Quicker Care With Telemedicine
According to the Association of American Medical Colleges, the U.S. will face a shortage of more than 130,600 physicians by 2025, including both primary care practitioners and specialists.
Part of the shortage is created by the millions of additional patients entering the healthcare system as a result of the Affordable Care Act. But doctors are also aging and retiring faster than new physicians enter the field. Lower reimbursement rates are driving others out of the profession, while fewer residency programs make it harder for potential candidates to become practicing physicians.
“From a workers’ comp standpoint, at that initial time of injury, there’s potential to triage normal severity, less complex claims,” Robert Hall, MD, medical director at Helios.
That poses a particular problem for workers’ compensation insurers and employers, who will have a hard time keeping claims durations short and costs down if there aren’t enough docs to go around.
Telemedicine, while not yet widely used, could be a way to connect patients and physicians faster and trim the cost of care.
“Telemedicine has been around for 20 years,” said Anne Kirby, chief compliance officer and vice president of medical review services at Rising Medical Solutions. “Now there’s been a real resurgence of interest in this area.”
Telephonic and video conferencing between doctors and patients has been used in rural areas where the nearest doctor can be too far away to receive care quickly enough. Now it can be used to reduce the time it takes to see a doctor and cut down on ER and office visits, shortening claim duration and lowering costs.
“From a workers’ comp standpoint, at that initial time of injury, there’s potential to triage normal severity, less complex claims,” said Robert Hall, MD, medical director at Helios. “In situations where someone has a superficial burn or skin wound, a provider who’s distant can look at that remotely and say if they need to be seen more aggressively, if they need certain medications, or if it will heal on its own.”
“Telemedicine would also be good for maintenance of care,” Hall said. “It can help determine if functional capacities are improving, monitor side effects and determine if care is needed from other providers.”
“Telemedicine can also provide access to a high-level physician who (an injured worker) might not normally be able to get an appointment with,” Kirby said.
However, Hall said, telemedicine could potentially increase costs if it leads to doctors calling for more diagnostic tests in lieu of a hands-on physical examination.
“If I’m remotely trying to evaluate a patient and all I’m going on is patient history and what little physical examination I can do over a call, I might be more prone to order an X-ray or CAT scan or MRI,” Hall said. “When we start ordering more tests, we find more abnormalities we need to address.”
And while telemedicine can allow doctors to see more patients in a shorter period of time, there are concerns that lack of in-person interactions could damage quality of care. Patients may feel less comfortable discussing sensitive topics over a phone call, and may not perceive the same level of empathy and compassion from their doctor that they would in person.
Face-to-face care would also be better for more complex, musculoskeletal injuries, which constitute a large portion of workers’ comp claims, according to Hall.
Some workers’ comp organizations are already experimenting with telemedicine.
“We’re actually piloting a program at Rising for our early intervention program,” Kirby said. A treating physician can pull up the company’s software on his computer or device, which offers high definition video services and built-in scheduling function.
WorkCare Inc., a physician-owned and managed occupational health services company, also employs video conferencing between first responders and physicians at the site of an injury, using tools as simple as FaceTime on an iPad.
“The goal is to maintain self-care and avoid unnecessary transport,” said Peter Greaney, MD, WorkCare’s medical director, president and CEO.
CorVel is working on incorporating telemedicine into their programs as well, including a claimant smartphone app, according to CEO Gordon Clemons.
Medicaid and Medicare also have telemedicine initiatives, according to Kirby, which shows that legislative support is generally strong.
“You just have to convince the treating physician that this is a good option for them,” she said. “In workers’ comp, you often have docs who don’t really want to talk with case managers. The good thing [about telemedicine] is that it helps the physician not lose control of the case.”
Some obstacles do remain, however. Jurisdiction and physician licensing largely determine where doctors can serve patients through telemedicine. Doctors may find it too time-consuming and expensive to maintain licenses in multiple states, if that’s what a telemedicine network requires.
Patients may also feel uneasy about not receiving a traditional physical examination. “The biggest drawback is people’s comfort level with it,” Clemons said. “We’re working on things we can control. We’re making it friendlier and integrating it with other forms of interfacing with the patient.”
