Telemedicine for Workers' Compensation
View Concentra’s Webinar on Telemedicine for Workers’ Compensation
In this webinar, you will learn about:
- Growing Acceptance and Popularity of Telemedicine
- Telemedicine: Group Health vs. Workers’ Compensation
- Regulatory Perspectives
- How Workers’ Compensation Telemedicine Is Being Used
- Answers to Common Questions About Telemedicine
- Myths and Misconceptions
- Telemedicine’s Benefits
- Key Considerations When Exploring Telemedicine
- About Concentra Telemed®
Ann Schnure, vice president of Concentra Telemed operations
Lisa Figueroa, MD, FACEP, vice president of medical operations, national medical director of health information technology, and national medical director of telemedicine
Ann is Concentra's vice president of telemedicine operations and overseas Concentra Telemed®, a proprietary telemedicine platform designed for work-related injuries. She is a nationally recognized expert with more than 30 years of experience in the workers’ compensation industry. Dr. Figueroa is a Concentra vice president of medical operations and Concentra’s national medical director for both health information technology and telemedicine. She is a board-certified emergency medicine physician with nearly 30 years of experience designing health care software for emergency medicine, urgent care and occupational medicine.
At the conclusion of the presentation, we will have a 10-to-15-minute Q&A session with Ann and Dr. Figueroa. You can submit your questions throughout the presentation to be answered during the Q&A session. We will answer as many questions as possible within the time allowed. A recording of the webinar will be emailed to you after the presentations. You can view it again at your convenience. Ann and Dr. Figueroa, we’re ready to begin.
Hello, everyone. The first thing we’re going to do is briefly go through the agenda of what we're going to cover today. First is: Why telemedicine? Growing acceptance. The difference between group and workers’ compensation telemedicine. What are some common questions? What are some myths? What are some things you as an employer or payor should consider if you're going to launch telemedicine? What are some emerging areas coming to telemedicine? And then we will look at Concentra’s telemedicine product itself and how to launch Concentra. This will be followed by Q&A.
Growing Acceptance and Popularity of Telemedicine
First, let's talk about “why telemedicine?” I tell people there are two things that have driven telemedicine – reasons why the time is right for telemedicine in the work comp case. Those two things are technology (smartphones) and bandwidth. Telemedicine has been around, but those are the two things that have really allowed it to happen. So what's the force driving the need for telemedicine?
Physician shortages. I'm sure we've all heard about counties now and parts of the United States and states that have no clinicians at all. Access to care, for both rural workforces and urban/suburban workforces, with logistics of leaving work, distance, transportation, off duty. We know that with trends, more patients are choosing the convenience of telemedicine. Studies reveal that many visits to emergency departments, urgent care visits, and brick-and-mortar visits to clinicians could be properly handled through telemedicine.
So, “Telemedicine in the Spotlight.” As I briefly said, telemedicine has been around a long time, around 60 years. It started with NASA. There was a need to be able to deliver health care remotely. It has been around with the VA, with a lot of situations by phone, in the shipping areas, etc.
But, like I said, with the smartphones available now and a widespread broadband, it's finally able to be done in a cost-effective way. When telemedicine launched many years ago, there had to be a direct tunnel line between two sides. Usually, there was a very expensive type of kiosk monitor setup that never made the product scalable beyond just a few sites. Telemedicine launched in a big way in group health in the last few years. Most large group health plans now have telemedicine in them. They’re addressing adoption challenges, high patient satisfaction. They’re seeing all kinds of growth in group health. Massive growth happened in group health and telemedicine in the late fall and winter of 2017. National news media, local news, clinicians, and health plans all were telling people there was a massive flu outbreak and to not go to the doctor, to try to use telemedicine, to not infect other people or get the flu by going to the doctor. This caused a huge surge increase in telemedicine visits on the health side.
