One of the questions posed to me when I have discussed the idea of medical travel in workers’ comp is what to do with follow-up care.
In an article this week from Reuters, Andrew Seaman wrote that people may happily, and safely, forgo in-person doctors’ visits after surgery by opting instead for talking with their surgeons by phone or video. Seaman said this was the result of a small study of U.S. veterans.
The study, conducted by researchers in JAMA Surgery, said most patients preferred the virtual visits and that the doctors didn’t miss any infections that popped up after surgery.
Lead author Dr. Michael Vella, of Vanderbilt University Medical Center in Nashville said, “These kinds of methods are really important in the climate we’re in now,”…”So I think anything you can do to save money, see more patients and improve access to care is really important.”
Vella and his colleagues also wrote that there is interest in so-called telehealth to increase access to healthcare while also decreasing the costs associated with traveling to office visits.
Past research has found that telehealth visits may be useful in the treatment of chronic conditions and after surgery, but less is known about patients preferences for these types of visits, they added.
The study team evaluated data collected over several months in 2014 from 23 veterans, Seaman reported, and all but one of them were men, who were seen three times after a simple operation that would require only a night or so in the hospital. One visit was via video, the second was via telephone and the third was an in-person office visit.
The researchers found that no post-operation infections were missed during the video or telephone visits.
Dr. Vella said, “The veterans were very good at describing their wounds,” … “There was one patient who thought they were having problems, we brought them into clinic and there was an infection.”
Overall, the study found that 69 percent of the participants said they preferred a telehealth visit over the traditional in-office visit. Those who preferred the telehealth visit tended to live farther away from the hospital than those who would rather come into the office.
“I think (the study) challenges the paradigm that we need to see all patients back for visits,” Vella said.
Dr. Vella cautioned that the study was small, and they could not say that telehealth visits won’t miss problems. The study also cannot assess how telehealth visits would work for patients who have undergone more complex surgeries, according to Dr. Vella.
An alternative opinion was given by Dr. Sherry Wren, who was not involved in the new study, and also cautioned that not all patient preferences will align with the telehealth model.
“There will be patients who want to be seen, be reassured and want a doctor to check something out,” said Wren, a professor of surgery at the Palo Alto Veterans Affairs Health Care System in California.
Still, she said, many patients will like the option.
“There is a subset of patient that it’s not going to be appropriate for, but I think it’s a great alternative for the vast majority of patients.”
Dr. Vella said future research showing the results of the real-world implementation of telehealth will provide more information on its safety.
“I think it’s just really important that people continue to look at it,” he said.
What does this mean?
It means that when medical travel is ever implemented into workers comp, and that day grows ever closer, after a patient goes home to his/her country, they will still be able to get follow up care from the surgeon who performed the surgery, without having to fly back to the medical travel destination several times.
Will it work for everyone? Both Drs. Vella and Wren indicated that there are people who will not want it, and that there are subsets of patients that it will not be appropriate for, but overall they were both very positive about the future of telehealth visits after surgery.
If it worked for American veterans, it can certainly work for injured workers covered under workers’ comp, Veterans, especially those from our two ill-designed, ill-planned, and ill-conceived wars in Iraq and Afghanistan certainly have wounds more serious than most injured workers would suffer as a result of a work-related injury.
The only thing that stands in the way of introducing telehealth into workers’ comp, with or without medical travel, is what is between the ears of the leaders and “so-called” experts in the industry who have thus far gone and done the same things over and over again, and expect different results.
And you know what that is? Crazy, stupid, ridiculous, without any credibility, and without any traction in logic, which, I suspect is where the stuff between their ears are in.