Telehealth post COVID-19

When COVID-19 struck, the industry's use of telehealth seemed to change overnight. Providers rapidly scaled offerings and states lifted many restrictions to increase access. In some cases, prior in-person visits or established relationships no longer were required for care. New fee schedules were created. Some states eliminated the requirement that remote medical care be conducted over an encrypted software program, allowing sessions over such platforms as Skype, Zoom, and Facetime. Others eased the requirement, temporarily in most cases, that a doctor be licensed in the state he or she is practicing in.

Many herald the expanded use of telehealth in workers' comp as long overdue and champion it as the new normal. The benefits are real - the ability to quickly connect with a medical professional has helped injured workers continue treatment, monitor medical equipment, have a video-based Independent Medical Exam, and accelerate the return to work.

Particularly helpful has been the ability of injured workers to continue physical therapy services, a rapidly growing component of workers comp. One Call, a Jacksonville, Florida-based company that provides physical therapy for injured workers, reported a 650% increase in telephonic rehabilitation referrals during the COVID-19 pandemic. The report notes that telephonic rehab adoption pre-pandemic was "not widely offered by adjustors," considered inferior to traditional in-person PT and injured workers worried that the technology would be difficult to use and treatment less effective. The aging workforce, defined as those 55 and older, represented 35% of recent telerehab adopters.

In many cases, it's the only way to ensure continuity of care during the virus. Workers appreciate the convenience, providers are growing more comfortable with it, and technological advances continue to increase the ability to diagnose, monitor, and treat patients.

Yet, there are challenges. Some workers are not technologically savvy, telemedicine is not a good fit for all injuries and treatments, the rapid proliferation increased the risk of fraud and scams, some doctors are reluctant to clear a worker for return to work without physically examining them, others worry telemedicine physicians can prescribe opioids without an in-person exam, which makes monitoring prescriptions more difficult, and there is limited data on the effectiveness compared to in-person visits.

The current dynamics are likely to stay in place until the virus is controlled. Beyond that, the seismic shift is not inevitable. It will require significant permanent regulatory changes, improved security, enhanced employee awareness, and an evaluation of effectiveness relative to in-person visits. A hybrid-model combining virtual and in-person visits is likely to emerge.

Employers can use this time to strategize with providers and claims adjusters about the future. Possibilities include:

• Determine the types of care needs that can be met virtually
• Understand the security and privacy risks and how providers are protecting your workers
• Know the metrics you want to measure: costs, time to return to work, misdiagnosis, opioid prescriptions, etc.
• Evaluate outcomes of recent cases that shifted to telehealth
• Educating employees about the telehealth offerings and the benefits (convenience, flexibility, shorter wait times)
• Consider adding virtual programs to wellness initiatives