Workers’ compensation is about 1.8 percent of the spend for total health care in the United States right now, and it is continuing to decline. Usually, the trends start in the health sector first and then workers’ compensation follows. So, for telemedicine, which has been around and offered lots of choices on the health side, workers’ compensation might be the last frontier for these new telemedicine offerings.
So what else has caused telemedicine to really take off? That is, growing acceptance by consumers and regulators. All states in the United States have adopted telemedicine in some form. There is lots and lots of discussion about telemedicine regulations.
If you Google “telemedicine” for any state, you will receive lots of information, primarily about Medicare and Medicaid because of the restrictions around both of those, and what can be treated state-by-state, and what they allow for. You’ll find some information about health care plans. And by the way, none of that applies to workers’ compensation. I'll talk about that. But all states have adopted telemedicine in some form. All states actually accept telemedicine in workers’ compensation now, in some form. We'll talk about what that means a little bit later. So we're right now, with workers’ compensation and telemedicine, with what we call the innovators, moving to where group health is with the early adopters.
So, we're following a typical update model for new innovations that happen. What we're seeing at Concentra since we launched, and that growth we're seeing, and how it's grown, is very typical to all new products that come out on the market.
Telemedicine: Group Health vs. Workers’ Compensation
So, Key Differences. One of the things that really causes confusion for people is getting confused about group health telemedicine versus workers’ compensation telemedicine. There are some important key differences.
Group health has a different relationship with it. Either the self-insured employer on the group health side or their TPA or insurance company contract with a telemedicine vendor, or a couple of them, to use their telemedicine offering. Many of the plans are restrictive. You have to go to one of those providers that they have contracted with to be in-network. As we all know, workers’ compensation does not work that way. You don't have that type of restrictions. There are different of PPOs and MCOs and things like that, which we'll talk about briefly. But there is a relationship between the employee and the patient with the provider in workers’ compensation that is different than in group health.
Group health, if you go to different pharmacy situations, even some really large employers have kiosks for their group health visits, which are great for strep throat, skin rashes, things like that – and are really not a good situation for workers’ compensation.
Also, with group health, some of the kiosks have wearables that can take blood pressure, and things like that. Once again, this is a very different model that really doesn't work well on the workers’ compensation side. So, when telemedicine first launched in the workers’ compensation side, some of the big players on the group health side in telemedicine launched products in workers’ compensation telemedicine. All of them have now left that market. They have all learned that it's such a different model, such a different product with state forms, employers wanting reporting done differently, return to work with work restrictions, and OSHA recordkeeping – all those things that they didn’t have experience with and don’t use on the group health side made the saleability of doing a workers’ compensation model not a good idea, and they all backed out of it.
Also, billing and reimbursement in the workers’ compensation sector is very different. Like I said, on the group health side, these players contracted – a lot of the payers did – with the telemedicine vendors. There were fees for that contract that paid for the telemedicine vendor, implementation charges, things like that. That was all paid upfront.
Again, on the workers’ compensation side, the billing has to be to a claim file or to a HCFA (Health Care Finance Administration) and billed. There's no way for those type of situations to be billed against the claims, and it doesn't work in the workers’ compensation ecosystem. And then, on the group side, it gives you the payer drive with the option, like I said, with a single platform. Some of the plans I've seen actually have two choices now.
And then there's another one that's come out for people who have no insurance or really high- deductible plans. There are some telemedicine offerings out there that only accept a credit card for the visit. They will not bill insurance at all. They’re supplying a product for people who have no insurance or who have really high deductible plans and are just going to be paying for health services out-of-pocket or out of a Health Savings Account (HSA) or Flexible Spending Account (FSA).
There are literally probably 200-plus telemedicine providers for these types of visits in the group health space. If you add all of the group health people that are doing some type of telemedicine, you would be in the thousands. What are the similarities of group health and workers’ compensation telemedicine? First, very similar experiences. Patients who choose to use telemedicine really like the experience. Both sides are seeing very high satisfaction rates. Also, both sides have learnings that are the same – and that is that there needs to be a robust communication and rollout to really get adoption of the product out there. If you want people to use it, you have to do some type of education and implementation and rollout to actually have any level of volume of visits.
