Disability

VR in Workers’ Comp

Health care researchers and workers’ comp insurers are discovering the versatility in virtual reality as a new tool for treating patients and training workers.
By: | February 20, 2017

Virtual reality is fast becoming a useful new workers’ compensation tool.

Health care researchers are testing novel ways to incorporate VR into patient rehabilitation while workers’ comp insurers are using it to better train adjusters and underwriters.

Areas where the application has promise include catastrophic injuries such as spinal cord injuries, phantom limb pain after amputation, severe pain after burns and rehabilitation.

“The industry is starting to use it,” said Zack Craft, vice president, rehab solutions, at One Call Care Management. “It’s being discussed at almost every rehab center out there.

Zack Craft, vice president, rehab solutions, One Call Care Management

“They see workers’ comp as a good area to test the waters; they see this as a funded source,” he said.

So how does a video image displayed on a large screen or headset help treat catastrophic injuries?

VR may help injured employees cope with pain and regain mobility after serious accidents. VR therapy may improve balance and help with motor learning and mobility. Incorporating video games with the therapy might also keep patients engaged and interested in rehabilitation for longer.

Treatment can be individually designed per patient based on the injury.  Biometrics can measure and adjust to how quickly patients are recovering. The development of the technology, though, is still nascent.

“I think we’re still years away from decent guidelines on which technology to use on certain conditions and for how long and what outcomes we can expect,” said Dr. Robert Goldberg, chief medical officer at Healthesystems.

Doctors tried VR in a study to determine if the technology can help in pain relief while changing bandages on significant burns. Results from the first group of patients were promising.

One of the most exciting potential areas for workers’ compensation payers is the way VR might also be used to replace or reduce opioids in the treatment of pain.

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Opioids are a huge cost for payers. That’s because the drugs are so widely prescribed, are addictive and prescription coverage for them can continue for years without remedy.

It is thought VR can help divert the injured worker’s thoughts away from lingering pain and reduce use of addictive painkillers.

“We’re on the cusp of something almost revolutionary if they can manage chronic pain,” Craft said.

“We need to show that the technology works in a way that makes financial sense.” — Zack Craft, vice president, rehab solutions, One Call Care Management

“When your brain is distracted and immersed into a full-body sensory experience it doesn’t focus on pain,” he added.

VR might also offer improved mirroring, a technique already used to help with phantom limb pain. Again, the VR display distracts the patient from focusing on the nerve-ending pain. That may help to rewire the brain to sense less pain and begin to recognize the missing limb.

Currently, VR is most commonly applied to the care of mental health conditions such as depression, post-traumatic stress disorder, autism and ADHD.

Far from the doctor’s office, VR is already playing a big role in workers’ comp as a training tool for employees, underwriters and adjusters, said Mahendra Nambiar, vice president of global insurance solutions and innovations lead at Capgemini.

“The No. 1 way we see VR used in workers’ comp is from the training space,” Nambiar said.

VR can be used to better train workers, such as a forklift operator, how to do a job more safely and avoid injuries, he said. It can also help the adjuster or underwriter learn to do a more consistent job when conducting a workers’ comp safety assessment.

“The uniformity and quality and inspection goes way higher” when VR is used for training, Nambiar said. VR training is often easier and cheaper than instructor-led teaching, he added.

There’s Promise to the Technology

Healthesystems’ Goldberg said he is hopeful about new uses for treating injured employees.

Dr. Robert Goldberg, chief medical officer, Healthesystems

“There’s promise to this technology,” he said.

Yet, there’s reason for concern.

Last year, the Federal Trade Commission fined the creators of the Lumosity “brain training” programs $2 million for deceiving consumers with marketing claims that their games can help users perform better at work and school, and reduce or delay cognitive impairment associated with age.

“Lumosity preyed on consumers’ fears about age-related cognitive decline, suggesting their games could stave off memory loss, dementia, and even Alzheimer’s disease,” said Jessica Rich, director of the FTC’s Bureau of Consumer Protection in a statement.

“But Lumosity simply did not have the science to back up its ads.”

Virtual reality can best be used as medical treatment when evidence-based care is already established, said Skip Rizzo, the director of medical virtual reality at the Institute for Creative Technologies at the University of Southern California, in Playa Vista, Calif.

