Quicker Care With Telemedicine
According to the Association of American Medical Colleges, the U.S. will face a shortage of more than 130,600 physicians by 2025, including both primary care practitioners and specialists.
Part of the shortage is created by the millions of additional patients entering the healthcare system as a result of the Affordable Care Act. But doctors are also aging and retiring faster than new physicians enter the field. Lower reimbursement rates are driving others out of the profession, while fewer residency programs make it harder for potential candidates to become practicing physicians.
“From a workers’ comp standpoint, at that initial time of injury, there’s potential to triage normal severity, less complex claims,” Robert Hall, MD, medical director at Helios.
That poses a particular problem for workers’ compensation insurers and employers, who will have a hard time keeping claims durations short and costs down if there aren’t enough docs to go around.
Telemedicine, while not yet widely used, could be a way to connect patients and physicians faster and trim the cost of care.
“Telemedicine has been around for 20 years,” said Anne Kirby, chief compliance officer and vice president of medical review services at Rising Medical Solutions. “Now there’s been a real resurgence of interest in this area.”
Telephonic and video conferencing between doctors and patients has been used in rural areas where the nearest doctor can be too far away to receive care quickly enough. Now it can be used to reduce the time it takes to see a doctor and cut down on ER and office visits, shortening claim duration and lowering costs.
“From a workers’ comp standpoint, at that initial time of injury, there’s potential to triage normal severity, less complex claims,” said Robert Hall, MD, medical director at Helios. “In situations where someone has a superficial burn or skin wound, a provider who’s distant can look at that remotely and say if they need to be seen more aggressively, if they need certain medications, or if it will heal on its own.”
“Telemedicine would also be good for maintenance of care,” Hall said. “It can help determine if functional capacities are improving, monitor side effects and determine if care is needed from other providers.”
“Telemedicine can also provide access to a high-level physician who (an injured worker) might not normally be able to get an appointment with,” Kirby said.
However, Hall said, telemedicine could potentially increase costs if it leads to doctors calling for more diagnostic tests in lieu of a hands-on physical examination.
“If I’m remotely trying to evaluate a patient and all I’m going on is patient history and what little physical examination I can do over a call, I might be more prone to order an X-ray or CAT scan or MRI,” Hall said. “When we start ordering more tests, we find more abnormalities we need to address.”
And while telemedicine can allow doctors to see more patients in a shorter period of time, there are concerns that lack of in-person interactions could damage quality of care. Patients may feel less comfortable discussing sensitive topics over a phone call, and may not perceive the same level of empathy and compassion from their doctor that they would in person.
Face-to-face care would also be better for more complex, musculoskeletal injuries, which constitute a large portion of workers’ comp claims, according to Hall.
Some workers’ comp organizations are already experimenting with telemedicine.
“We’re actually piloting a program at Rising for our early intervention program,” Kirby said. A treating physician can pull up the company’s software on his computer or device, which offers high definition video services and built-in scheduling function.
WorkCare Inc., a physician-owned and managed occupational health services company, also employs video conferencing between first responders and physicians at the site of an injury, using tools as simple as FaceTime on an iPad.
“The goal is to maintain self-care and avoid unnecessary transport,” said Peter Greaney, MD, WorkCare’s medical director, president and CEO.
CorVel is working on incorporating telemedicine into their programs as well, including a claimant smartphone app, according to CEO Gordon Clemons.
Medicaid and Medicare also have telemedicine initiatives, according to Kirby, which shows that legislative support is generally strong.
“You just have to convince the treating physician that this is a good option for them,” she said. “In workers’ comp, you often have docs who don’t really want to talk with case managers. The good thing [about telemedicine] is that it helps the physician not lose control of the case.”
Some obstacles do remain, however. Jurisdiction and physician licensing largely determine where doctors can serve patients through telemedicine. Doctors may find it too time-consuming and expensive to maintain licenses in multiple states, if that’s what a telemedicine network requires.
Patients may also feel uneasy about not receiving a traditional physical examination. “The biggest drawback is people’s comfort level with it,” Clemons said. “We’re working on things we can control. We’re making it friendlier and integrating it with other forms of interfacing with the patient.”
Developing technology and evolving internet speeds also matter, he said. “We have to look out three years from now and ask what the capabilities and availability of smartphones will be. Will smartphones be good enough to be used as a telemedicine device?”
The best way to advance the use of telemedicine is to diversify it and adapt it to the needs of the provider.
Both video and telephonic conferencing can work in different situations. Some payers may opt for doctors to communicate remotely with paramedics and other first responders, rather than patients. Telemedicine should also be seen as a supplement to – not a replacement for – in-person care.
Medical professionals debate how serious the physician shortage will be, but telemedicine could nevertheless expedite care and ease costs for healthcare providers, workers comp carriers and employers alike.