San Diego Zoo and Medcor Set Up Telemedicine Program for Employees in Amazon

 
Johan Perez checks depth with bamboo pole in shallow part of the muddy Elto Madre river. On board in the red 55 gallon drum, is fuel — one of two such drums on the riverboat traveling roughly 20 hours each way to reach the research station at Cocha Chashu. Between the two boats on this mission, the Medcor team carries a spare outboard engine and 4 props. On this trip, both boats had had to replace propellers damaged by submerged logs and shifting shallow bottoms. Every few hours, they must stop to clean silt from the engine intake. And, in some places, when the current is too strong to manually push the boat, the team is forced to backtrack to find a deeper channel.
 
 
When the San Diego Zoological Society was chosen by the Peruvian government to manage its research station in the Amazon jungle — the trackless Manu National Park — it had the responsibility of providing emergency medical care to its staff.
 
 
The hazards: poisonous snakes and crocodiles, malaria and yellow fever, parasites and fungus, as well as normal strains, sprains and lacerations.(WCxKit)
 
 
Helicopter evacuation? Forget it. The dense jungle canopy, long distance and bad weather in the rainy season make it next to impossible – even if the nearest helicopters weren’t on the other side of a mountain range.
 
 
So, the zoological society hired Medcor, an on-site medical firm based in Illinois, to help establish a wilderness medical program to manage a research station in the jungle, at Cocha Chashu in the Amazon jungle of Peru. The zoo contracted with the Peruvian government to help manage the site. Since the zoo has worked with Medcor for years in San Diego, they already had experience working together and had proved the effectiveness of this kind of risk management in other projects.
 
 
June 8, Medcor founder and CEO, Philip Seeger, and EVP Curtis Smith traveled to the jungle with the zoo’s risk manager, David Matthias, to conduct a first-hand assessment of all the travel and evacuation logistics. Medcor needed to assess the medical needs and response options for people at the station that is so remote it requires four days travel from the United States each way, the last two by small boats, 10 hours a day.
 
 
This means the 20-year-old Cocha Chashu station, according to Medcor executive vice president, Curtis Smith, is two days to the nearest town. So telemedicine is essential, particularly when the science group is too small for an onsite medical professional. Research groups vary from two people up to 30, staying from days to months.
 
 
While navigating the rivers, they test two different satellite systems to connect to Medcor’s existing triage call center. Medcor’s telemedicine service is already used by over 80,000 worksites (and many mobile workers) in the US and is available 24/7. Connecting from the jungle involves data, audio and video links – all of it battery and solar powered.
 
 
Shortly after arriving at the station, the Medcor team had opportunity to use their triage service on a real patient. The first on-site injury? An insect bite (presumed to be a spider) that was becoming inflamed. Treatment was given immediately and the patient recovered without complication, Smith said.
 
 
Medcor is also working with locals who provided travel and support services for the station. The project includes stocking the station with essential medical supplies; protecting them from insects, heat and humidity is key to having them available when needed. Supplies in place could be used by researchers being directed by Medcor clinicians remotely, or used by Medcor staff who travel on-site to support large groups.
 
 
Wilderness medicine is not new for the company, which supports a clinic at the base camp of Mount Everest, provides on-site medical services at Yellowstone National Park, and has ranged far afield with services on Pacific islands, as well as remote areas in the US. “Of course wilderness medicine is specialized,” says CEO Philip Seeger, “but there are many similarities to our core on-site services in the US, too, Most of the injuries we deal with are still sprains and strains, and we have to train and support our staff, get reports to our clients on time, and stay in compliance with HIPAA and other regulations. Delivering our services remotely forces us to become more efficient overall – many of those improvements also benefit our patients and clients using our services here is the US.”
 

Author Rebecca Shafer
, JD, President of Amaxx Risks Solutions, Inc. is a national expert in the field of workers compensation. She is a writer, speaker, and website publisher. Her expertise is working with employers to reduce workers compensation costs, and her clients include airlines, healthcare, printing, publishing, pharmaceuticals, retail, hospitality, and manufacturing. See www.LowerWC.com for more information. Contact: RShafer@ReduceYourWorkersComp.com.
 