For example, mirroring is already proven to help patients with phantom limb pain by using a real mirror. VR is simply a new tool to improve on the proven technique.

One Call is looking at ways to measure different outcomes when using VR, such as quality of life improvements, cost and clinical outcomes. The company is also developing ways to track and develop its own VR data.

“We need to show that the technology works in a way that makes financial sense,” Craft said.

The Cost of the Technology and the Treatment

According to a “2016 Goldman Sachs Global Investment Research Report,” the virtual reality and augmented reality market could reach $80 billion in revenue by 2025. Its use in health care alone could generate $5.1 billion in sales.

“Looking beyond video games, we see real estate, retail and healthcare among the first markets that VR/AR disrupts,” Goldman Sachs said in the report.

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“I think you’ll see it impacting claims this year,” Craft said. “Over the next one to two years I can’t even image where we’ll be with it.”

Goldberg expects workers’ comp payers will probably decide each case individually.

“I don’t think they are going to hold back on new technology scripts,” Craft said.  Some insurers are going to be very willing to approve scripts on VR rather than opioids, he said.

The challenge pertains more to the cost of VR’s technology than its medical value. Carriers will need to understand how to vet VR products, and recurring costs.

The technology may become obsolete more quickly than expected and there are other data costs that may make it difficult for adjusters and case managers to gauge the projected cost of the equipment for each claim.

The good news is that the cost of the VR technology is falling.

“It’s exciting because every day there’s new technology,” Craft said. “It’s no longer in the future; it’s here.” &

Juliann Walsh is a former staff writer at Risk & Insurance. Comments or questions about this article can be addressed to [email protected]

More from Risk & Insurance

More from Risk & Insurance

Risk Scenario

The Betrayal of Elizabeth

In this Risk Scenario, Risk & Insurance explores what might happen in the event a telemedicine or similar home health visit violates a patient's privacy. What consequences await when a young girl's tele visit goes viral?
By: | October 12, 2020
Risk Scenarios are created by Risk & Insurance editors along with leading industry partners. The hypothetical, yet realistic stories, showcase emerging risks that can result in significant losses if not properly addressed.

Disclaimer: The events depicted in this scenario are fictitious. Any similarity to any corporation or person, living or dead, is merely coincidental.

PART ONE: CRACKS IN THE FOUNDATION

Elizabeth Cunningham seemingly had it all. The daughter of two well-established professionals — her father was a personal injury attorney, her mother, also an attorney, had her own estate planning practice — she grew up in a house in Maryland horse country with lots of love and the financial security that can iron out at least some of life’s problems.

Tall, good-looking and talented, Elizabeth was moving through her junior year at the University of Pennsylvania in seemingly good order; check that, very good order, by all appearances.

Her pre-med grades were outstanding. Despite the heavy load of her course work, she’d even managed to place in the Penn Relays in the mile, in the spring of her sophomore season, in May of 2019.

But the winter of 2019/2020 brought challenges, challenges that festered below the surface, known only to her and a couple of close friends.

First came betrayal at the hands of her boyfriend, Tom, right around Thanksgiving. She saw a message pop up on his phone from Rebecca, a young woman she thought was their friend. As it turned out, Rebecca and Tom had been intimate together, and both seemed game to do it again.

Reeling, her holiday mood shattered and her relationship with Tom fractured, Elizabeth was beset by deep feelings of anxiety. As the winter gray became more dense and forbidding, the anxiety grew.

Fed up, she broke up with Tom just after Christmas. What looked like a promising start to 2020 now didn’t feel as joyous.

Right around the end of the year, she plucked a copy of her father’s New York Times from the table in his study. A budding physician, her eyes were drawn to a piece about an outbreak of a highly contagious virus in Wuhan, China.

“Sounds dreadful,” she said to herself.

Within three months, anxiety gnawed at Elizabeth daily as she sat cloistered in her family’s house in Bel Air, Maryland.

It didn’t help matters that her brother, Billy, a high school senior and a constant thorn in her side, was cloistered with her.

She felt like she was suffocating.

One night in early May, feeling shutdown and unable to bring herself to tell her parents about her true condition, Elizabeth reached out to her family physician for help.

