We have been living in the dark ages of workers’ compensation.
California workers’ compensation care delivery technology history was made by a partnership between Alchemy Logic System Inc., dba RateFast (Santa Rosa, CA) and KuraMD (Roseville, CA).
Santa Rosa, CA, October 11, 2016 at 4:38 p.m.pst
Dr. John Alchemy, MD, QME successfully connected to an injured worker for a PR-2 visit using the HIPAA secure environment of KuraMD telemedicine platform. A complete history and physical exam was performed, followed by the creation of a legally compliant PR-2 report and an MRI request for authorization (RFA) written on Rate-Fast.com using only the Apple iPhone 6+ device. The iPhone was being simultaneously charged by a 2013 Tesla Model S 85 Kwh battery. This landmark event is the first documented instance of 100% mobile delivery of care to an injured worker.
Dr. Alchemy was later quoted saying, “I just never gave up hope. RateFast has already disrupted the category of workers’ compensation report writing and injury mapping. Now with KuraMD that delivery channel is totally mobile. Effective delivery of work comp care in California has just been turned on 24/7, anywhere, anytime-and it’s in your pocket now.”
A lawsuit filed in July of 2016 argues that female workers receive fewer benefits than males in the California workers’ compensation system. According to this USA Today article, the lawsuit makes a case that women are systematically prevented from receiving full benefits for two primary reasons:
- Some medical conditions, such as carpal tunnel syndrome, are allegedly more common among women.
- The consequences of some conditions, such as a mastectomy performed in order to treat breast cancer, are not seen as causing disability.
Although we don’t know the full details of the lawsuit, the news coverage about the case raise some important questions that everybody involved in workers’ compensation should understand.
In this article, we’re going to take a close look at how apportionment, functional loss, and gender can impact an injured worker’s disability rating and benefits.
Continue reading Gender Discrimination in Workers’ Compensation
An underdog tale of a physician armed with a simple tool
Not so long ago, a certain patient with a work-related injury was sent to a state Qualified Medical Examiner (QME) by the insurance carrier. The QME gave the patient a 0% whole person impairment rating. The QME charged the medical-legal fee schedule, which is approximately twice the primary treating fee schedule.
Then, the patient’s primary treating physician (PTP) performed an impairment rating exam using RateFast. Guided by the RateFast app, the physician obtained a complete history and measurement set. Four body parts were evaluated: neck, right shoulder, right elbow, and right wrist. After the exam and measurements were analyzed by RateFast, it was determined that the patient had a 17% whole person impairment—compared to the 0% WPI assigned by the QME.
The insurance company was understandably confused. The patient couldn’t have both a 0% and a 17% impairment rating. So which rating was correct? The rating that was calculated by the qualified medical examiner? Or the number produced by the treating physician?
In search of answers, the insurance company showed the RateFast report to the QME and asked for a review. The QME responded that he had not actually performed any of the required exams, or measured the range of motion for the injured body parts. After reviewing the RateFast report, the QME advised that the insurance carrier discard his own 0% rating, and instead adopt the 17% impairment rating from RateFast.
The RateFast report was then shot like a pebble from a sling into the heart of the the California state disability evaluation unit (DEU).
The RateFast report was accepted by the DEU, and the case prepared for settlement.
What can we learn from this story?
A qualified medical examiner’s process is not necessarily any more accurate than reports created by primary treating physicians. The main factor that separates good reports from bad reports—and excellent reports from good reports—is the tool used to document, collect, and analyze data from the patient’s examination.
When the QME and the stakeholders were confronted with overwhelming documentation and actual measurements supporting the findings, there was a little else to do but accept the RateFast report as correct—for the benefit of all. Correct reports that deliver the right value the first time serve all stakeholders—the injured worker, the insurance carrier, and the employer. Incorrect reporting invites frustration, litigation, delay, and skyrocketing costs.
RateFast invites you to get on the right side of impairment rating—while at the same time increasing efficiency and profitability in your medical clinic. You can contact us for a demonstration.
Update for 2021: RateFast Express is an even easier alternative to the wonderful RateFast software. Try RateFast Express today!
If you’re a medical provider in the U.S., then you know that on October 1st 2015 we will be switching from ICD-9 to ICD-10 codes. There are more than 100,000 new codes.
A lot of medical workers are concerned that the transition might be rocky, but RateFast users need not fear.