So, Telemedicine Going Mainstream. What do the statistics tell us is going to happen with telemedicine and where we are? By the way, if you can see on the bottom, these statistics are mainly from 2017. And this has only just grown. Over 75 percent of health delivery organizations use or plan to use telemedicine in the future. Almost all health organizations, if they don’t already have telemedicine, they are studying it and figuring out how to use it in their system and with the type of care they deliver. And then, 54 percent of workers’ compensation professionals surveyed say telehealth and telemedicine is a useful tool in containing health care costs.
And then 80 percent of large employers use telemedicine and telehealth as two elements in their health plan, and that’s expected to jump to over 90 percent for 2019.
So like I said, it has gone mainstream. It is very common on the healthcare side. In fact, there's some plans health plans out there now that give people a certain number of telemedicine visits per year, a high-deductible plans like that. There are some really interesting things being offered out there in telemedicine on the health side. It really has started to become a mainstream product and not just the shiny new penny on the health side where it's just going to be part of all the ways health care is delivered.
What does it mean for workers’ compensation? I briefly touched on (the fact) that there’s been a lot of regulatory work on telemedicine for workers’ compensation. There are two groups. In fact, there's a group that called CTel (Center for Telehealth and e-Health Law) and (another group) the Center for Connected Health Policy (CCHP). These are lobbying groups that work on making progress with state regulations and telemedicine for payments. health plans accepting telemedicine, working on Medicare rules, licensing, things like that.
So workers’ compensation has two organizations that they have to, as a provider in the workers’ compensation space, pay attention to (in order) to make sure that you can do telemedicine. First is, every single date has a medical board and licensing requirements and has requirements on telemedicine and licensing.
So in all 50 states except, for now, Florida, if you are delivering telemedicine in that state, if the patient is there, the clinician needs to have a license (a medical license) in that state, so that you start with globally from that state. Then, you look at the state's global telemedicine rules and the rules and regulations they have even before you get to the workers’ compensation rules from the medical board. Texas was one of the most famous ones because the Texas Medical Board was not allowing first-visit telemedicine in their state.
They got sued by one of the largest health care deliverers of telemedicine. They settled and actually reversed their rules on that. Texas was one of the last states to change that. So, when you go to the workers’ compensation regulations in every state – and every state has different rules on that – there are states, such as the state of Washington. It’s one of the most restrictive laws in the United States about telemedicine and what can be done in the workers’ compensation arena.
There are some states that have no regulations at all, on workers’ compensation at all. There are no regulations and basically there’s nothing prohibiting telemedicine. So, there are all of these kinds of things that have to be considered, state-by-state. For example, in the state of Nevada, where the first report of injury when you see a doctor has to be “wet signatured” by the patient. That's why as Nevada is not a good state to be doing the first visit injury-wise because you can't get a wet signature from the patient on a telemedicine visit. There’s lots of work going on.
Regulatory activity going on. It is a lot. In any state, if there are not regulations now, that doesn’t mean there won’t be regulations coming out shortly because the state might be working on them. There are several states that, in the workers’ compensation arena, have working groups – Tennessee, Oregon, Georgia, Colorado – that are working on regulations with working groups right now.
How Workers’ Compensation Telemedicine Is Being Used
So, what are some workers’ comp telemedicine options?
Key considerations are: occupational medicine versus generalist; single visit versus continuity of care; phone versus video. There are all kinds of different ways that telemedicine is being used. There is a triage-only option. That is where triage is done via telemedicine and maybe phone or video. By the way, several of the workers’ compensation regulation in states that have weighed in on telemedicine say it has to be done only by video. It cannot be done by phone. A big we hell I'm going at this point. I am so sorry has a key considerations and there's all kinds of ways different ways that telemedicine is being used. There's a triage only option and that is where triage is done versus via telemedicine and baby phone or video by the way several of the work, huh?