Dr. Johnson had been Elizabeth’s doctor for a number of years and, being from a small town, Elizabeth had grown up and gone to school with Dr. Johnson’s son Evan. In fact, back in high school, Evan had asked Elizabeth out once. Not interested, Elizabeth had declined Evan’s advances and did not give this a second thought.

Dr. Johnson’s practice had recently been acquired by a Virginia-based hospital system, Medwell, so when Elizabeth called the office, she was first patched through to Medwell’s receptionist/scheduling service. Within 30 minutes, an online Telehealth consult had been arranged for her to speak directly with Dr. Johnson.

Due to the pandemic, Dr. Johnson called from the office in her home. The doctor was kind. She was practiced.

“So can you tell me what’s going on?” she said.

Elizabeth took a deep breath. She tried to fight what was happening. But she could not. Tears started streaming down her face.

“It’s just… It’s just…” she managed to stammer.

The doctor waited patiently. “It’s okay,” she said. “Just take your time.”

Elizabeth took a deep breath. “It’s like I can’t manage my own mind anymore. It’s nonstop. It won’t turn off…”

More tears streamed down her face.

Patiently, with compassion, the doctor walked Elizabeth through what she might be experiencing. The doctor recommended a follow-up with Medwell’s psychology department.

“Okay,” Elizabeth said, some semblance of relief passing through her.

Unbeknownst to Dr. Johnson, her office door had not been completely closed. During the telehealth call, Evan stopped by his mother’s office to ask her a question. Before knocking he overheard Elizabeth talking and decided to listen in.

PART TWO: BETRAYAL

As Elizabeth was finding the courage to open up to Dr. Johnson about her psychological condition, Evan was recording her with his smartphone through a crack in the doorway.

Spurred by who knows what — his attraction to her, his irritation at being rejected, the idleness of the COVID quarantine — it really didn’t matter. Evan posted his recording of Elizabeth to his Instagram feed.

#CantManageMyMind, #CrazyGirl, #HelpMeDoctorImBeautiful is just some of what followed.

Elizabeth and Evan were both well-liked and very well connected on social media. The posts, shares and reactions that followed Evan’s digital betrayal numbered in the hundreds. Each one of them a knife into the already troubled soul of Elizabeth Cunningham.

By noon of the following day, her well-connected father unleashed the dogs of war.

Rand Davis, the risk manager for the Medwell Health System, a 15-hospital health care company based in Alexandria, Virginia was just finishing lunch when he got a call from the company’s general counsel, Emily Vittorio.

“Yes?” Rand said. He and Emily were accustomed to being quick and blunt with each other. They didn’t have time for much else.

“I just picked up a notice of intent to sue from a personal injury attorney in Bel Air, Maryland. It seems his daughter was in a teleconference with one of our docs. She was experiencing anxiety, the daughter that is. The doctor’s son recorded the call and posted it to social media.”

“Great. Thanks, kid,” Rand said.

“His attorneys want to initiate a discovery dialogue on Monday,” Emily said.

It was Thursday. Rand’s dreams of slipping onto his fishing boat over the weekend evaporated, just like that. He closed his eyes and tilted his face up to the heavens.

Wasn’t it enough that he and the other members of the C-suite fought tooth and nail to keep thousands of people safe and treat them during the COVID-crisis?

He’d watched the explosion in the use of telemedicine with a mixture of awe and alarm. On the one hand, they were saving lives. On the other hand, they were opening themselves to exposures under the Health Insurance Portability and Accountability Act. He just knew it.

He and his colleagues tried to do the right thing. But what they were doing, overwhelmed as they were, was simply not enough.

PART THREE: FALLING DOMINOES

Within the space of two weeks, the torture suffered by Elizabeth Cunningham grew into a class action against Medwell.

In addition to the violation of her privacy, the investigation by Mr. Cunningham’s attorneys revealed the following:

Medwell’s telemedicine component, as needed and well-intended as it was, lacked a viable informed consent protocol.

The consultation with Elizabeth, and as it turned out, hundreds of additional patients in Maryland, Pennsylvania and West Virginia, violated telemedicine regulations in all three states.

Numerous practitioners in the system took part in teleconferences with patients in states in which they were not credentialed to provide that service.