Over at the California Work Comp Report podcast, we’ve just released an episode featuring workers’ compensation attorney Phil Walker.
Phil will be joining us for more podcasts as we explore the intersection of law, medicine, and patients’ needs in work comp.
You can check out the episode called “Attorneys in Workers’ Comp: A Historical Perspective” here, and you can also read a complimentary blog post.
Phil has over 30 years experience in several different workers’ compensation systems from Canada to Mexico to the Rockies.
He is an expert on the AMA Guides, 5th edition (which California currently uses for evaluating and rating work injuries). Phil helps employers figure out if doctor’s work-comp reports are correct.
For more information about Phil and his services, you can visit his website here.
If you’re reading this on our blog, then you can see that the RateFast website has undergone a major overhaul. But it’s not just the exterior that’s new and improved. The new version of the RateFast application has a ton of new features.
Here are just a few of the benefits:
Write reports anywhere
Use any computer or tablet with internet access to write, print, and securely store Doctor’s First Reports, PR-2 Reports, and PR-4 reports.
Impress insurance carriers with your thoroughness
The software guides physicians through exams according to the rules outlined in the AMA Guides. You’ll ask all the right questions and take all the measurements necessary to produce a perfect work-comp report.
Receive laser accurate impairment ratings
Gone are the days of staying late at the office figuring out your patients’ impairment ratings. When you write a PR-4 report using RateFast, you’ll receive an accurate and justifiable whole person impairment, complete with references to specific sections and rules in the AMA Guides.
Send out grammatically correct, perfectly formatted reports
RateFast reports are written in conversational language and formatted like the official forms by California’s Division of Workers’ Compensation. You can preview your reports in your secure account, download them as digital documents, and print them out.
Get your whole team involved
Now, your entire clinic can help move work-comp claims forward. Administrative staff, nurses, physician’s assistants, and MDs can all manage work injuries and contribute to reports.
RateFast is completely free to join: you’ll get 2 free reports to start.
To learn more, call us at (707) 304-5949 or email us at email@example.com.
The process of digitization is taking information from the real world and overlaying it with a set of digital perimeters, which allows that information to be put into a system.
This allows for meaningful content to be created for consistent conclusions across large numbers of users.
Electronic Medical Records (EMRs) have gained wide popularity over recent years, but to what extent have Workers’ Compensation reports been digitized in a similar way?
There really hasn’t been a concerted effort to digitize WorkComp by any one group or entity.
There are some impairment reporting softwares out there that will give you the header of the section of the report you’re supposed to fill out. But in these cases, the user is left with a blinking cursor to ask the questions and perform their own physical exam, at their current level of understanding.
We’re talking about guiding the patient and medical provider through a very specific process to make sure reports are as complete and compliant with the law as possible.
Digitization of Workers’ Comp means getting every part of the WorkComp reporting process standardized, using computer technology.
With the rise of cloud computing and centralized and data repositories, the time is now to start this process.
This benefits everyone in the workers’ comp process, but most importantly, it benefits the injured worker. Injured workers get caught in a spiral of inefficiency and errors which draws their cases out much longer than they need to be.
Digitization means faster and more accurate reports; there is currently no penalty for turning in wildly inaccurate reports. Once this process does get digitized any missing information will become blatantly clear.
Has this happened elsewhere? Yes- take a look at the automobile industry. As soon as cars appeared on the market, both new and used, there needed to be a system for determining their value. This guy Les Kelley showed up, of Kelley’s Blue Book– he didn’t have a computer, but he used a specific set of questions that determined how much a car’s value was worth and how much its resell value was. Within a couple of years he took over, his system was an industry standard.
So what does this look like in an Impairment Exam? Let’s have an example:
A QME is doing an exam for a right shoulder injury. The QME took two measurements with the goniometer in all planes of motion. This report gets submitted, and the report is digitized, meaning that someone takes the information and places it into a standardized format to confirm the opinion of the QME. However, what the QME either forgot or wasn’t aware of, is that in upper extremity injuries, you need to measure both the injured and uninjured parts of the body. Therefore half of the functional measurement set is missing, as no measurements were taken on the left shoulder. With digitization the data that’s missing is made extremely clear. This will improve accuracy and consistency in monetizing work injuries.
A study from 2006 found as much as 79% of reviewed reports for the low back were incorrect. Hopefully with the process of digitization this number will significantly decrease. Questions or comments on digitization? Write us at firstname.lastname@example.org