 
 
Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers comp issues.
 
©2011 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@ReduceYourWorkersComp.com.

Nine Questions to Ask When Coordinating Managed Care Providers

Coordinated medical care refers injured employees to specific physicians, integrating the protocols and goals of the overall workers compensation management program and coordinates with health insurance, i.e., managed care.

 
It means planning before an injury happens and educating your employees about proper procedures.(WCxKit)
 
Managed care, if set up properly, reduces medical and indemnity costs, fine tunes medical treatment, creates a care-plan, sets a return-to-work date and requires periodic re-evaluation between the physician and case manager.
 
Having a WC coordinator to post checklists and host employee meetings can go a long way to steering your injured employees and on-duty managers to the right physician.
 
Finding the right managed care vendor is another matter. In addition to PPO providers, consider onsite occupational clinics. Yes, set your own clinic, really. I've worked airlines, state parks and other large organizations, including hospitals that have onsite clinics. It offers convenience and quality control.
 
Questions for the Managed Care Vendor
1. Does the managed care vendor have enough providers in its network to deliver prompt service and provide adequate geographic coverage?
 
2. What mechanisms are in place for provider evaluation and other issues related to quality of care?
 
3. How does the managed care program integrate with the claims administrator?
 
4. Are providers willing to visit the facilities and learn about the employers’ corporate culture and needs?
 
5. Do network doctors appear to be caring and concerned, or rushed and rude?
 
6. Are providers return- to-work oriented? Do they provide transitional duty job restricitons so the employee on the FIRST VISIT so employers can quickly place the injured employee is an open position, e.g. in a job pool for instance.
 
7. Does the provider have less litigation than others?
 
8. Do medical costs from this provider compare to other providers — remember you don't always want lower costs per visit, you want employees to return to health and productivity sooner, and sometimes that may cost MORE per visit, but cost less overall.
 
9. What are OVERALL costs of employees treated by this provider — in outcome based provider subsets, cost of the overall claims are lower because employees return to work more quickly and need medical care less often.
 
When your company forms a partnership with the right insurance company or claims administrator, they will appoint a dedicated adjuster who understands investigation.
 
Look to allow a 24-hour turn around time in response to injury reports. Also, be sure your managed care vendor gives the employer the retaining right to choose legal counsel, settlement authority, second injury and subrogation.
 
Your company must maintain control at all levels of workers compensation to be sure your costs do not escalate. There are many steps in the process that could serve as money sieves.
 
Fraud, other money sponge, can also be prevented and detected when all parties involved in workers compensation — supervisors, managers, claim adjusters and medical providers, work as a team.
 
Surveillance by qualified investigators is used to verify the extent of the disability, establish the ability of the employee to do transitional duty work and determine if the worker is working elsewhere may be necessary in some cases.(WCxKit)
 
Knowing when to implement this type of fraud investigation means planning for it ahead of time and being aware of all legal ramifications of investigative work.
 
Five questions to ask when coordinating your medical care and other tips to save your workers compensation department money #WorkersComp.
 

Author Rebecca Shafer, JD, President of Amaxx Risks Solutions, Inc. is a national expert in the field of workers compensation. She is a writer, speaker and website publisher. Her expertise is working with employers to reduce workers compensation costs, and her clients include airlines, healthcare, printing/publishing, pharmaceuticals, retail, hospitality and manufacturing.  See www.LowerWC.com for more information. Contact:  RShafer@ReduceYourWorkersComp.com or 860-553-6604.

WORK COMP CALCULATOR:   http://www.LowerWC.com/calculator.php
 
WC GROUP:  http://www.linkedin.com/groups?homeNewMember=&gid=1922050/
SUBSCRIBE: 
Workers Comp Resource Center Newsletter

Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers comp issues.

©2010 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact
Info@ReduceYourWorkersComp.com.