Even if Evan hadn’t cracked open Dr. Johnson’s door and surreptitiously recorded her conversation with Elizabeth, the Medwell telehealth system was found to be insecure — yet another violation of HIPAA.

The amount sought in the class action was $100 million. In an era of social inflation, with jury awards that were once unthinkable becoming commonplace, Medwell was standing squarely in the crosshairs of a liability jury decision that was going to devour entire towers of its insurance program.

Adding another layer of certain pain to the equation was that the case would be heard in Baltimore, a jurisdiction where plaintiffs’ attorneys tended to dance out of courtrooms with millions in their pockets.

That fall, Rand sat with his broker on a call with a specialty insurer, talking about renewals of the group’s general liability, cyber and professional liability programs.

“Yeah, we were kind of hoping to keep the increases on all three at less than 25%,” the broker said breezily.

There was a long silence from the underwriters at the other end of the phone.

“To be honest, we’re borderline about being able to offer you any cover at all,” one of the lead underwriters said.

Rand just sat silently and waited for another shoe to drop.

“Well, what can you do?” the broker said, with hope draining from his voice.

The conversation that followed would propel Rand and his broker on the difficult, next to impossible path of trying to find coverage, with general liability underwriters in full retreat, professional liability underwriters looking for double digit increases and cyber underwriters asking very pointed questions about the health system’s risk management.

Elizabeth, a strong young woman with a good support network, would eventually recover from the damage done to her.

Medwell’s relationships with the insurance markets looked like it almost never would. &

Bar-Lessons-Learned---Partner's-Content-V1b

Risk & Insurance® partnered with Allied World to produce this scenario. Below are Allied World’s recommendations on how to prevent the losses presented in the scenario. This perspective is not an editorial opinion of Risk & Insurance.®.

The use of telehealth has exponentially accelerated with the advent of COVID-19. Few health care providers were prepared for this shift. Health care organizations should confirm that Telehealth coverage is included in their Medical Professional, General Liability and Cyber policies, and to what extent. Concerns around Telehealth focus on HIPAA compliance and the internal policies in place to meet the federal and state standards and best practices for privacy and quality care. As states open businesses and the crisis abates, will pre-COVID-19 telehealth policies and regulations once again be enforced?

Risk Management Considerations:

The same ethical and standard of care issues around caring for patients face-to-face in an office apply in telehealth settings:

  • maintain a strong patient-physician relationship;
  • protect patient privacy; and
  • seek the best possible outcome.

Telehealth can create challenges around “informed consent.” It is critical to inform patients of the potential benefits and risks of telehealth (including privacy and security), ensure the use of HIPAA compliant platforms and make sure there is a good level of understanding of the scope of telehealth. Providers must be aware of the regulatory and licensure requirements in the state where the patient is located, as well as those of the state in which they are licensed.

A professional and private environment should be maintained for patient privacy and confidentiality. Best practices must be in place and followed. Medical professionals who engage in telehealth should be fully trained in operating the technology. Patients must also be instructed in its use and provided instructions on what to do if there are technical difficulties.

This case study is for illustrative purposes only and is not intended to be a summary of, and does not in any way vary, the actual coverage available to a policyholder under any insurance policy. Actual coverage for specific claims will be determined by the actual policy language and will be based on the specific facts and circumstances of the claim. Consult your insurance advisors or legal counsel for guidance on your organization’s policies and coverage matters and other issues specific to your organization.

This information is provided as a general overview for agents and brokers. Coverage will be underwritten by an insurance subsidiary of Allied World Assurance Company Holdings, Ltd, a Fairfax company (“Allied World”). Such subsidiaries currently carry an A.M. Best rating of “A” (Excellent), a Moody’s rating of “A3” (Good) and a Standard & Poor’s rating of “A-” (Strong), as applicable. Coverage is offered only through licensed agents and brokers. Actual coverage may vary and is subject to policy language as issued. Coverage may not be available in all jurisdictions. Risk management services are provided or arranged through AWAC Services Company, a member company of Allied World. © 2020 Allied World Assurance Company Holdings, Ltd. All rights reserved.




Dan Reynolds is editor-in-chief of Risk & Insurance. He can be reached at [email protected]