By the way, several of the workers’ compensation regulation in states that have weighed in on telemedicine say it has to be done only by video. It cannot be done by phone. A big word of caution: most of the states that are working on regulations are all going to be requiring that it be done using video.
So, a phone visit for a telemedicine visit isn't going to be accepted in many states. There are lots of models out there where they're (using telemedicine) doing rechecks only, and that means the patient is seen in the bricks and mortar (setting) and, at some point, their care is moved to telemedicine, to video. Then there is a one-and-done model, usually done by a generalist, which is kind of like urgent care, where they don’t do any follow-up care in telemedicine. They would be facing the patient only on the first visit, no continuity of care. Then, there’s a comprehensive model where there are occupational medicine experts. The employer can begin their care and stay in telemedicine for the right use case and the right injury. The video visit can be done for their full treatment plan. This is the model Concentra offers.
Now I will hand it over to Dr. Figueroa.
Dr. Lisa Figueroa - Answers to Common Questions About Telemedicine
Let’s talk about common questions. Ann and I do lots of presentations around the country.
Some of the more frequently asked questions are:
What can be treated via workers’ compensation telemedicine? I’ll go into detail on that answer here shortly.
Can an adequate evaluation be made via video? The answer is, absolutely, yes. The interaction between the patient and the clinician via video allows the clinician to get a detailed history from the patient, mechanism of injury, and also to do a comprehensive video examination. So, the patient is mobile. The device is mobile.
So whether it's a smartphone or tablet or it's a detachable camera on a monitor, the patient can take that camera directly to the area of injury. The clinician can ask the patient to perform range of motion exercises. They can ask them to do strength testing because they're mobile. If there are lower extremity injuries or back injuries, they can follow the patient and watch their gate.
So, absolutely, an adequate evaluation can be done via video.
Back to our Common Questions: What happens if additional visits are required? Ann had mentioned that many visits that start in telemedicine will continue in telemedicine. Now, we know that not all visits are appropriate for telemedicine or, I should say, not all injuries are appropriate for telemedicine. But for those that are, typically we start the visit in telemedicine and, if additional visits are required, we schedule that patient to return to telemedicine for recheck.
If the patient’s condition is not appropriate for telemedicine, and the patient is there with the clinician on a telemedicine visit, the clinician rightly so and appropriately so will refer the patient for in-person care. So, whenever there's a question or concern that that injury is not appropriate for telemedicine, the clinician will send the patient or refer the patient for an in-person evaluation.
More Common Questions.
First: How secure is telemedicine for injury care? Very secure, as long as you're using HIPAA-compliant software for that video interaction. With the patient and clinician interaction, you cannot use FaceTime or any other applications that are not HIPAA-compliant.
Next: Is there any legal risk involved? The very brief answer to this is the legal risk is the same as it would be for an in-center evaluation. So, clinicians follow the standard of care in telemedicine as they would in a bricks-and-mortar facility. The legal risk is the same for both.
Question: Is it easy to implement? Yes. It's easy to implement. It’s important to make sure you have the right people in place – we’ll go through this in more details – and education and communication throughout the organization. That’s both on the employer’s side and with your telemedicine vendor.
Question: Will employees use it and like it? History has told us that the answer to that question is absolutely yes. Thousands and thousands of (telemedicine) visits/workers comp injury cases tell us that employees will use it. Our rating system within our current Concentra Telemed solution allows us to look at patient satisfaction scores we received. They absolutely like it.
Final question: Will it save me money? So, this is the employer asking the question, right? I would say the answer to this question is, if the patient joins a telemedicine solution to see a clinician timely. A lot of patients that get injured at work often wait until a convenient time to see a clinician – not always, but often. If a patient sees a clinician in telemedicine timely; if they are compliant with recheck visits; if they follow the protocols and the treatment plan that the clinicians has asked them to follow, then the case duration will be shorter, and that’s where your money savings comes in.
