The RateFast Self-Driving Impairment Report

New technologies are applied to old, outdated systems. People attached to the old, bad technologies will point out how the new technology bares no resemblance to what they’re used to. It makes you wonder why that is. We spoke to Dr. John Alchemy about a few analogies pertaining to those clinging to something that flat out doesn’t work.

For more information on this episode, and other helpful tips about workers’ compensation, visit the RateFast Blog.

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The RateFast Self-Driving Impairment Report

Cory Oleson (Host): Welcome to the California Work Comp report. Today’s Tuesday, September 28 2021. This is your host, Corey Olsen. Back at it again with Dr. John Alchemy to discuss the self driving impairment report. You’re not going to want to miss this one, folks. So here we go.

Welcome back. How are you doing today, John?

Dr. John Alchemy: Doing great, Cory. It’s good to be back here and talking about more impairment.

Cory: Yeah, it feels good. Especially because it seems like we have have at least a bit of an audience because between last episode now we are celebrating over 4500 listens and downloads and streams to our podcast. So it feels good.

Dr. John Alchemy: It’s awesome. Awesome.

Cory: If you’re a listener, and you listen to us regularly, and you’re coming in again, and everything like that, we really want to thank you for doing this for listening to us and hearing all that we have to say because we were in it for a good cause. And we believe that just getting the information about doing workers compensation, we’ll combat all of the bad workers compensation that’s out there. And it’s not all bad. But it should be all good. For everybody.

Dr. John Alchemy: Well, and we have to start somewhere. So we’re starting here.

Cory: Yeah, the journey of 1000 miles, begins with 4500 podcasts, please. So today, our topic is the self driving impairment rating. And this is one of those ones, John, where I consider myself an audience member a bit because I’m very interested to hear what you have to say about it. So we have, in this climate we have the talk of and the horizon of self driving cars. And in many respects, we do have self driving cars, it’s just there’s all these kind of categories as to when when something is fully right, or, things like that. It’s an evergreen topic in the in the in the social. What’s that journey of Zeitgeist is? Yeah, I’m curious to know about the self driving impairment rating.

Dr. John Alchemy: Take it away, take it away. Yeah. Well it’s a good analogy to talk about what’s happened in the driving in the automotive industry compared to know what’s happening in the impairment industry. And I thought that today we could talk about the parallels. And the similarities between automotive of which there are so many transitions taking place now. And impairment rating, obviously, the Automotive Department is a little bit larger about market segment than impairment rating, but I think the analogies are valid nonetheless.

Cory: Without even accounting for the proportions of the size of the automotive industry, I think that it’s just as confusing as workers compensation.

Dr. John Alchemy: I think it can be so and fortunately, I have access to a Tesla car. And so a lot of the analogies I’m drawing I’m not just talking about I’ve actually experienced personally. Yeah, and also the impairment rating, of course, I’ve experienced personally and I’ve had opportunity to see how it’s impacting the different segments of impairment rating and, and how people’s acceptance of it is coming along, how it’s, how it’s changing behaviors, and changing what people used to do and what they’re starting to do now. About five years ago, the automotive industry really changed with Tesla and the electric car industry. And it for the most part kind of went unnoticed. A lot of people, including myself, so self entrenched in fossil fuel cars, and the whole infrastructure of gasoline that we grew up with, and taking the car in for oil changes and buying parts for your car, and all of these things, and this do it yourself. I think Cory probably our parents used to change their own oil in the driveway.

Cory: I’ve been known have been known to do it.

Dr. John Alchemy: You’ve been known to do it? Well, you stay tuned to this podcast. That’s right. I’ve got a few things to say to you.

