor ailments through videoconferencing or telephonic methods.

“Organizing the logistics of face-to-face consultations with multiple patients takes time,” Duncan said. “By addressing less serious cases using telemedicine, doctors have more time to analyze and treat complex cases.”

But significant clinical and technical risks go hand-in-hand with these benefits.

Risks to Telemedicine Providers

“Healthcare can’t be treated like any other consumer product; it’s much more complicated than requesting a ride to the airport,” Duncan said. In exchange for convenience and efficiency, patients and providers may sacrifice quality of care.

Without in-person interactions with patients, medical professionals may run the risk of misdiagnosis, which can cause physical harm to the patient and professional liability to the healthcare provider.

Traditional malpractice policies cover the medical professional for an error in judgment or treatment that fails to meet the standard of care. Technology introduces another layer of uncertainty.

“If the clinician fails to diagnose an abnormality on a CT scan, is it due to his or her professional error, or did the technology contribute to the oversight?” McMahon asked. “Perhaps the internet connection was weak or the image quality wasn’t high enough, which resulted in the clinician missing an area of shading that could suggest cancer, for example.”

There have not been many claims stemming from this type of technology failure, but McMahon and Duncan are keeping a close eye on this potential issue as telemedicine grows more prevalent.

Delivering healthcare online also increases cyber and privacy exposures that could land providers on the wrong side of HIPAA compliance. Electronic records shared with third-party telemedicine technology platforms may be at greater risk.

Licensure issues also arise when state lines can be so easily crossed in the cloud. Medical professionals must be properly licensed in the states where they provide care, but using telemedicine means that a patient’s location could be anywhere. Telemedicine regulations can vary by state in areas such as informed consent, standard of care, credentialing of providers, and remote prescription practices.

A Cross-Functional Approach to Mitigate Risk

Telemedicine may be the healthcare delivery model of the future, but providers should implement it strategically, with the help of a cross-disciplinary team.

“Billing and finance team members should be involved to determine how telemedicine-related reimbursements will work. Currently, 29 states and D.C. mandate reimbursement for some telemedicine services, but amounts vary,” Duncan said.

Clinical input is necessary to determine what staff will use it for which types of injury, and what patient population it might serve. The IT group should discuss the cyber and information privacy exposure, as well as the technical aspects of implementation. Legal and compliance teams can weigh in on contractual, jurisdictional, and licensure issues.

The full team needs to monitor the quality of care—is it the same or better than before?

“No one discipline has enough perspective to solve these challenges effectively in isolation. You need to engage cross-functional teams early, and then think about where telemedicine can be effective,” Duncan said.

Manage Liability Holistically

Insurance is the final piece of the puzzle.

Organizations should work with insurers and brokers to make sure current policies will meet their needs. Cyber and professional liability limits may need to be increased. Technology partners should also have the appropriate cyber and E&O coverage.

In particular, professional liability policies should respond to both the traditional exposure of a physician making a medical error, as well as exposures introduced by the telemedicine technology itself.

“If the technology malfunctions and that leads to a misdiagnosis or bodily injury, the healthcare provider can still be held liable on a negligent credentialing theory,” McMahon said.

One solution is to have the medical malpractice exposure and the technology E&O coverage from the same insurer, to avoid potential conflicts if there is a liability claim implicating both parties. Said McMahon, “We are looking very closely toward developing an integrated product to provide a comprehensive solution.”

Notes Duncan, “Telemedicine is here to stay, and we want to help protect our healthcare clients as they embrace it.”

To learn more, visit https://business.libertymutualgroup.com/business-insurance/industries/health-care-providers-insurance-coverage.

 1 United States Census Bureau. https://census.gov/newsroom/press-releases/2017/cb17-100.html

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This article was produced by the R&I Brand Studio, a unit of the advertising department of Risk & Insurance, in collaboration with Liberty Mutual Insurance. The editorial staff of Risk & Insurance had no role in its preparation.