Myths and Misconceptions
Now, let’s look at some of telemedicine’s myths and misconceptions. We’ve heard a lot of this out on the road. Lots of questions asked of us.
First: Is telemedicine only used for triage or first aid? The answer is no. In telemedicine, we can see the entire injury case if it's an appropriate visit. It is certainly beyond first aid. So, we have medical clinicians – physicians – treating patients and certainly beyond first-day cases. We’ll talk about those that are appropriate in just a few moments.
Second: I already mentioned that a thorough physical exam is possible via telemedicine. We get a lot of questions regarding whether a telemedicine exam is a comprehensive exam, and the answer is yes. Now, certainly we don't have the ability to do comprehensive neurological examinations with all of the cranial nerves tested. Nor can we do a thorough eye examination, but those are the not appropriate for telemedicine.
Third: The primary benefit of telemedicine is to address after-hours care. That is a myth and misconception because there are opportunities 24/7, 365 days a year for these patients to be seen. So, when they're injured, they can join telemedicine and be seen.
Fourth: Following an after-hours telemedicine visit, the employee should be transferred to a bricks-and-mortar facility. That is incorrect, and I have mentioned those cases where they're seen initially and then transferred to a brick-and-mortar facility. Again, entire cases can be seen using telemedicine. So, after hours, if the patient is seen via telemedicine, we will schedule that patient for a telemedicine recheck, when appropriate.
Fifth, and finally: Telemedicine can't be used to treat the entire sport injury case. I have mentioned several times that it absolutely can (be used to treat an entire injury case).
Next, we’ll talk about Frequently Cited Benefits. We've heard many of these in lots of telemedicine presentations and in the literature.
First is access and convenience. So, it's getting that patient the needed injury care and being sent by a clinician timely. So, within minutes to hours of the injury happening – more likely not minutes, but hours after the injury has happened – and especially in remote locations or after hours.
It says especially in those areas (remote locations). Yes, but again, urban areas also have access and convenience challenges. There are issues with traffic or no transportation. So, yes – especially in remote locations, but certainly urban locations have access and convenience concerns during those times as well.
Second, employees can receive care at the workplace, at home, or on the road. This is a huge value add for the person. They don't have to travel to a center, wait in the waiting room, wait to be seen by the clinician then, after the clinician has seen them, be checked out of the facility and drive back to the workplace. They can their telemedicine visits at work, at home or on the road, and without any need to arrange transportation.
Now let’s talk about Costs. We talked about reduced case duration – the fewer emergency department or in-person urgent care visits. That's really applicable for after hours.
When a telemedicine-appropriate injury is seen after hours, there’s no need for an emergency department or urgent care visit, and that improves productivity because we keep the patient at work for as long as possible.
Key Considerations When Exploring Telemedicine
Tech/equipment. When you're considering a telemedicine solution, make sure that you review the technology and equipment to ensure:
- It’s HIPAA-compliant
- You have access to video and audio
- It supports the workflows that are important to your organization
- Your injury care-specific workflows support electronic medical records (EMR)
- There’s actionable reporting so that you are able to give information back to the employers regarding outcomes and patient satisfaction and
- Accessibility is 24/7 and 365 days a year
Experience of the provider. The experience of the provider is extremely important. We're talking about occupational medicine. We're talking about workers’ compensation injury care. We need clinicians who understand:
- Occupational medicine and the way to practice injury care medicine and occupational medicine
- OSHA recordability (Occupational Health and Safety Administration)
- Return to work
- Communication to the employer is critical with these injuries
We need clinicians who:
- Embrace telemedicine and technology
- Utilizes the same electronic health record across the network for continuity of care
- Confirm in-network participation with the payor. That’s very important.