Cory: Yeah, alright,

Dr. John Alchemy: The point being is that cars went from something very simple and something very kind of kind of taken for granted to something very different. Now, I don’t think probably any of our listeners could do a repair on their own car as they sit now in anyone’s driveway, just because of the computer and the technology, regardless if the cars electric or gas, and as users, we become less and less able to affect or change, or participate in the actual maintenance of our cars, and the cars have just become something that we use. And because of that it has to be simple, and it has to be no-brainer, or it’s just not going to make it in the marketplace. And that’s kind of the old concept, I think, behind any type of technology or innovation that’s looking to disrupt an entrenched market, like cars. Tesla did some really interesting things all at once. And this is even just leaving out their whole play on, sustainable power power storage. As they’re, I think they filed in Texas to become an energy supplier people.

Cory: Texas of all people!

Dr. John Alchemy: Yeah. Yeah. and I mean, look at the problems with the power grid, when they froze last year.

Cory: A couple inches of snow and the whole thing fell apart.

Dr. John Alchemy: Talk about disruption. But it’s interesting, when you look at one company, all of the technologies, markets, it’s changing. And so just a couple basically going from the crisis of greenhouse gas and global warming, to electric versus fossil fuel probably the most obvious. And I listed in my notes, just no-brainer, right? Getting off the fossil fuel. I was listening to it to a podcast from Elon Musk. And he said if you really think about it, our dependence and use of fossil fuel is probably the most stupid experiment in the history of mankind. Because we know we’re using a finite source as our energy we know, it’s damaging our planet, our living environment. And still, we’re doing it and what’s up with that, and it’s true, you you can only kick the can down the road, so many, so many generations.

Cory: Yeah, it’s such a, kind of a microcosmic picture of just a lot of philosophies that just kind of need to change, you just kind of hang on to momentum until a lot of these, it’s sort of like multi generational, like, it’s, uh, I’ll just hang on to this momentum and hope that me, nor my son has to deal with his baby. Right, him and his son will have to deal with it.

Dr. John Alchemy: Hopefully I don’t have to deal with that conversation.

Cory: That’s right.

Dr. John Alchemy: So anyway, there’s that obvious the other thing Elon Musk has talked about multiple times is that he was not going to be successful at converting the market to electricity unless he had a super compelling product that was I think the word he used hands down better than any fossil fuel car ever made faster, more efficient, more options just a better experience all of these things, it just it just had to win and not just win, but when big in all of these categories safety all of these things that an electric car had to prove to everyone driving a fossil fuel car to get them to pay attention and say, well, maybe this is a change and not just as an environmental thing, but as a quality of life and just a better car that had to happen.

In the whole approach to cars, not something that you sell to someone to get from point A to point B but, a computer on wheels, that is continuously monitoring data using that data for multiple dimensions, be it driving patterns, safety, finding the fastest route the software that goes into that the pioneering of updating the software in your car, in your garage at night through your home WiFi as opposed to bring going into a dealer and having them operate an operating system. And here’s really where we see a lot of the dependence going away from the user as far as the technical understanding and needing to know the workings of their vehicle to more of what I’m here to use this car, and it has to be simple. And it’s got to work for me and more of a model that’s plug and play. And some people want to know how their cars work, and that’s fine, but most of us probably don’t.

Cory: Yeah, the operative word for that being like layers of abstraction as an armchair programmer, abstracting layers, which is done in programming, like when you do that, when you run into, you call like a higher level programming language and stuff, like a lot of those things are done, just to kind of streamline the process for you, the user to kind of get it will get to your destination quicker, and things like that. So in that respect I mean, that levels of abstraction are good when, you don’t want to be driving one of those jalopies while also taking the traffic and the weather and the condensation for the area and updating the firmware on your model T and stuff like that. It’s nice to have technology to do that for you, you know?

Dr. John Alchemy: Yeah. And, impairment ratings are very similar, we’re taking away a lot of the technical understanding and requirements for users, be them, doctors, claims adjusters, attorneys, judges, anyone who needs to have an accurate impairment rating, rather than here’s an impairment rating, you can have confidence in, it’s consistent, it’s accurate. Here’s your impairment rating. Yeah, we can give you the details, if you have a question, but here it is, stop worrying about it, we’ve been worrying about it since impairment ratings came into existence, that someone in the back room with a pen and paper sat down and did this, and there’s probably an error, and you’re probably right. But as we go forward with digital impairment rating, and the slicing and dicing of customized impairment ratings based on the individual, a lot of these concerns are going away, and we’ll talk about that a little bit more an example.

