Updated: Jan 5, 2022
Coronavirus and shelter-in-place rules have occurred quickly and turned so much of our society on it’s head, truly, overnight. Many things about how we live and do business have changed; both temporarily and permanently. One example is the increasing opening of minds to telemedicine as an acceptable form of remote care for work comp. In fact, states are clearing the way by changing, eliminating and/or suspending regulations that have limited the availability to remote offerings. This certainly makes sense for certain types of injuries where “hands-on treatment” isn’t necessary and to help avoid further spread of the virus. All of these developments are positive of course. Whenever workers can be seen over telemedicine we can receive faster care and frequently at a lower cost to the employer or insurer. However, as a premium auditor and consultant who works to reduce the cost of work comp program for his clients, I’m always interested in how new developments, like telemedicine, can impact pricing. I have always heard from experts I trust that, legally (I’m not a lawyer), visiting with a doctor over telemedicine is treated the same as visiting the doctor in person. So, that telemedicine appointment should result in a claim. If there’s a doctors visit involved, it should result in at least a medical-only claim even if the doctor prescribes self-care. Claims appear in your Experience Modification Rate and increase future premiums. I think where you have to be careful is developing a knee-jerk reaction to send everyone to telemedicine other than obvious ER situations and obvious band-aid/first-aid situations. One of the problems or complications you could run into, for example, is unnecessarily generating a claim where self-care was the appropriate level of care. Another problem could arise when you generate a claim through a telemedicine visit only to have the doctor recommend a different level of care because an in person, hands-on evaluation is necessary. In the latter case, you just generated the cost of two visits instead of one. Most of you probably know that I’m a huge fan of Injury Triage Services like Medcor for reducing claims, claim costs, and injury duration. In the case of Medcor, you call as soon as you can following an incident and speak with an RN/medical professional. The Medcor nurse triages the claim with a proprietary software system that is based on physician-based protocols; evidence-based medicine. No claim is generated unless the triage properly indicates a doctor referral. If the triage process calls for self-care/first aid, there is no claim. But, if your organization offers telemedicine, Medcor can properly triage an incident directly to the proper level of care; telemedicine, clinic or ER. Thus, no risk of a two doctor visits (telemedicine and then referral on to clinic or ER). Everything is so fluid right now. For example, many of the payroll auditing and classification rules were written having never contemplated what we are going through right now with COVID-19. NCCI is posting guidelines that seem to be changing weekly pending industry feedback and legislative changes in the various states. Telemedicine and work comp is no different. And, I’m really interested in hearing from any of you with experience in this area.
I hope you and your loved ones are healthy and safe.
Best Regards, Stuart
Stuart Cytron, MBA has been published in trade journals such Construction Forum St. Louis and St. Louis Business Journal among others. You can read more about Stuart and how he developed a passion for helping businesses reduce work comp expenses on his website.