Developing technology and evolving internet speeds also matter, he said. “We have to look out three years from now and ask what the capabilities and availability of smartphones will be. Will smartphones be good enough to be used as a telemedicine device?”
The best way to advance the use of telemedicine is to diversify it and adapt it to the needs of the provider.
Both video and telephonic conferencing can work in different situations. Some payers may opt for doctors to communicate remotely with paramedics and other first responders, rather than patients. Telemedicine should also be seen as a supplement to – not a replacement for – in-person care.
Medical professionals debate how serious the physician shortage will be, but telemedicine could nevertheless expedite care and ease costs for healthcare providers, workers comp carriers and employers alike.
5 Tools to Help Risk Managers Before a Cyber Loss
Risk management professionals in health care have to be both paranoid and hyper-diligent because organizations in that sector face threats from multiple fronts that can put them out of business.
Every patient is potentially a plaintiff. Regulators are reviewing a lengthy list of concerns, including employee safety, employment practices, patient safety, patient privacy, facility safety, Medicare billing, environmental impact and tax status.
There have been a myriad of articles outlining the benefits of cyber liability Insurance after a data breach. While most people know that cyber liability insurance pays for claims following a loss, many overlook the benefits for risk managers prior to a breach and even in absence of a data breach.
Here are five pre-breach benefits provided by leading insurers and their partner vendors that may reduce the potential for a breach as well as possibly reduce the damages.
1. Compliance training.
Some insurers provide customized web-portal delivered training to employees regarding the handling of personally identifiable information (PII) and personal health information (PHI).
One way risk managers can improve their organization’s cyber liability risk profile is to train their employees how to properly handle private information. Privacy attorneys will tell you that their discussions with regulators are far more pleasant when they can quickly demonstrate that an honest mistake was made by well-trained employees rather than negligence or indifference.
2. Test your network.
Insurers have partnered with well-known security firms to help assess the strength of an organization’s network security. This shouldn’t be viewed as a threat to the competence of an IT department, but rather an additional assessment that doesn’t deplete an IT budget.
3. Manage risk.
Most insurers offer risk management content from highly specialized vendors on a web portal specifically for the use of the insurance buyer. These portals typically contain sample privacy policies for websites and employee handbooks, data breach examples, loss calculation tools, risk management tips, news articles and claim contact information.
4. Call an expert.
Some insurers will provide access to both legal and IT professionals to ask questions about incidents that may or may not constitute a breach. The lawyers help understand the various state and federal regulations and what needs to be reported.
5. Develop a breach response plan.
Included with the cyber liability insurance policy, risk managers will often find a roadmap of what to expect in the event of a breach. On that list they may find a “breach coach” that coordinates forensic security vendors, law firms, public relations professionals, insurance company claims contacts and more.
Sometimes you get what you pay, but in the case of cyber liability insurance policies, risk managers get an insurance product in addition to a host of services that help lower their risk profile.
When you’re ready to purchase cyber liability insurance, make sure you review the additional service offerings to be sure it includes these additional benefits.
Diversifying Top Management in Workers’ Comp
The panel at the inaugural Women in Workers’ Compensation (WiWC) Forum. From left to right: Eileen Ramallo, Elaine Vega, Nina Smith-Garmon, Nancy Hamlet, Michelle Weatherson, Nanette de la Torre, Danielle Lisenbey.
Across the country, the business community is engaged in a robust conversation about women being under-represented among c-level positions.
Why aren’t more women breaking into upper management roles? Does gender bias still exist? And, perhaps more importantly, what can women and men do to add more diversity to top leadership ranks?
Elaine Vega and Nancy Hamlet, of Healthcare Solutions, the Duluth, Ga.-based health services provider to the workers’ compensation and auto liability/PIP markets, have discussed the issue between themselves many times over the years.
The duo agreed that starting an industry-wide conversation would be an effective start to addressing the challenge. After three years of internal discussions, the inaugural Women in Workers’ Compensation (WiWC) Forum became reality. Judging by the attendance, content and feedback, it was an auspicious, very successful, debut.
Specifically, Healthcare Solutions and LRP Publications teamed up at the National Workers’ compensation and Disability Conference (NWCDC), held Nov. 18-21, 2014 in Las Vegas, to present the first WiWC event focused on the development of women as leaders within the industry. The WiWC debut featured a keynote speaker, a panel discussion and a networking cocktail hour.