And then obviously, the better quality of life back to the car. And back to the car analogy, being dependent on volatile pricing of fuel, out here gas, for 55 bucks a gallon and being dependent on these wild swings. And, and how about just, you don’t have to go to the gas station anymore. You know? That’s huge.

Cory: Yeah, especially, it’s it’s wintertime, you don’t want to get out of your car. Do all that. Yeah, yeah, it’s all those things. It’s not winter time yet, but when it is, you don’t want to get out.

Dr. John Alchemy: Well in it all adds up, it’s not only the cost, but the inconvenience, once a year, I don’t know how much or a week how much you drive, but the gas station, 1520 minutes filling up, and you do that 52 times, a year and that’s stuff you could be doing with your life elsewhere.

Cory: It’s true. I would I shudder to think about the person that, St. Peter handing me the kind of the analytics of my life afterwards showing the files. Yeah, at the gas station, or, in my younger days on the side of the freeway waiting for somebody to bring me a thing of gas, things like that. Right. Think first car things, but yeah, definitely. Yeah. And especially when you have a when you have a system, that just just like a what, like a well put together workers compensation system that does sort of a similar thing, as we’ve talked about that RateFast does, is collects collects data on our good, our reports that have been accepted and everything like that. So not only is it doing the physician a favor of saving all that time and effort and such that would just be spent kind of stressing out over how to do a worker’s comp report, but also the data that’s collected helps every other doctor that’s using RateFast to get through their impairment reports quicker and better as well.

Dr. John Alchemy: So yeah, you don’t have to keep looking over your shoulder and saying, Gee, I wonder if this report is right or did you know someone, put the decimal in the wrong space, or did they forget all that stuff, it just, it just becomes much less of a concern and you can focus more on okay, let’s get the next page go and let’s do the next exam. Let’s get the next impairment report started, and it’s really a whole different quality of life for the providers. Absolutely.

And then this last part, which is the whole podcast is about is self driving. And that’s something obviously, Tesla’s been in the news a lot about is their Driver Assist or auto steer feature or autopilot, however you want to call it, but eventually, it will go to the point where cars will do self driving on surface streets and understand complex situations. And the only question is, what system is going to be triumphant in getting to that point the fastest. And that there are different ways of looking at it. But Tesla’s view is A) going to total visual system cameras only, no radar, and none of that, for reasons of conflicting information cost hardware costs delivery to the end user at an efficient price, and then this new concept of the neural net, that many years ago, this concept of the neural net was, machine learning and being able to put layered systems of logic and understanding and almost a self realization of a program to learn more, the more data that it’s given.

And it was interesting, because I was listening to a comparison between Whammo, that have has these cars out driving the streets with all these spinning whirly gigs, and things that it’s measuring the environment, and they maybe, let’s say they maybe have 600 cars out there, and you’re looking at Tesla collecting it now from a growing fleet of a million in some cars and going up by 30, 40,000 cars per quarter. And that is, that is their data collection system, you kind of think about, it’s like, Gee, I wonder who’s gonna win that one?

Cory: Yeah, it’s completely incidental to the, just the making electric cars, if suddenly you think that you can rely on kind of like, when Uber first came out and everything, it’s like people said, well, I have a car, I can put that to work.

