Telemedicine in the Texas workers’ compensation system has been a long time coming. Twenty years ago, the Texas Research and Oversight Council on Workers’ Compensation (ROC) published a report on the potential of telemedicine in the system1 . The ROC report pointed out that the long-distance delivery of health care via telecommunications could speed up injury diagnoses and treatment, facilitate the rapid transfer of medical documentation, reduce costs, and increase injured-employee satisfaction with medical services and outcomes.
The ROC study further recognized at the time that widespread implementation of telemedicine would be delayed until the day this new concept received legislative acceptance, and until communication technology adequately addressed concerns for security, privacy and confidentiality.
That day has arrived!
In 2017, the Texas Legislature passed a comprehensive bill removing certain limitations for telemedicine, and in 2018, the Division of Workers’ Compensation (DWC) passed rules allowing for billing and reimbursement of specific telemedicine and telehealth services in workers’ compensation, regardless of their geographic location. Also, telecommunication devices today can deliver highly secure real-time communications between medical professionals and patients.
Medical doctors and workers’ compensation health care networks are now aligning their medical delivery pathways to make telemedicine a functional reality in Texas. RediMD is one such group of medical doctors already successfully providing primary-care medical services with live telemedicine technology. On December 1, 2019, RediMD, teamed up with the workers’ compensation health care network Injury Management Organization Inc. (IMO) to deliver telemedicine diagnoses and services from treating doctors to injured employees without the employees having to leave their homes or workplaces.
The process is straight forward. When an employee is injured, the employee reports the injury to the supervisor or employer, then calls a designated toll-free phone number for immediate attention, with bilingual services available. RediMD staff schedules the injured employee’s appointment, collects demographic information, and begins the process seamlessly.
This joint program, coined IMO Telemed, allows an injured employee to see and speak interactively with a medical professional through any device that has a web cam and internet connection such as a smart phone, laptop computer, desk top computer, I-Pad or tablet. This method allows prompt diagnosis and early services for most of the injuries in workers’ compensation, such as low back soft-tissue injuries, sprains, and strains, but not for others such as major lacerations or those needing emergency services. However, RediMD can also triage and determine if the injury is one their doctors can treat or if they must refer the injured employee to an urgent care or emergency room for treatment.
Most telemedicine appointments with RediMD doctors average 15-20 minutes, during which the medical doctor can diagnose the injury and prescribe an immediate medical course-of-action. This could be any combination of referrals for diagnostics (X-ray, MRI, etc.), referrals for specialists, or prescriptions for non-narcotic medications at a convenient and appropriate pharmacy. If a specialist is necessary, the RediMD doctor will refer the injured employee to one within the IMO Med-Select Network. The RediMD doctor will then schedule follow-up appointments as required. In addition to the delivery of medical services, the IMO Med-Select Telemed program and RediMD doctors use telemedicine communications to provide rapid and secure transfer of necessary documents and forms, such as DWC-73’s, often within an hour via fax, e-mail or by portal access.
In the IMO Med-Select Telemed program, RediMD doctors are available for real-time consultation 24 hours seven days a week and offer bilingual services. These doctors report that their telemedicine services improve recovery and lower medical costs. Since their medical remedies are typically delivered within hours after the injury, most injured employees with nonemergency low-back injuries can receive instructions and prescriptions the same day of the injury, and experience full recovery after an average of just three telemedicine appointments.
In contrast, employees who rely on office visits for these types of injuries may wait an average of four to five days for their first appointment.2 The resulting inactivity and delay can aggravate the injury, prolong recovery, and require as many as 20 office visits, with additional services such as physical therapy to treat and monitor the patient’s progress. Not surprisingly, RediMD’s telemedicine patients report higher levels of satisfaction as well.
The goal of the IMO Med-Select Telemed program with RediMD is to facilitate early treatment, lower claim costs, increase return to work rates, and improve injured-employee satisfaction with care. At the end of each appointment, telemedicine software can immediately send a brief survey to the injured employee for feedback on ways to improve services and satisfaction.
Insurance Journal also argues in favor of telemedicine. In its article, Telemedicine Takes Workers’ Compensation into the Future, the journal notes that “With telemedicine, the worker has immediate access to care and therefore the healing process can begin more quickly than if the treatment is extended due to wait times or distance concerns.”3 The article also says, “The worker gets better so much quicker and that ultimately drives down the cost of their medical care”.
Telemedicine also has an unexpected benefit. It is ideal for injured employees who are reluctant to visit clinics, especially during seasons when their chances of contracting viral infections increase from exposure to other patients. Moreover, telemedicine is a feasible solution for injured employees who live in geographically remote areas with limited availability of high-quality medical care.
Despite the medical and cost advantages that telemedicine provides, DWC’s data collection does not yet indicate widespread use of the available programs. One reason could be incorrect coding of these services. DWC requires that telemedicine services must be coded with a Place of Service code 02 in 24B of the CMS-1500 02/12. Increased and accurate data collection at DWC would improve their ability to actively monitor and research the effectiveness of telemedicine in the Texas workers’ compensation system.
There are strong indications that telemedicine will continue to play an increasingly important role in general health and workers’ compensation care. Besides treating doctors, RediMD’s other specialties, such as orthopedics and infectious disease doctors have also accessed telemedicine to improve care and reduce costs, especially in rural areas. IMO Telemed is also exploring the addition of other specialties that experience shortages in the workers’ compensation system, such as psychiatry and counseling.
Catherine Benavidez, President and CEO of IMO recently announced, “Our industry is beginning to endorse and embrace telemedicine. It is a managed care tool that provides efficiencies, satisfaction of care and cost- effective care. We anticipate additional qualified treating and specialist provider-options within our IMO Med-Select Network – Telemed model in 2020.”
Telemedicine has truly arrived. Companies like IMO and RediMD have successfully embraced telemedicine in workers’ compensation. This innovative medical approach increases early intervention in work-related injuries, reduces recovery duration, improves injured-employee satisfaction, cuts medical costs, and decreases injured-employee exposure to viral contagions in clinics. Telemedicine delivers real advantages. It is here to stay.
1 | Research and Oversight Council on Workers’ Compensation, Telemedicine Applications in the Texas Workers’ Compensation System (February 1998)
2 | Texas Department of Insurance, Research and Evaluation Group, 2018, https://www.tdi.texas.gov/reports/wcreg/documents/accesstc2018.pdf
3 | Jones, Stephanie K. “Telemedicine Takes Workers’ Comp Into the Future.” Insurance Journal, 16 May 2019, www.insurancejournal.com/magazines/mag-coverstory/2019/05/06/525626.htm.