“We believe this is just the beginning for the WiWC organization,” said Hamlet, senior vice president of marketing, adding that the event’s main theme was the conversation regarding challenges that still exist for women in the workplace is “current, real … and relevant.”
Originally the forum was allocated a room to hold 150 people. Vega and Hamlet worried about the room being too large, so they asked LRP what the contingency would be to make the room smaller if they couldn’t fill it. They needn’t have worried, as more than 400 women, and some men as well, registered and attended, requiring an even larger room.
“Clearly, the topic is relevant and there was plenty to discuss,” said Vega, senior vice president of account management.
Hamlet explained that WiWC was formed to create an open forum to promote a strong sense of community and support for current and future female leaders in the workers’ compensation industry. Going forward, the WiWC forum will provide insight and ideas with opportunities for members to:
- Engage … with accomplished industry professionals and build lasting relationships.
- Enrich … their knowledge base with tactical insights from speakers and panelists.
- Explore … opportunities and challenges facing women leaders today.
- Encounter … senior executives’ perspectives on leadership.
- Examine … leadership strategies and how to effectively apply the strategies.
- Empower … themselves and others to achieve success and groundbreaking results.
At the inaugural event, keynote speaker Peggy Holtman, co-author of “Leading at the Edge: Leadership Lessons from the Extraordinary Saga of Shackleton’s Antarctic Expedition,” discussed how a seemingly unconnected historical event can offer critical lessons on leadership in the workplace, especially for women looking to move into top executive spots.
After Holtman’s talk, a panel discussion, moderated by Vega, offered the perspectives of five workers’ compensation industry executives on ways in which women can navigate past the glass ceiling. Panelists included Eileen Ramallo , EVP Healthcare Solutions; Danielle Lisenbey, CEO Broadspire; Nanette de la Torre, VP Zenith; Nina Smith-Garmon, EVP Mitchell International; and Michelle Weatherson, Director, Claims Medical and Regulatory Division, State Fund of Calif.
The panelists discussed a wide range of topics related to women in workers’ compensation. For example, one topic focused on the need to take the big risks when it comes to moving past workplace barriers. Other topics included the importance of women in higher positions serving as sponsors and advocates for younger, less experienced women; and the impact of industry consolidation on women’s careers and how to best manage that change. Another topic was how women could best master conflict and emotions in the workplace.
“What’s clear is conflict has to be managed; it will not go away. It will only get worse,” said Healthcare Solutions’ Ramallo. “It then can create other rifts that won’t necessarily be visible immediately, but can have a very large impact. You have to be able to understand what it is early on from another’s perspective, why the situation exists, and then encourage and try to resolve a conflict situation, whatever may be driving it.”
In the wake of the first WiWC Forum, Hamlet noted that while there are countless general reports showing that women have not yet achieved equal representation in top leadership positions in the workplace, studies deal with averages rather than individual stories. And while women must continue to look at the data and work toward closing the gap, hearing from accomplished women in the workers’ compensation industry at NWCDC drove home critical messages on a person level.
Today, Vega and Hamlet are looking to expand WiWC to make it “truly owned” by the industry. For example, they expect to recruit companies interested in becoming sponsors, forming an advisory council, creating a charter and discussing future possibilities for the organization on both the national and regional levels.
“Much remains to be done, but I have confidence that we will come together and make the organization stronger so that it prospers for years to come,” Hamlet said. “After all, it’s clear that our industry is filled with talented women who can make things happen!”
Vega added that WiWC has already received requests to live stream the event in the future, so it will examine the feasibility of that option in an effort to be even more inclusive.
“We have a shared vision for improving opportunities for current and future women leaders in workers’ compensation,” Vega said. “It doesn’t matter our gender or our title, it’s all about supporting the greater vision. As was said several times at the event, this is just the beginning. We hope more women and men will join us in this continued dialogue.”
This article was produced by the R&I Brand Studio, a unit of the advertising department of Risk & Insurance, in collaboration with Healthcare Solutions. The editorial staff of Risk & Insurance had no role in its preparation.