Telehealth and Workers' Compensation: Benefits and Recovery Outcomes

Topics: Workers' Compensation

Summary: Telehealth options for injured employees have grown in popularity due to the coronavirus pandemic. Learn about the benefits of telehealth in workers’ compensation and how AmTrust has expanded telehealth services during COVID-19.

Telehealth and Workers' Compensation: Benefits and Recovery Outcomes

Defined as the delivery of health care and related services via telecommunication technologies, telehealth is getting the attention of the workers’ compensation industry – from regulators and healthcare providers to employers and insurance carriers.

There is a growing belief that digital health care can offer an ideal platform for companies looking to keep their workforce healthy. A synthesis of digital technology, data and medicine, telehealth has the potential to transform the workers’ compensation industry by providing:
  • Instant assessment of a workplace injury, allowing for immediate triage
  • Efficient, personalized treatment
  • Anytime access to clinical data
  • Remote patient monitoring
  • Time savings by eliminating trips to the emergency room, treatment clinic or doctor’s office
  • Claims specialists with the ability to collaborate with various specialists
  • Better recovery outcomes for injured employees
  • A tremendous opportunity for employers to reduce their healthcare costs

Telehealth: A Promising Tool for Managing Workers’ Compensation Costs & Optimizing Injured Employee Outcomes

Although stakeholders have been slow to adopt it, telehealth has undeniable value, more so during the coronavirus pandemic. According to the presenters at the National Council on Compensation Insurance’s 2019 Annual Issues Symposium, digital healthcare has the chance to be a “game changer” in the work comp industry.

Here are a few statistics to consider:
  • Currently, 76% of U.S. hospitals connect with patients and consulting practitioners via video and other technology, according to the American Hospital Association (AHA).
  • Whether through Medicaid or a private insurance provider, every state in the U.S. offers coverage for telemedicine.
  • Today, 35 states and the District of Columbia have enacted “parity” laws, which generally require health insurers to cover services provided via telehealth the same way they would reimburse for services provided in person, per the AHA. 

Expansion of Telehealth Services During COVID-19

The Workers’ Compensation Research Institute (WCRI) recently released a study that looked at the use of workers’ compensation cost containment strategies such as hospital in-patient and outpatient fee regulations, provider choice and treatment guidelines in all 50 states and three federal workers’ compensation programs as of January 1, 2021. Based on surveys completed by state workers’ compensation authorities, the report found that the use of telehealth has expanded dramatically due to the COVID-19 pandemic. Before 2020, telemedicine for workers’ compensation cases was allowed in less than half of all states. However, the study found that 25 states either added a telemedicine option or expanded their usage for worker’s injuries.

Also, Congress has re-introduced The Temporary Reciprocity to Ensure Access to Treatment (TREAT) Act. The law would allow providers to bypass state and federal licensing requirements during public health emergencies, such as COVID-19 while improving access to care for consumers.

Helping Injured Workers Recover Faster

An important part of the rehabilitation process, telehealth seamlessly connects injured employees with healthcare and rehabilitation services, expediting the recovery process so recovering employees can return to the workplace sooner. Thanks to advancements in telehealth technology, physicians can zero in on a worker’s injury to determine its extent and ultimately the best treatment option.

While telemedicine isn’t a viable option for severe or life-threatening injuries, it makes sense for many common workplace injuries, from strains and sprains to cuts and minor scrapes.

Potential Obstacles of Telemedicine

Incorporating telemedicine into the workplace does present certain challenges such as language and cultural barriers, privacy and cybersecurity concerns, and regulatory and reimbursement issues. While it will not affect spending on catastrophic claims, telehealth can be an invaluable tool for employers managing, more minor workers’ compensation injuries.

When it comes to utilizing telehealth, experts recommend that medical practitioners and claims adjusters strike a balance between telemedicine and in-person care to ensure the best treatment outcome for every injured worker. With the potential to transform the workers’ comp industry, telehealth connects patients, physicians, employers and insurance providers in a way that works for everyone.

AmTrust Adjusts Workers’ Compensation Medical Care for Injured Employees

Employees, who are injured on the job, especially during COVID-19, when visiting a physician in person could put them at risk, now have more options regarding their care and treatment for their work-related injuries. AmTrust is working with our partners to ensure injured employees have access to their providers, medications and treatments, including medical treatment via telemedicine while following safe social distancing guidelines.

