March 13, 2020
Tele-Triage Comes to Workers’ Comp
A new idea in telemedicine, doctor triage, is reducing costs in workers' comp while providing more flexibility for doctors and injured workers.
We are all familiar with the concept of nurse triage to help manage work-related injuries. A new telemedicine concept, doctor triage, takes the idea to the next level.
The telemedicine approach reduces costs, increases flexibility for both doctors and patients and allows for consultations 24 hours a day. Patients speak with board-certified physicians who determine if self-care, emergency room or clinic visits are appropriate and do so more authoritatively than is possible with nurse triage. Early results from our own Doctor Now program find that 99% of the people who were recommended for self-care returned to work without additional treatment. Part of the reason appears to be that, among those who speak with a doctor, self-care recommendations are followed more often.
Doctor triage is part of the growing trend in enhancing telemedicine programs. The number of patients using telemedicine services increased to 7 million in 2018, up from less than 350,000 in 2013. In 2017, about 70% of employers offered telemedicine services as an employee benefit.
Telepresence combined with telemedicine creates saving not just in direct costs for treatment but also in indirect costs. In the U.S., the average total time for a medical visit is 121 minutes, with a minimum travel time of 37 minutes. The average clinic visit is 84 minutes, and the average emergency room visit is two hours, often extending well beyond. Most of the time is not spent with the physician but is spent waiting to see the doctor. By contrast, the average telemedicine visit takes 15 minutes (including wait time); the average time for a doctor triage call is less than 7 minutes.
Adults in the U.S. spent 1.1 billion hours of unnecessary time traveling and waiting for a doctor last year, resulting in additional costs of lost productivity and lost time from work.
Workers’ comp is an area that still remains very much uncharted for telemedicine, and that needs to change. Our young Doctor Now virtual clinic shows the potential. Looking at recent doctor triage sessions: 61% of the calls were for self- care, and 99% of those callers agreed to the self- care and returned to work. Only one person was referred to the emergency room for chest pains. Others were referred to clinics for evaluation and treatment of eye injuries, fractures, lacerations, etc. All received appropriate care, and most returned to work in some capacity.
The tele-triage approach is especially valuable for those who use our electrodiagnostic functional assessment (EFA). Employers use it to screen employees when they join a company, to establish an objective baseline on physical condition and abilities that can be used as the basis for comparison when an injury occurs — the baseline and comparison let everyone see whether a work incident caused dysfunction, and the baseline provides a goal for treatment.
With EFA, a truck driver who feels he or she sustained a back at injury at work could simply pull to the side of the road and call the 24/7 clinic line. If no emergency care is needed, and there is a baseline EFA for the body part in question, the triage doctor can schedule a second EFA, sometimes for the same day. The triage doctor can also recommend self-care.
If there is no baseline EFA and there needs to be an additional evaluation outside of the triage, a virtual clinic evaluation can be arranged, typically within the hour. The individual can be seen while still at work or in the comfort of his or her home.
Virtual clinic visits offer the injured worker specific analysis; treatment often leads to full-duty release within four visits. Virtual clinic evaluations are typically $150 each. Therefore, with simple musculoskeletal disorders (MSD), a full-duty work release can be obtained for under $1,000, with no narcotics prescribed — telemedicine doctors are not allowed to prescribe narcotics. This is truly a good outcome for everyone.
Even in a state where the employer must give the employee a panel of doctors to choose from, the virtual clinic is one option presented to the employee, along with other panel providers. Insurance carriers are embracing this concept and adding the specialized virtual clinic providers to their panel.
New telemedicine services improve outcomes for not only employees but employers. The return-to-work results and cost savings for employers are dramatic, but the outcome for workers is even better: improved quality of life.