Congresswoman Giffords Rehabilitation Likely Workers Compensation: Learn About Physical Rehab

Most people would not think of workers compensation when hearing about the Tucson, Arizona tragedy where Congresswoman Gabrielle Giffords and 18 other people were shot. As Congresswoman Giffords and the members of her staff are federal employees, and as they were at an official function for Congresswoman Giffords, she and her staff would be covered for workers compensation by the U.S. Department of Labors Office of Workers Compensation Programs, which administers the Division of Federal Employees Compensation. This type of workers compensation is called FECA – Federal Employees Compensation Act.
 
 
Congresswoman Giffords, like other employees with a brain injury, will be going through physical rehabilitation. Most everyone understands that rehabilitation “rehab” is medical care to improve a medical condition, but most people do not know what rehab consist of. (WCxKit)
 
 
Rehab is specialized medical care for the treatment of a disability from injury or illness. The goal of rehab is to stabilize the injured employees medical condition and to assist the employee to recover from the injury or illness. The rehab process is administered by a team of specialists as the injured employee will normally need the medical expertise of a variety of doctors.
 
 
Rehabilitation hospitals are not all the same. One rehab hospital may specialize in burn cases while another rehab hospital may specialize in traumatic amputations. The initial medical provider treating the employee for his/her injuries needs to identify a rehabilitation hospital that is appropriate for the employee's medical condition. The rehabilitation hospital must have the proper mixture of specialty services needed by the employee. 
 
 
Rehab strives to return the employee to their pre-injury condition, but not everyone will have a 100% recovery. Most injured employees admitted to a rehabilitation hospital start with a program designed to provide the employee a path to full recovery.   However, often is unknown how much recovery an employee will have until the employee has been in rehab for a period of time.   Rehab will assist the employees who do not recovery 100% to learn to live with their disabilities. 
 
 
When an employee is sent to a rehabilitation hospital, it is because they need specialized services to recover their ability to function. Rehab incorporates numerous medical specialties that work together as a team. For an employee with a brain injury, the medical teams that will assist them include:
 
1.      Neurophysiologist
2.      Neurosurgeons
3.      Neuro-ophthalmologist
4.      Audiologist
5.      Speech Therapists
6.      Rehabilitation Case Manager
 
 
With a brain injury, other parts of the body may be affected. Some of the additional medical specialists that can be brought in to assist with the rehab include:
 
1.      Physical Therapist
2.      Occupational Therapist
3.      Vocational Rehabilitation Specialist
4.      Rehabilitation Nurse
5.      Clinical Psychologist
6.      In addition to all these specialties, the rehabilitation hospital will either provide or be able to refer an injured employee to dieticians, chaplains and social workers.
 
 
When the injured employee is transferred from the post-accident hospital to the rehabilitation hospital, the medical team at the rehab hospital will thoroughly review the employee's medical records to establish the types of specialized medical care that will be needed. In addition to reviewing the medical history, the employee will be put through a series of test to establish the medical and physical restrictions that prevent the employee from functioning better. 
 
 
Once admitted to the rehabilitation hospital, the employee's disability level will be measured using two scales. The Functional Independence Measure is used to asses the physical and cognitive abilities of the injured employee, and the Functional Assessment Measure is used to gauge emotional status, orientation, attention, community integration, reading and writing skills and employability. 
 
 
The physical and cognitive test will include testing to see if the employee can stand on his/her own, walk without assistance or not, chew and swallow without assistance, talk and communicate freely, and the testing will show if the employee can understand and comprehend instructions. Each of the specialists will also administer their own evaluations to see what the employee can and can not do. Based on the assessment of the medical team, a customized program is designed to diminish or eliminate the disability.
 
