The Growth in Telemedicine – Its Potential Impact on Workers’ Compensation Claimants

“Telemedicine” is defined by Arizona statutes as:

“the practice of health care delivery, diagnosis, consultation and treatment and the transfer of medical data through interactive audio, video or data communications that occur in the physical presence of the patient, including audio or video communications sent to a health care provider for diagnostic or treatment consultation.”

Not surprisingly, in the United States, telemedicine has found its greatest acceptance in the less densely populated states of the west and southwest, including the Grand Canyon State. Patients in those regions often must travel significant distances to obtain in-person care. Arizona, the nation’s sixth largest state in land area, remains among the least densely populated, with an average of only 56 people per square mile.

Combined with its relatively low physician-patient ratio of about 225 doctors per 100,000 residents, it is perhaps not surprising then that Arizona generally has been in the forefront of efforts to gain greater acceptance of telemedicine as a legitimate diagnostic tool. In the mid-1990s, the state legislature and the University of Arizona established the Arizona Telemedicine Program, which currently provides medical services in twenty rural communities.

Relevance to Work-Related Injuries and Illnesses

Many injured workers find it difficult to travel any significant distance to attend a required periodic physician evaluation appointment. This may be due to the nature of the injury itself or to practical issues such as a lack of reliable transportation. Whatever the cause, however, the unfortunate result is often a missed appointment. If repeated, this can be the basis for suspension or even termination of benefits.

While telemedicine holds the promise of more convenient, less stressful treatment and evaluation options for some claimants, at least two significant changes to Arizona’s workers’ compensation law will be required for this to become reality.

First, the periodic evaluation provision of the Arizona workers’ compensation law must be amended to permit, in appropriate cases, evaluations to be conducted by video consultation. At present, the statute requires travel, albeit to a “reasonably convenient” evaluation site. It seems clear that a policy that permits the use of video consultations could in many cases be a more humane and efficient option. This change will not happen without explicit authorization in the statute, however.

Second, while workers’ compensation insurers must typically pay a claimant’s “reasonable and necessary” medical expenses, at present only private group disability and blanket disability insurers are required by law to pay for otherwise covered treatments delivered through telemedicine. The extension of this requirement to workers compensation insurers, which would likely also require legislative action, would require those insurers to pay for appropriate medical treatment of claimants, whether delivered in person or via a telemedicine consultation.

The Insurance Carriers’ Stake

The growing acceptance of telemedicine is undoubtedly driven in part by consumer demand, but insurers are also beginning to recognize its potential for increasing efficiency and reducing healthcare delivery costs. However, studies among employers whose group health insurance plans cover employees’ medical treatment via telemedicine show that the average per-visit cost savings are nearly $250.00.