Workflow. We talk about workflows internally within the telemedicine workspace. But, we’re also concerned with the workflows at the employer location. When an employee gets injured, what are the workflows that they follow? How does that first report of injury happen? How does the patient get to telemedicine to be seen for their injuries? So, you have defined workflows, and those are followed.
Communication. Once the injury visit is complete, the employee needs to have clear instructions on return to work and their activity status information.
They also need to understand when they are scheduled to be seen and how to follow their home exercise program.
We need to make sure that we notify the employers immediately on the patient's activity status and their return to work. Also, the TPA/payor/managed care need to receive timely clinical information to support that the continuum of care and claims management.
So, just like we would in a center for injury care, all of these communications need to be timely and to take into consideration that the employers as well as the payors need all of the specific information for that particular injury case for that patient.
Focused Implementation Enables Uptake. So when you're implementing a telemedicine solution, you need to make sure that there is pre-planning. Ann will speak to this in more detail. Pre-planning includes choosing that telemedicine provider and ensuring the occupational health experience. I mentioned how important it is for the clinician to understand occupational health space, and that they understand state regulations and practices.
Pre-planning. In this phase, you want to make sure that you understand whether there are fees associated with the injury care visits, whether there are equipment technology fees and what the fees are for that specific visit. You want to understand the equipment needs and provide a private space for the patient. That's extremely important. If you are implementing a solution, and you have that employee have their telemedicine care at the workplace, they must have a private space. Space is determined by the patient, so if they say they are in a private place, that’s the primary criterion. The patient has to feel they are in their own private space.
Education. Identify and engage advocates within your organization, but make sure you have the right people involved in the initiative. Leverage existing processes and workflows. There's usually no need to redesign a workflow and redesign any processes. It is usually very easy to follow your current processes and just institute a telemedicine solution with those workflows and processes in mind. Obviously, we need to make sure that the telemedicine workflows and processes are explained to stakeholders.
Build Awareness. So you have your telemedicine solution to place. You get your buy-in from your leadership. You promote the offerings to the employees. Make sure they understand that they can receive their injury care with telemedicine and exactly the process they need to follow in order to do that.
Patient Experience. Make sure the patient experience is a good one. That's absolutely paramount with telemedicine. You need to ensure a user-friendly approach so that the software is easy to access and there's a streamlined, integrated process. The patient needs to understand exactly what they need to do to join a telemedicine encounter to get their injury care.
Monitoring and Reporting. Monitoring and reporting also are extremely important as you institute and implement the telemedicine solution. How is it going? How are the patient's feeling about their experience with telemedicine? How are the outcomes? All of that is extremely important when you're implementing the telemedicine solution.
Emerging Areas in Telemedicine.
Wearables. We have mentioned wearables. Wearables really are looking at solutions that are non-invasive alternatives for continuous 24-hour monitoring of health activity, mobility, and so forth.
Peripherals. Peripherals are a little bit different. Peripherals are the opportunity to connect via your software for telemedicine stethoscope and otoscope, being able to examine the patient with these peripheral units that allow for the physician or the clinician to examine certain areas of the body that would not be able to be examined without them.
Additional Use Cases. Additional use cases for telemedicine include behavioral health, which I think is a phenomenal use case for telemedicine and a very fast growing area of telemedicine. Bloodborne pathogen exposure has been tackled in the industry – looking at whether or not it's an appropriate use case for telemedicine – but, in fact, it is a wonderful use case for telemedicine. Concentra Telemed is doing this very successfully to date. and consent of telemedicine doing this successfully. For a very nice use case of telemedicine, consider your bloodborne pathogen exposures. Travel health and post-operative recovery, as well as specialist utilizing telemedicine for their care, as well.
About Concentra Telemed
We've been talking a lot about telemedicine in general. Concentra Telemed is an application that an employee would download from the App Store or Google Play and install on their smartphone or tablet. We talked about mobile devices. That application would then give them access to our clinicians, and they would receive their injury care.