 
There is no standard time frame for a person to be in a rehab hospital. One employee may be fully recovered in a month or less, while another employer with extreme injuries could be in the rehab hospital six months or more. However, during the time the employee is in the rehabilitation program, much of the physical and cognitive testing will be repeated to measure the employees progress. Also, prior to the discharge from the rehab hospital, the Functional Independence Measure and the Functional Assessment Measure test will be repeated to measure the employee's overall level of improvement while in the rehab program. (WCxKit)
 
 
Physical rehabilitation is usually reserved for the employees who have the most severe disabilities, but it can often be effective in reducing the disability level (and the amount of the permanent partial disability award) in mid-level workers compensation claims. When your workers compensation adjuster and nurse case manager are working with an employee that has been admitted to a physical rehabilitation program as the result of an injury, support your employee throughout the process. Many employees who are admitted to a rehab program return to work to be productive again.
 
 

Author Rebecca Shafer, JD, President of Amaxx Risks Solutions, Inc. is a national expert in the field of workers compensation. She is a writer, speaker and website publisher. Her expertise is working with employers to reduce workers compensation costs, and her clients include airlines, healthcare, printing/publishing, pharmaceuticals, retail, hospitality and manufacturing.  See www.LowerWC.com for more information. Contact:  RShafer@ReduceYourWorkersComp.com or 860-553-6604.

 
WORK COMP CALCULATOR:   http://www.LowerWC.com/calculator.php
 
WC GROUP:  http://www.linkedin.com/groups?homeNewMember=&gid=1922050/
SUBSCRIBE: 
Workers Comp Resource Center Newsletter

Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers comp issues.

©2011 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact
Info@ReduceYourWorkersComp.com.

The Role of Medical Opinions in Managing Federal Workers Compensation

The federal workers’  compensation system, administered by the Department of Labor’s Office of Workers’ Compensation Programs (OWCP), works differently than state workers’ compensation systems but still offers many opportunities for obtaining medical opinions. Here is a brief primer on the rules related to obtaining medical opinions.  

1. Ask the Treating Provider for Clarification, Rationale and Notes
OWCP relies  on the treating provider of record to provide sufficient detail and rationale to enable their Claims Examiners to make claims adjudication and treatment authorization decisions. The employing agency has a right to review these notes. Exercising that right is easier if the employer routinely asks injured employees to sign an authorization for release of medical information related to the claim. 

2. Facilitate Referral for a Specialist Opinion
A common mistake  made by treating providers unfamiliar with the federal system is to state an intent to refer to a specialist in a treatment note, and hope that this will suffice to “make it so.” Unlike many state systems, in which a case manager will note this request and act on it, such automatic review and action is not part of the federal system. Support staff at the treating provider’s office should arrange referrals and may receive assistance from agency representatives.
 
The approved treating  provider may refer the patient to any specialist for consultation or care, without obtaining OWCP pre-authorization. An injured worker wishing to see a specialist should request this of the treating provider. As long as the specialist is a local enrolled provider, uses the diagnosis codes for the accepted condition(s) in billing and submits bills properly, payment should not be a problem. 

3. Use Agency Medical Exams
In state workers’ compensation,  the employer or insurer can usually obtain a second opinion exam from an appropriate specialist. The federal employer does not have this option. Although the employing agency may request a second opinion examination from OWCP, there is no guarantee they will grant the request. If the claimant is still on the federal agency employment rolls, the employer may refer the claimant for an Agency Medical Exam, according to Office of Personnel Management (OPM) guidelines (5 CFR 339). The Agency Medical Exam will not usually be given the same weight by the OWCP Claims Examiner as the treating provider’s opinion, but it may trigger OWCP actions such as an OWCP arranged second opinion exam. There are strict rules about setting up Agency Medical Exams.

4. Ask for Clinical Claim Reviews  
Federal agencies
 with access to in-house or contract Occupational Medicine physicians and/or nurse case managers should utilize their services to review medical documentation provided in relation to workers’ compensation claims. Reviews by clinicians can provide you with needed information and medical analysis related to causation, prognosis and return to work planning. Critical review of the medical documentation provided in relation to the claim can be used to determine whether continuation of pay should be controverted, and are useful when an agency is deciding whether to challenge a claim based on the medical facts.
 

