Here’s the rest of my interview with Keith Newton, Concentra CEO. Part 1 is here.
MCM – How has the market reacted to the launch of telemedicine?
Newton – Early adopters are coming on board; like other new services in work comp, everyone wants it then there’s a bit of a lag after initial launch [as the more cautious wait to see what happens]. Most of big players – TPAs and insurers – are [looking at or considering] coming on board. It is much easier to adopt [internet-based medical “visits”] if it is as familiar as possible to all users. Adoption will be faster if there’s less disruption to the normal medical process.
MCM – How will Concentra charge for this service?
Newton – There will be no change to reimbursement, it is based on normal fees for office visits. Payers will see savings in efficiency and time savings for employer. [There may be] Other savings from lower ancillary costs from lower utilization.
MCM – Talk about licensure and regulatory compliance. There’s a lot of movement towards telemedicine in many states, and it seems a lot of confusion about what is allowed, what entity regulates TM, fees, etc.
Newton – There have been some licensure and certification challenges, we have 5 coordinators doing intake for 4 full-time MDs dedicated to this to begin; 2 in CA, 1 in MD, 1 in NV. One example is we have a Maryland physician driving to one of our Washington DC centers to do their Telemedicine work from there…[we’ve done] lots of regulatory compliance work.
State regulations aren’t keeping up with changes in telemedicine. We evaluated this on a state by state basis, every legislative branch has something going on with telemedicine.
MCM – Is this partially a defensive strategy to protect Concentra’s occ medicine business?
Newton – We’ve got to protect our turf a little bit…there could be some cannibalization of own practice, but ultimately we know 1 of 8 workers will access a Concentra practice for injury care – and telemedicine will enable us to add more of those visits without bricks and mortars expansion and the expense of that.
Our goal by the end of the year is 320+ centers and 100 dedicated worksites.
What does this mean for you?
I expect telemedicine is going to be the next big thing – and unlike a lot of the other fads we’ve seen in comp, it will have a major disruptive effect.
We have already had one case wherein the worker didn’t like the WC treatment provided by authorized physician and went to group benefits teledoc and was excused from work for the injury. We are concerned about continuity of care, MCC, the release of information, etc…..noting here so that others are aware of the different aspects involved….
Joe – I always respect your look into the future and the impact it will have on WC (workforce of the future, etc.). However, I am not there yet with Telemedicine.
While Telemedicine is the shiny new penny, what is the real value and impact in WC? The standard office visit and follow-up care are not the issue in WC medical. The cost and utilization of primary care has actually been improving in WC. The real challenge comes from the complex cases – psycho-social and chronic pain issues. I have a hard time seeing where Telemedicine will impact these patients. In addition to patient acceptance (you need to take a close look at the typical WC patient demographics), I can’t see the physicians treating these complex patients being able to use current technology to improve that treatment.
While Telemedicine may find a place in WC medical, I don’t see it having a “major disruptive effect” in WC medical until it can address the complex patients.
Always good to hear from you Ken.
We don’t know where telemedicine will go, but we do know it is going to be significant in all aspects of medical care delivery and management.
couple examples – use telemedicine apps for pharmacists to talk to prescribing doc about opioid-benzo issues, polypharmacy, etc
use TM for therapists to evaluate actual work conditions and wearables remotely monitored to track movement.
a lot of this is about preventing bad care, and quickly addressing potentially problematic issues. TM is really promising.
Ken,
Here in Texas we have 254 counties…35 of these have no doctors in the county. Even when there is a doctor in a rural area, they usually do not have a lot of experience with occupational medicine and many do not accept WC patients. When a patient needs specialty care, it is not uncommon to have to drive 60 or even 100+ miles to a metro areas.
We see telemedicine as an opportunity to expand access to care in under-served area. It might not make any difference to the average injured worker living in a city where medical care is plentiful. But when you step outside that world, you can see where it can be very impactful.
Jennifer,
I agree there will be places were Telemedicine will have an impact on WC and the one you point out is an excellent example of that impact.
However, if you are talking about major cost drivers of WC (Prato’s Law holds) I don’t see it having an impact on those 20%.
I also agree with Joe – there are ways that Telemedicine can improve the effectiveness of the medical services to a broad population but, when it comes to those 20% I still have trouble with the impact for them today.
As the technology advances and the “process” is developed for Telemedicine this may shift my thinking – being able to monitor medication, monitor physical activity and the patients mental state. When we can adapt the technology and process to assist in that aspect of the patients treatment then we can start to see a “major disruptive effect”
As Joe pointed out, you have to start somewhere. I think it will be a while before we get there on those 20%