Injured employees can search for telemedicine options when looking for approved providers. Telemedicine services are listed as a specialty, and national providers such as Concentra offer telemedicine services in the following states: AK, AZ, CA CO, CT, DE, FL, GA, HI, IA, IL, IN, KS, KY, LA, MA, ME, MD, MI, MN, MO, NC, NE, NH, NJ, NM, OH, OK, OR, PA, RI, SC, TN, TX, UT, VT, VA and WI.

Once the employee is registered, they are connected to a coordinator to process the intake; then, the call is transferred to a clinician. The clinician examines, diagnoses, treats the worker and then transfers them back to the care coordinator for checkout. At checkout, the care coordinator will review any work restrictions and set up any necessary follow-up care, including rechecks. The injured employee will receive paperwork for a visit via a secure email.

Routine or Follow-up Evaluations Telemedicine Appointments

If an injured employee is involved in ongoing treatment, the first step for the injured employee should contact their provider to see how they are currently seeing patients. Injured employees should contact the provider’s office if they are open to confirm the rescheduling process and update their treatment. Providers may conduct telephone screening before confirming appointments and then offer telemedicine solutions to help address treatment needs. The provider offices should have physicians and contact information available to triage the worker’s questions and concerns.

Physical Therapy Telerehab Appointments and Open Claims

Our physical therapy partner, Medrisk, triages all newly injured employees for Telerehab or virtual physical therapy (PT). If this service is appropriate for PT for an injured employee, they will be enrolled to allow their treatment to take place. There will be a review of all open claims assigned for approved PT conducted by our medical resources to identify if patients can be recommended to Telerehab or a home exercise program (HEP).

Availability of Essential Treatment Services

We are also working with our partners to ensure all other essential treatment services, including pharmacy, durable medical equipment, home health, diagnostics, transportation and translation, are available during this time.

What is AmCares®?

AmCares® is a 24/7 nurse line available to injured employees where nurses use nationally recognized triage guidelines to identify the appropriate level of care for an injured employee’s injury:
  • Self-care
  • Telemedicine
  • Occupational Clinic
  • Urgent Care
  • Emergency Room
With AmCares, AmTrust customers can now opt in to have nurse triage as part of their claims program. A customer enrolls in the program by providing AmTrust with their locations and preferred providers. If the customer doesn’t have preferred providers, the nurse utilizes AmTrust’s network directory to identify a best in-network provider.

Nurse Triage Process

  • The injury occurs on the job site
  • Supervisor and/or employee calls the AmCares Nurse Triage phone number with company name and location
  • A Registered Nurse (RN) assesses the injury and identifies the level of care needed
  • The nurse educates the employee on self-care treatment or if needed, directs the employee to the most appropriate level of care
  • An AmCares Injury Report is sent within 30 minutes to the predesignated contacts and AmTrust for First Notice of Loss (if a claim needs to be established)
  • Service includes triage, FNOL, a follow-up call for self-care, and point of care reports for AmTrust and the employer
  • Claims resulting in the filing of a First Notice of Loss with AmTrust will incur a medical charge
  • One phone call addresses nurse triage and claims reporting
  • Nurses speak both English and Spanish, other languages available as needed

Benefits of AmCares

The focus of AmCares is to get injured employees to the right level of care as soon as possible. Policyholders using AmCares generally see an increase in injured employee satisfaction and network utilization, and they may see a reduction in:
  • Medical costs
  • Lost time from work
  • Unnecessary emergency room visits
  • Lag time
  • Case management involvement as claim develops
AmCares is seamlessly incorporated into our claims medical management process. Following nurse triage, our predictive nurse assignment model identifies claims that have a high potential to require medical management. Our nurses proactively partner with the injured employee to set claim expectations and provide medical information and support throughout recovery. The AmCares nurses facilitate and coordinate quality and effective care for our injured employees to ensure a medically appropriate return to work.

AmTrust is Trusted for Workers’ Compensation Insurance

AmTrust has recently hired nurses and pharmacists to interact with injured employees telephonically while working closely with our adjusters to resolve claims in strategic ways. The medical case managers will enhance our commitment to our insureds and their employees. Please contact our claims team or your claims adjuster for further information about medical treatment options during the coronavirus pandemic.

This material is for informational purposes only and is not legal or business advice. Neither AmTrust Financial Services, Inc. nor any of its subsidiaries or affiliates represents or warrants that the information contained herein is appropriate or suitable for any specific business or legal purpose. Readers seeking resolution of specific questions should consult their business and/or legal advisors. Coverages may vary by location. Contact your local RSM for more information.

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