The platform can be used for new injuries and injury rechecks. It is an application that is supported 24/7.
So other things we mentioned are:
- Convenience. I’ve talked about this in generalities, but Concentra Telemed is available 24/7, 365 days a year. Injured employees can receive care at work, at home, or on the road. There is no need to arrange transportation or find someone to cover shifts. Wait times are minimal with no interruptions.
- Easy access. We talked about this. They can use a home computer that has a detachable camera. That is also a permissible way to have a telemedicine visit. Our access is nationwide. That is also very important.
- Care quality. We have Concentra clinicians. They are employees who are trained to the Concentra model, so they have occupational medicine experience and training. They understand about OSHA recordables, return to work, and the importance of communication with the employer. These are all aspects of Concentra Telemed.
- Managed claims/costs. Keeping the employees working for better productivity. We manage the claims and the costs. You have fewer emergency department visits. You keep the employees working more quickly. Shorter case durations. Decreased time to first injury care visit as well as compliance with recheck visits so we can decrease those visits. Use Concentra Telemed to manage treatment throughout the life of the claim. That is a huge value-add for telemedicine.
- Security. Security and HIPAA-compliance platform are extremely important. Our platform is HIPAA-compliant. Patient records are stored in the EHR, and not on the video platform. No documentation or patient information is captured on the video platform. It’s all in the electronic health record. And a frequently asked question is: Are video visits recorded? No, they are not.
What Can Be Treated Using Concentra Telemed?
I mentioned this earlier. I was going to talk about what can be treated using Concentra Telemed. We treat initial work-related injuries and illnesses.
If you look at this list, we talk about...
- Grade I and II upper and lower extremity strains and sprains. In lay terms, that equates to relatively minor strains and sprains of the upper and lower extremities. I say relatively minor because some of the minor injuries were misinterpreted, again, as first aid, but we certainly see beyond first aid injuries.
- We do see first-degree burns.
- Back strains and sprains. We absolutely see those. We see those patients that do not have significant limitations. So, if they're in a wheelchair or they’re not able to walk or they have significant pain and limitations in their movement, those are not appropriate for telemedicine.
- Neck strains and sprains are the same as the back.
- We see lots of contusions, and those are contusions without deformity.
- And contact occupational dermatitis. So, this is the landscapers of the world who may come in contact with plants that may cause rashes.
- Tendonitis and repetitive-use injuries. Those are in the shoulders, the wrists, the carpal tunnel syndrome. Those are some examples of repetitive-use injuries.
- And as I mentioned earlier the bloodborne pathogen exposures, an excellent use case for telemedicine. Patient gets exposed. They get an opportunity to speak to a clinician very quickly. They relieve a lot of that anxiety. Patients get their blood work done at an outside facility, and then we see them again to recheck. It is an excellent use case for telemed.
Very quickly, we're going to talk about how to use Concentra Telemed. To get started, the most important thing is that the patient, that is, the injured employee, needs access to a quiet, private place. Privacy is up to the patient to determine if they are in a private place, and it is a requirement. They need equipment: computer, mobile device, iPad, smartphone. It does not have to be theirs because, as Dr. Figueroa explained, we’re not putting information that's going to be downloaded to anybody's device that someone else could read a patient's medical records. So they just need to be able to have a device, and of course an internet connection. They also have to have an email address. It’s part of a logon information when they create a profile. We also ask for a valid photo ID and the signed authorization from the employer. These are all very simple things to do. On mobile, they download an app from the App Store. Ware happy to help we provide.
We are happy to help. We provide 24/7 support and are happy to help anyone who is struggling was downloading an app, filling out the information on the app, etcetera.
On the next slide, we’re going to talk very quickly about employer billing for telemedicine services.