Liberty Mutual Insurance offers a wide range of insurance products and services, including general liability, property, commercial automobile, excess casualty and workers compensation.

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4 Companies That Rocked It by Treating Injured Workers as Equals; Not Adversaries

The 2018 Teddy Award winners built their programs around people, not claims, and offer proof that a worker-centric approach is a smarter way to operate.
By: | October 30, 2018 • 3 min read

Across the workers’ compensation industry, the concept of a worker advocacy model has been around for a while, but has only seen notable adoption in recent years.

Even among those not adopting a formal advocacy approach, mindsets are shifting. Formerly claims-centric programs are becoming worker-centric and it’s a win all around: better outcomes; greater productivity; safer, healthier employees and a stronger bottom line.

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That’s what you’ll see in this month’s issue of Risk & Insurance® when you read the profiles of the four recipients of the 2018 Theodore Roosevelt Workers’ Compensation and Disability Management Award, sponsored by PMA Companies. These four programs put workers front and center in everything they do.

“We were focused on building up a program with an eye on our partner experience. Cost was at the bottom of the list. Doing a better job by our partners was at the top,” said Steve Legg, director of risk management for Starbucks.

Starbucks put claims reporting in the hands of its partners, an exemplary act of trust. The coffee company also put itself in workers’ shoes to identify and remove points of friction.

That led to a call center run by Starbucks’ TPA and a dedicated telephonic case management team so that partners can speak to a live person without the frustration of ‘phone tag’ and unanswered questions.

“We were focused on building up a program with an eye on our partner experience. Cost was at the bottom of the list. Doing a better job by our partners was at the top.” — Steve Legg, director of risk management, Starbucks

Starbucks also implemented direct deposit for lost-time pay, eliminating stressful wait times for injured partners, and allowing them to focus on healing.

For Starbucks, as for all of the 2018 Teddy Award winners, the approach is netting measurable results. With higher partner satisfaction, it has seen a 50 percent decrease in litigation.

Teddy winner Main Line Health (MLH) adopted worker advocacy in a way that goes far beyond claims.

Employees who identify and report safety hazards can take credit for their actions by sending out a formal “Employee Safety Message” to nearly 11,000 mailboxes across the organization.

“The recognition is pretty cool,” said Steve Besack, system director, claims management and workers’ compensation for the health system.

MLH also takes a non-adversarial approach to workers with repeat injuries, seeing them as a resource for identifying areas of improvement.

“When you look at ‘repeat offenders’ in an unconventional way, they’re a great asset to the program, not a liability,” said Mike Miller, manager, workers’ compensation and employee safety for MLH.

Teddy winner Monmouth County, N.J. utilizes high-tech motion capture technology to reduce the chance of placing new hires in jobs that are likely to hurt them.

Monmouth County also adopted numerous wellness initiatives that help workers manage their weight and improve their wellbeing overall.

“You should see the looks on their faces when their cholesterol is down, they’ve lost weight and their blood sugar is better. We’ve had people lose 30 and 40 pounds,” said William McGuane, the county’s manager of benefits and workers’ compensation.

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Do these sound like minor program elements? The math says otherwise: Claims severity has plunged from $5.5 million in 2009 to $1.3 million in 2017.

At the University of Pennsylvania, putting workers first means getting out from behind the desk and finding out what each one of them is tasked with, day in, day out — and looking for ways to make each of those tasks safer.

Regular observations across the sprawling campus have resulted in a phenomenal number of process and equipment changes that seem simple on their own, but in combination have created a substantially safer, healthier campus and improved employee morale.

UPenn’s workers’ comp costs, in the seven-digit figures in 2009, have been virtually cut in half.

Risk & Insurance® is proud to honor the work of these four organizations. We hope their stories inspire other organizations to be true partners with the employees they depend on. &

Michelle Kerr is associate editor of Risk & Insurance. She can be reached at [email protected]