In this post, we discuss telehealth care for compensation claimants. The decree to stay at home to flatten the curve of COVID-19 has the potential to disrupt the recovery of people injured at work or in transport accidents. But how easy is it for compensation claimants to access telehealth care? And what are the limitations of this mode of care delivery?
Maintaining a rehabilitation program is important
Early intervention combined with active participation in rehabilitation by injured people promotes the best recovery outcomes and facilitates early return to work. Compensation schemes mandate that in return for wage and medical treatment benefits, claimants must attend medical assessments and participate in rehabilitation. If claimants don’t participate they can be at risk of losing benefits.
Better to be at home
For some compensation claimants it is best to stay at home rather go to medical appointments. Travelling to medical assessments can add extra stress and sometimes increased pain for injured people. Concerns about contagion risks will add further worry and stress for claimants, and may even result in people avoiding or deferring necessary treatment. Claimants who decide or are required to stay at home can still access treatment through telehealth consultations.
Telehealth services – involving telephone and/or videoconferencing – are now approved by all Australian compensation schemes. Services available via telehealth include appointments with GPs, physical therapists, psychologists and other allied healthcare providers, as well as case managers.
Not all telehealth services are equal
Most compensation schemes fund telehealth consultations via both video and telephone. However, some schemes such as WorkSafe Qld will fund video and telephone consultations for GPs, medical specialist and psychiatrists, yet only fund video-based consultations for allied health providers. The justification for this difference is not clear. It also means that claimants who do not have tablets or computers, or are not technologically savvy, will miss out on treatment.
Extra steps for compensation claimants to access telehealth
It is not all smooth sailing for compensation claimants wishing to access telehealth services. There are several administrative hurdles to clear first.
The first hurdle for claimants is to find information about how to obtain telehealth services, and which are approved. Telehealth information can sometimes be found on a scheme’s COVID-19 information page, or a ‘frequently asked questions’ page, but on other sites it is more easily located with information targeted to service providers rather than clients. Compensation scheme websites can frustrate searchers by sending them in loops or to external sites without providing the key information.
(Photo by Lindsay Henwood on Unsplash)
Almost all scheme websites direct claimants to seek advice about eligibility for telehealth from their claims managers or healthcare providers, and in some cases from their employers. Most schemes advise claimants that due to COVID-19, offices have restricted access or are closed and to expect delays in getting answers to queries. This is the same for many employers and healthcare providers, which leaves injured claimants facing gaps in information and support.
Beyond identifying potential eligibility, approvals are also required. For example, claimants must provide a current certificate of capacity to ensure ongoing eligibility for wage and medical benefits. Some schemes have acknowledged the additional workload GPs are facing, and have approved extensions to the durations of capacity certificates. While certificates can be obtained via telehealth consultation with GPs, some schemes stipulate claimants must first seek permission from claims managers. For example, in Victoria, people who contract COVID-19 at work will have to contact their agent first to seek approval for the GP telehealth consultation so that they can get a referral for telehealth services. Once this has been obtained the worker then must re-contact the agent to gain approval for the recommended telehealth services. In the NSW workers’ compensation scheme, telehealth services ‘require pre-approval from the insurer and must be consented to by all parties – the worker, practitioner and insurer’.
Additional layers of administration to get approval from claims managers already experiencing high workloads will likely cause disruption in rehabilitation services, adding worry, stress and potential delay in recovery for claimants.
Advantages of telehealth
Major benefits of telehealth services include claimant choice about whether sessions are video or telephone only (except for Worksafe Qld). Better client engagement; reductions in appointment cancellations and late arrivals; self-reporting progress with home exercise programs through apps such as Physitrak, are other reported advantages.
Geographical limitations and travel restrictions from COVID-19 are overcome with the use of telehealth services. The tyranny of distance will remain an issue for compensation claimants and schemes long after the COVID-19 pandemic is controlled and may warrant the ongoing use of telehealth.
Ease of contact between provider and client is both an advantage and disadvantage of telehealth software. There are ethical issues that need to be resolved around the use of chat functions, and clinicians’ duty of care for vulnerable claimants who send texts out of hours and on weekends.
Barriers to telehealth services
Several practical issues interfere with the efficient use of synchronous telehealth services. Access to hardware and available finance to pay for internet data can impact use of telehealth. Given the increase in unemployment and reduction in household incomes since COVID-19 arrived, claimants may no longer be able to use shared resources. Compensation schemes may need to facilitate access for claimants in these circumstances.
User confidence (for both healthcare providers and patients) is another important influence on whether telehealth is an appropriate medium for delivering health services. Operational barriers like compatibility of platforms and connectivity problems can cause lags that reduce the quality of video and sound, interrupting clear speech and transfer of information.
There are further important practical and ethical considerations with the use of telehealth services. Similar to Medicare requirements, compensations schemes can hold healthcare providers responsible for ensuring that the telehealth services provided are compliant with clinical needs, security and privacy laws. End-to-end encryption of data, data transfer outside of Australia, and compatibility of telehealth software with secure data storage mechanisms used by telehealth software hosts are considerations that also need to be addressed. Healthcare providers who have not previously used telehealth have a steep learning curve to ensure safe and confidential service provision for compensation claimants.
Delays in medical assessments, determination of claims and dispute resolution
Independent and Joint Medical Evaluations that are traditionally used to determine and resolve eligibility and entitlements of new claims for compensation have been impacted by COVID-19 restrictions. In NSW, SIRA has temporarily deferred all in-person psychiatric and physical assessments.
Medical assessments conducted via telehealth can offer a safe alternative, and potentially avert the delays that will occur from postponed in-person assessments. Evidence about online medical assessments is scarce, and further investigation is needed.
(Photo by Malvestida Magazine on Unsplash)
The need for quicker service delivery
Telehealth services represent an important way to ensure that compensation claimants are able to access the services they need. At the same time, infectious disease epidemics and economic downturns have a history of exacerbating both social inequity and health inequalities. We also know that lack of information, delays in the delivery of services, and slow administration of claims are persistent barriers to better experiences and outcomes for injured workers and compensation claimants. This was most recently apparent in the findings of the Victorian Ombudsman in her reports on WorkSafe Victoria. Delays contribute to poor quality service and injured worker dissatisfaction which negatively impacts claimant recovery, slows return to work and ultimately extends the length of a claim.
Delays in administration for the approval and delivery of telehealth services, while understandable in these times, cannot remain unaddressed. Compensation authorities could expedite telehealth services by simplifying claimants’ access to information about telehealth services, and supporting healthcare providers to improve the provision of telehealth services. Such steps will ensure that the benefits of telehealth are maximised in the context of injury compensation systems, rather than adding further barriers to optimal claimant experience and recovery.