Written reviews  by clinicians are also helpful in obtaining needed decisions from OWCP, including treatment authorization or referral for second opinion exams. Agency clinician correspondence with the treating provider can be invaluable in obtaining clarification of opinions, enhancing progression toward recovery, triggering decisions about maximum medical improvement, and soliciting cooperation in return to work planning.

5. Ask for DOL Second Opinions
The OWCP Claims  Examiner may decide that a second opinion examination is needed in order to obtain additional information about a claim, when the documentation coming from the treating provider is not clear or contains discrepancies. Such an exam is usually performed by an appropriate specialist, via a network contracted with DOL. These exams usually require the Claims Examiner to prepare a Statement of Accepted Facts (SOAF) for the examining physician. These exams are most often performed to determine whether surgery is needed, whether an accepted condition has resolved or reached the point of maximum medical improvement, or the degree of disability. Federal agencies should monitor the medical progress and documentation closely, and if questions arise, request a second opinion from the Claims Examiner.
 
It is important  to make a clear and concise justification for this action, and follow up the response. Once the second opinion exam is done, ask for a copy of the report. Clarify with the Claims Examiner the status and plans related to follow-up actions indicated by the second opinion, such as additional testing, other specialty evaluations, or obtaining a review and response from the treating provider. It is important to find out what the Claims Examiner is planning to do if the second opinion is in conflict with the treating provider’s opinion or treatment plan. The Claims Examiner may decide to obtain a “referee” exam (or IME). A referee exam is performed by an appropriate specialist who is usually under contract with the given DOL district office. Make sure you ask for the referee report, since it will often provide the basis for a return to work offer or necessary administrative decisions. (workersxzcompxzkit) 
 
Summary
Although the treating  provider of record is the primary source of clinical information needed by the Claims Examiner, there are other options available to federal agencies to obtain additional clinical perspective and opinions.
 
Work Comp Roundup welcomes as a new . . .
Guest Author:  Marianne Cloeren, MD, MPH, FACOEM is medical director of Managed Care Advisors, Inc. (MCA). Since 1997, MCA has successfully designed, implemented, and managed employee health and welfare and workers' compensation programs for large public and private corporations, and local, state and federal government entities. Our team of consultants and clinical professionals are in the business of maximizing health and productivity. Contact Dr. Cloeren at 301-469-1660; mcloeren@managedcareadvisors.com;  www.managedcareadvisors.com.

 
FREE WC IQ Test: http://www.workerscompkit.com/intro/
WC Books: http://www.reduceyourworkerscomp.com/workers-comp-books-manuals.php
TD Calculator: www.reduceyourworkerscomp.com/transitional-duty-cost-calculator.php
WC Calculator:
http://www.reduceyourworkerscomp.com/calculator.php


Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers' comp issues.
 
©2010 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@ReduceYourWorkersComp.com

Medical Cost Containment is Right Here, Right Now

What Is Medical Cost Containment?

We practice medical cost containment  by looking for opportunities to reduce the number of treatments your injured employees receive or to reduce the cost of those treatments.  Simply put an employer looks for ethical ways to save money by cutting medical costs. Many problems I experience between employers and TPAs and insurers is a direct result of the employer not knowing the services that are available. They don’t ask for them because they don’t know them.

What Kinds of Services Are Available to Help Reduce Costs?

1.  Preferred Provider Organization (PPO):  Physicians who are part of a large network of medical personnel.  It may be possible to negotiate treatment fees if the level of participation you offer is significant.
Find out about networks — or subsets of doctors — that have better performance than others.

2.  Third Party Administrator (TPA) find out if they have services to reduce medical costs.  You may have to pay extra.  The services they offer may or may not be tied to them and you should find out if cost and quality would be affected.

3.  Telephonic Nurse Case Management:  Nurses remotely manage workers’ comp cases to coordinate medical care and determine extent of disability.  This is not a substitute for a claims adjuster.  

4.  Hospital, Medical, Review Services:  Each reduces the medical and hospital provider bills to the fee schedule amount or to “usual and customary” (U&C)  fees. (workersxzcompxzkit)

5.  Utilization Reviews:  Used late in the treatment cycle to determine whether a treatment was, in fact, necessary, or whether a requested procedure is indicated.

