The onset of the COVID-19 pandemic brought a sudden increase in the adoption and use of telehealth for injured worker visits. Before March, telehealth visits represented less than one percent of the evaluation and management (E/M) visits billed to Pinnacol for insured workers’ care. In April, telehealth surged to 22 percent of the billed E/M visits and stayed above 10 percent through May. However, by August, the frequency had dropped back to pre-pandemic levels, representing less than one percent of the billed visits again.
Despite the drop-off in utilization, 86 percent of the providers responding in a June 2020 Pinnacol survey stated they were still offering telehealth in their practices. Although patients were requesting telehealth visits less often for on-the-job injuries, providers reported that simply having telehealth available reduced the exposure risk for patients and allowed them to maintain their relationship and care instead of postponing visits.
Most respondents reported improved patient satisfaction and compliance with keeping scheduled appointments when utilizing telehealth. Patients were reported to be progressing; specifically, home therapy exercises were going well. Test results were easily communicated, and patients were getting more familiar with the technology over time. Some providers noted the value of seeing the patient’s home environment.
In an August presentation, Professionals in Workers’ Compensation, Paul Ogden, MD, chief medical officer for WorkWell, said video visits helped protect workers and staff, with about half their visits still being conducted remotely.
On the con side, technology challenges were noted as the main concern. Some patients were either reluctant to devote time to understanding the process or trying a virtual visit, while slow or poor connectivity limited the success of the interaction. Other providers reported visits took more time, as they needed to train patients to use the technology. Troubleshooting the equipment often took more skill and time than was allotted for the visit. Others reported some patients didn’t have high-speed internet access, wireless data plans, or smartphones.
As expected, providers reported 70 percent of the virtual visits were for follow-up care. Many providers stated they would prefer hands-on initial evaluation visits.
Also, as expected, some services, such as wound care, treatment of complicated injuries, massage, acupuncture, and chiropractic manipulation, could not be provided in a virtual setting. Providers also reported that impairment ratings, independent medical exams and some maximum medical improvement assessments are very challenging to complete in a virtual environment.
Providers who have implemented telehealth were generally satisfied that telehealth met the needs of their patients and practices when used appropriately. As with virtual group health visits, the cost and outcome benefits are still undetermined and although telehealth has some limitations, providers reported telehealth will likely continue to be offered as an option as it has worked well for patients and staff so far.