Employer Billing for Telemedicine Services
There’s confusion about this. It’s very straightforward. It comes on a HCFA. It is one line of code for the visit with a 95 modifier. In the location field, a 02 goes there; 02 tells the system that the care was deliver virtually and same as a 95 modifier. A couple of states have already weighed in on the fact that you cannot add a technology fee onto there. It’s not something you can bill on a HCFA. So, if you do use a provider who wants to charge an implementation contract fee or charge for usage of their software, it cannot be put on the medical bill. It has to be paid some other way.
At Concentra, we don't ask for a contract or an implementation fee. We don't charge for a language fee. If we need an interpreter, we provide 283 different languages, if someone doesn't speak English. We also have care coordinators, and we don't charge for the care coordinator, who does the intake as well. The bill looks just like (the bill you get) from bricks-and-mortar, but you will clearly identify it as telemedicine. Plus, it will say that it was a telemedicine center the care was delivered at.
If you're going to use telemedicine, you should expect quality reporting. You should be able to get information on how your telemedicine program is going. You should receive information and an ease of use for the patient and the employer. At Concentra, we have an employer portal. If the employer uses that for bricks-and-mortar, they’re going to receive telemedicine reports exactly the same way. They’re going to look the same, and they're going to utilize them the same.
Of course, a patient can't walk out of a telemedicine visit with paper. So, we're going to email the patient their activity status and the summary of their visit after every single visit. They will get those two reports within minutes after their visit is over.
Where is Concentra Telemed Available?
So, which states accept Concentra Telemed? Concentra currently is live in 38 states.
There are some states we've chosen not to go into because of regulatory issues. There are other states where the population of the state is very low, and we don't currently have bricks-and-mortar. But, we're live in 38 states, which covers 87% of the population of the United States. We're in a big chunk of the United States and happy to discuss any questions with anyone about anything specific state that we are not in. We are 24/7, 365 days a year, so we're open on Christmas and Thanksgiving if someone's injured. For night shift on Thanksgiving, you’re going to hard-pressed to find many places other than Concentra Telemedicine that’s open.
Launching Concentra Telemed at Your Workplace
So, what do you need to do to be successful to launch Concentra Telemedicine? This is the one of the things that we have learned: you need to do some pre-planning to really have a successful program. The big question for an employer is, “Where are my employees going to do their telemedicine visit if they’re going to do it at work?” where am I boys going to do the telemedicine visit if they're going to do it at work? They need to have privacy, like a sick room, an office, a conference room. Every single employer has walked through this and no two have done it exactly the same way. Everybody has had to solve for what works in their workplace.
Then, they're going to have to decide on devices. We've seen employers that have a large population of employees in a single location, like a distribution center warehouse, purchase iPads, used laptops, that type of thing. Where that piece of equipment is going to be used often, they may go ahead and get it set up for telemed. We highly recommend you don't do this if there are only going to be used for a few visits a year because equipment, if it doesn’t get used often and stay on, people will have to spend time taking updates on the computer or the iPad to get it to work.
Then, make sure there's communication, that supervisors know about telemedicine. Safety, whoever that person or group is that your people report their injury to, partner with nurse triage, that there is communication that about the program that is of benefit and why it's a good thing. Like I said before, make sure you partner with all the people involved in the workers’ compensation ecosystem. That is the TPA. There’s triage nurse case manager, etc. Devise an effective way to communicate and do training. We provide all kinds of support. We have all kinds of literature and marketing materials and things that have been customized for the employer. We try to take the work out of it for employer; they can just customize what we have prepared.
Then, make sure that you have an engaged workforce. They know how telemedicine works. They know how Concentra Telemedicine Works. They understand the benefits.
We've seen the utilization of telemedicine jump tremendously when someone's done these things. Then, anytime there's a way to build awareness in any way, do that. Some people have SharePoint portals, do an email blast, anything like that, is always helpful. Concentra has samples to use, so leverage this material. It will help you to encourage utilization.
So with that we wanted to give a little bit of time before they left for any questions at this time.