Dr. John Alchemy: Yeah. So these these big transitions, these big disruptions, there’s some books written around this concept and the kind of the standard, the books that I’m familiar with, call it the zero to one divide. And that means going from nothing to something significant, like a major change a major step, a major disruption, and that is to be compared against something, as opposed to an iteration. So you have Uber come down the pipe, for example. Or you have Tesla come down the pipe, and then you have people that also want to get into the space, and they’re not really there to disrupt it, they’re there to take advantage of the new market segment, and tweak it a little bit so it’s like one to 1.1, or one to 1.2, or we’re making those little buttons that pop off the back of your phone that you can hold it in green and yellow, as opposed to black, stuff like that.

Cory: Yeah. It’s, kind of outside of the utility at that point.

Dr. John Alchemy: Yeah. Right. But as that as an industry when when something happens like that, you’re either on the front end or the back end of the tidal wave of the change that’s coming. And as, as a person and a company you really need to make the decision, if you’re up for the journey, or not sure, you can wait and get a cheaper, more polished, product five years from now. But, but you’re not going to have the opportunity to leverage the disruption in a way that can be beneficial to what you’re trying to do for the industry, as someone who comes along late and I think, as a phone analogy, most of us can say that not many of us are using the phones on the wall anymore in the house. It’s just kind of sits there.

Cory: There’s no phone that has a cord in my house that isn’t intended for charging it.

Dr. John Alchemy: Yeah, yeah. In my phone on the wall, really, in case there’s an emergency and I can’t find my cell phone. I mean, that’s the only reason I continue to have a landline. That’s it.

Cory: Yeah, and I mean, what you were saying about being sort of kind of attaching yourself onto something that has already crossed the zero to one, divide the on off the IO divide. As a person who plays music, just thinking about historically, bands and everything, a lot of times you’ll hear about like, oh, this this band was the first metal band ever, something like that. And then right, you find out oh, no, that was built on a foundation of, of all these other things that are happening. And I think a lot of people not not that they’re thinking about the first metal band when they’re making their startup company or something like that.

But I think a lot of people are sort of afraid to do something that is that is so radically new, because it’s a risk, there is a risk involved with it. So what it requires in order to successfully pull it off is an original vision, I think that it’s invaluable, and it’s, it’s necessary, but I think a lot of people, it’s almost like the time and effort that’s required to get to the point where you’re having that original vision, it’s like, oh, I could just make the thing with the green and orange buttons on it instead. So yeah, that is why it’s important to see what divides need to be crossed, especially if it’s relevant to something that will help people.

Dr. John Alchemy: So yeah, and you really have to be ready to do a pivot. And getting back to the Tesla analogy, Elon Musk, in his interview with saying, look, when Tesla started, they just wanted to build electric motors for other car companies. And lo and behold, no one would buy them why because they wanted to make gas cars. And then they thought they would drop it, in a lotus, and, just put a battery in lotus. And now they have, they don’t have to manufacture a car, and they can just put in a battery and electric motor, well, they found out that they basically had to rebuild, 90% of the car to make it electric friendly. And that’s when the light went on and said, we’re building cars from the ground up. And that was really the beginning of Tesla’s we understand it. Yeah, absolutely.

Cory: Yeah. When I was living on on the coast, I used to drive by the Tesla factory all the time. And it was kind of when they were coming up, it was before I knew much about it. So it was just like, oh, what is that? what is that huge place?

Dr. John Alchemy: Yeah, and back when I got one of my first Tesla’s in 2017, I remember the delivery center, you walked in there, it looked like an Apple store. And there was someone that would greet you, and they would put the app on your phone. And then you would go sit down and have an espresso from the Tesla embossed espresso machine. And then they would take you out and walk you through your car, and make sure that you knew about it and off you would go and to me, that’s when it really clicked on me that hey, this is the new model of software transportation, essentially. And if you haven’t bought your stock, yesterday, you better buy it today because, this is really going to take off and it’s very clear, like when the first smartphones came out, it was it was a wildfire when it switched over. And I think we’re seeing that in electric cars now too. With with a production constrained Tesla, they just cannot. I mean, there’s a chip shortage, but aside from that, they have a difficult time keeping up with demand.