6. Nurse Triage and Senior Nurse Reviewer: Nurses that care part of the initial intake can reduce medical only and lost time claims, turning them into “self-care” claims.

7. Medical Advisors and Peer-to-Peer Doctors: These doctors help interpret medical records, speed IMEs, eliminate unnecessary IMEs and speak with other doctors to discuss return to work, treatment, and many other things.

Make sure to ask how these services are communicated to the workforce. Get samples of the materials! Ask the regional coordinator to visit your workplace to show and explain all of their services.

“REDUCING FRAUD” Podcast or Webcast
DOWNLOAD NOW
:
http://www.workerscompkit.com/gallagher/mp3
By: Private investigator with 25 years experience.

Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker about workers’ comp issues.

©2009 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@ReduceYourWorkersComp.com

Workers Compensation and Injured Employees

It Isn’t “US” Against “THEM”
Look around.   Are there horror stories of how employers, insurance companies and government agencies stick spokes into what should be a smooth-running workers’ compensation process?  Oh yes!

Recently  the city of Atlanta spent more than $171,000 over a five-year period fighting the claim of five gravely injured city workers – we are talking about one being brain damaged and the other four in wheelchairs.   So, what’s the point?  The workers have serious, life-altering injuries.  Are they likely to return to their jobs?  No.  It would be better to settle the claims and move them onto permanent disability status thus giving them and their families peace of mind.

Every employer  needs to ask:  “What is the bottom-line GOAL in resolving injured employees workers’ compensation claims?  Reducing the COST & LENGTH of claims and returning the employee to work. While it may be all about the money, it’s also very much about the employee.

Create a Positive, Effective Response When Employees Are Injured
Proactive Communication:  Inform employees of the policies, programs and procedures expected of them in the event of a work-related injury. 

Be interested  in the injured worker’s concerns such as:  Who will pay my medical bills? How long will I be out? Will I lose my job? How will I support my family;  Do I have a workers’ comp claim? If I can’t do my regular job, is there another one for me? 

Have a Plan
1. Know what to do when the injury occurs.
2. Make sure the worker receives prompt, adequate medical care.
3. Send a company representative with them to the medical facility.
4. Complete all relevant paperwork.
5. Arrange for personal items and car to be taken home.
6. Answer questions, be reassuring and convey interest in their well being.

Reactive Communication:  Following the injury establish and maintain communications with the injured employee so s/he remains psychologically connected during recuperation and focuses on the final objective of returning to work as soon a medically able as a healthy, productive employee.
1. Remain in weekly telephone contact.
2. Send a get-well card.
3. Set-up weekly meetings at the workplace.
4. Make sure the injured worker keeps all medical appointments, even if you  arrange transportation.
5. Arrange for a transitional duty assignment when the worker is medically able.

Employers with  a plan can answer questions when they arise (and they will) and allow the parties to resolve them without resorting to lawsuits or other harsh methods. ( workersxzcompxzkit).

Engaging injured  workers in an adversarial battle of wit and wills is a death knell  to reducing costs and does nothing for the workplace environment, the employee’s attitude or the employer’s reputation.  And, sends people running for their lawyers.

Author:  Robert Elliott, J.D.

Click on these links to try it for yourself.
WC Calculator: www.ReduceYourWorkersComp.com/calculator.php
TD Calculator: www.ReduceYourWorkersComp.com/transitional-duty-cost-calculator.php
WC 101: www.ReduceYourWorkersComp.com/workers_comp.php

Do not use this information without independent verification. All state laws are different. Consult with your corporate legal counsel before implementing any cost containment programs.

©2008 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@ReduceYourWorkersComp.com

Professional Development Resource

Learn How to Reduce Workers Comp Costs 20% to 50%"Workers Compensation Management Program: Reduce Costs 20% to 50%"
Lower your workers compensation expense by using the
guidebook from Advisen and the Workers Comp Resource Center.
Perfect for promotional distribution by brokers and agents!
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