Tag Archives: Virtual Doctor Visits

Follow-up Visits After Surgery: Telehealth, Medical Travel and Workers’ Comp

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.

The Doctor will see you now….Online

Happy New Year!

Now that the holidays are over, and a new year has begun, I wanted to take some time off from writing until I could find a topic worth writing about. I think I have done that with an article that was published on December 21, 2012 in the Wall Street Journal by Anna Wilde Mathews. Her article entitled, Doctors Move To Webcams, profiled a recent trend in healthcare that, while involved with primary care, could have significant impact on how medical tourism and medical tourism for workers’ compensation will be conducted in the future.

The article discusses virtual doctor visit services, which allow patients to connect with physicians from their homes. Ms. Mathews points out that WellPoint and other insurers such as Aetna and United Health plan to offer or are already offering such services to its employer and individual plans, or to certain employers as in the case of Aetna and United Health. WellPoint’s plan will allow people to consult with physicians on-demand using laptops, tablets and smartphones. A growing number of employers such as Home Depot, Booz & Co. and Westinghouse Electric are moving to include remote consultations to their benefits.

However, such services, Mathews points out, are generating tension with state regulators and doctor groups. They argue, Mathews says, that remote visits make sense when a patient is communicating with their regular doctor, but that care may suffer when patients are connecting with physicians in other cities or states, or countries (emphasis mine). A survey by Mercer, a unit of Marsh & McLennan mentioned in the article, indicates that 15% of very large employers use some form of telemedicine, and another 39% are considering doing so.

In an earlier post, Medical Tourism and Workers’ Compensation: What are the Barriers?, I discussed some of the legal barriers to implementing medical tourism into workers’ compensation, with long-distance communication and the issue of prior face-to-face contact between patient and physician as some of the minor barriers that need to be overcome. A more complete discussion of the barriers to implementing medical tourism into workers’ compensation can be found in my White Paper, Legal Barriers to Implementing International Medical Providers into Medical Provider Networks for Workers’ Compensation.

Mathews quoted Ginny Proestakes, director of health benefits at General Electric, which is testing a virtual-consult service from United Health Group’s Optum for employees in Ohio, and plans to roll it out more broadly this year. “The ability to communicate with a doctor 24/7 via the Internet, without an appointment, at an attractive price point, is very appealing.” Employers and insurers say such services could possibly ease the shortage of primary-care doctors. Ann Boynton, deputy executive officer for health coverage for California’s Public Employees’ Retirement System, said that if it does not drive down the costs, then it isn’t worth it. They started testing a service for phone and online video from Teledoc last year. Teledoc has clashed with regulators in Texas over its service, but Teledoc said that its doctors have performed more than 100,000 consults with no malpractice claims. Teledoc has clients such as Aetna, Blue Shield of CA, and Highmark.

Currently, Mathews indicates, only 13 states allow doctors to establish a relationship with a patient, without an initial in-person visit, according to the Robert J. Waters Center for Telehealth and e-Health Law. What this means for medical tourism in general, and for medical tourism in workers’ compensation, specifically, is until more states allow such visits for primary care, and more insurers offer it under individual and group plans, the barriers I mentioned in my earlier post and my White Paper are still formidable, although minor and must be overcome. Medical tourism facilitators must take this into consideration when they market, plan and sell medical tourism packages to potential patient clients. The doctors themselves, and the hospitals they work at, must also take this into consideration.

For implementing medical tourism into workers’ compensation in the US, one must be aware of state regulations and whether or not virtual doctor visit services will be included in the treatment plan for injured workers. The day when the nurse will say to a patient in the US, that the doctor will see you now, when the doctor is thousands of miles away is still not here, but that day will come.