Cory: Absolutely. Yeah, absolutely. Hopefully that is bringing up lay interest in programming as an embedded programmer. I hope that that it’s funny, you get into something, you find a hobby that you really like doing and then suddenly there’s a worldwide shortage on that thing that you just, have to have.

Dr. John Alchemy: Yeah, you have to have to have it.

Cory: But we have here, something that something that you’ve called A Tale of Two ratings, and I’m intrigued about this, John.

Dr. John Alchemy: Well, if this is something commonly that we’re seeing at the timeline for RateFast right now, and I’m seeing it, I’ve seen it more and more and now I’m actually starting to see it less and less but but the example I wanted to bring up was actually an insurance adjuster company that purchased the RateFast directly, there was a doctor that didn’t want to do it, and they couldn’t get access, QME. And I won’t go into my feelings about QMEs and doctors impairment ratings in general. But anyway, so they purchased the report directly from RateFast, RateFast wrote the report for them. And then the insurance adjuster felt for some reason compelled or I think, I think systematically required to obtain a second party review service of the report that they had purchased from RateFast. And, I won’t go into the details about, what triggers in an impairment report to be reviewed by a second service.

Cory: We have plenty of material on that already.

Dr. John Alchemy: But anyway, so the second review service basically lifted up the hood on the Tesla car and saw a Fronk or just an open space in there. And they’re like, where’s the motor, and if I can’t see a motor, this car can’t drive. And if it can’t drive, it must be broken, and therefore the rating must be zero. And that’s exactly how they reviewed the report. And they even went as far as to say, this RateFast rating value is arbitrary. And it they simply, they just had no explanation as to how the rating, was done to such, detail on the amount of information that was in the report they were reading.

Cory: Essentially, what I’m imagining in my mind is that you traveled, it’s almost as if you traveled back in time and then handed somebody a cell phone and told them it was a telephone, they’re like, this is not a telephone.

Dr. John Alchemy: Yeah, it’s very similar to that. And what we’re dealing with is an adjuster who wants to be on the leading edge, definitely wants to do the right thing wants to get an accurate impairment rating. So they have, they have one foot in, I want to be innovative, I want to get this done, I want to do the right thing. And then the other foot has kind of stuck back in this, oh, I better hire some, cottage industry impairment rater, to make sure that this is okay, because I still need that blanket to hold on to in order to feel good about the rating, because I don’t know how to check impairment ratings. I’ve hired a service with a great reputation. But yet, I think I better have my, gasoline mechanic, take a look at the electric car here. And give it that. The 20 point maintenance check in, there’s no oil dipstick. Now what do you do?

Cory: And so yeah, so we have kind of two, I wouldn’t even necessarily say competing, because it’s not, to this point, it’s sort of a, just just two things that are introduced to each other. So to two philosophies here. And so we have one that is sort of, I mean, pretty much at this point, your only real knowledge of it is that it’s just another philosophy, and their only real knowledge of it is, I don’t know what I’m looking at, therefore, it must be wrong.

Dr. John Alchemy: It has to be wrong. Yeah. What well, it is in their context in their world, it can’t be correct, because, it wasn’t written old school, and that they don’t have the tools to understand what they’re looking at. So the easiest thing to say is, yeah, the money you paid me to look at this as correct, and I’m telling you, it’s just a wrong report. So, therefore, your money was wasted, which I will argue with a little bit later. Yeah, probably was wasted.

So but the issue is, RateFast, and digital impairment rating as it continues to grow and become more of a flywheel, the more information we get, the more data we get, the more things we’re able to infiltrate with, digital determinations and algorithms and stuff, is that we’re only getting better and more granular at what we’re doing. And it’s simply just another example of software eating up an industry. It’s not that the invention of the electric car is is is all that, earth shattering, it’s the way that the software is being overlaid on the car. That’s the real innovation that’s happening.

Cory: It’s the way that the individual components kind of dovetail into other kind of aspects of life. Kind of irrelevant or tangentially related topics and industries and stuff.

Dr. John Alchemy: Right. So the adjusters to be commended on, wanting to, to invest in the new technology, and that’s exactly what they did when they purchased the report and the report’s fine, there’s nothing wrong with it, but it’s understanding it and getting your head around, wow, the things I’ve worried about in the past, I don’t have to worry about now. And I can either use that time to do more work more efficient, more meaningful work, or I can, give it over to an old mechanic that doesn’t know what they’re looking at and pay them money to do something that really is not going to affect the outcome or the validity of the report in any way. You know.

So we have these Luddites. Yeah and it’s, I don’t want to use his negative term, but these people who hang on to manual calculations and narrow understandings, those things are kind of gone, we’re not worrying about the things that they worried about, because there’s so many metrics that are now used in a report to determine a rating, that you can’t go at it from one angle and say, yeah, I’m going to, get a get the correct impairment rating by using one approach when we’re now using five, let’s say, to arrive and adjust for values. So I think we’re finding a lot of these people stuck on the zero side of the divide, and there. And it’s been interesting, because doctors are really the first ones who want to do the crossing, they traditionally don’t like impairment reports, it sucks up a lot of time. It’s not good revenue. It’s just a loser in every direction for a doctor.

Cory: So I mean, you’ve explained this, so I’m not asking you directly, but I have, asked you this directly. It’s like, how do you get into an industry where, that it’s just bad, it’s just made in a way that it just, things are just don’t work? And I mean, for you, John, you had a vision of making it better. But, yeah, for the people that don’t want to adjust to that, it’s sort of like, what, you’re just a masochist at that point. Because you clearly got into it, knowing that into work on knowing that it was like an inefficient system and everything, and then when presented with something that could be a better option. If you don’t want it, then you are hurting yourself, or you’re wasting your time or something.

Dr. John Alchemy: Yeah, I mean, I guess there’s a lot of ways we could, we could talk about that. But the one thing that, that I think we’re coming across is that I’m seeing a lot less resistance from stakeholders on RateFast reports than I ever have. And I’m seeing things in reports saying, send this case to rate fast for rating, that’s just part of their treatment plan. And, hopefully, it’s becoming a brand that people have faith in, they know, it’s an unbiased, standardized report that’s getting better and better. And it’s something that they can invest their reputation in, as well by knowing it’s the good faith and credit of RateFast. And that’s really ideally what we want, we want value in our reputation and our product, above all things. And if we don’t have that we really, we really don’t have anything to bring to the market.

Cory: The good news being that we do have some very enthusiastic customers of ours, so yeah, yeah. So we’ve got that part covered, that’s good.

Dr. John Alchemy: Well, and they’re doing well, and they’re spending their time on things to grow their business and their market share, as opposed to arguing with adjusters and attorneys and the DEU about, ratings that were manually done, and getting caught in that they can be freed from that, which is really nice. And we’re, I think we’re just at a point now where, and this has happened to me personally, a couple of times that, the first time you hear about Google or Facebook or Uber, like it’s already happened, it’s like, when did this happen? And then suddenly, everyone’s using it. But, the company was started, like, six years ago, where was it? And how did it come out of the blue? It didn’t it just, it was just such a useful concept and so disruptive that, it had to prevail. And I was back on the zero side of it, and just learning about it.

Cory: Sure. Yeah, absolutely. Sometimes you think you’re on the one side, then you have yet to make the leap and things like that.

Dr. John Alchemy: Yeah, and RateFasts the exact same way. I think that eventually the markets going to wake up and say, yeah, what were we thinking? And wow, this did happen a long time ago. And we either discounted it or didn’t know about it or didn’t understand it. But of course, everyone uses it now. And there’s a lot a lot less angst about impairment rating, hopefully. And we move on and innovate something else.

Cory: Yeah, that needs to be done. When they discover that we will be at the at the subatomic granularity level, we will have, in the way that we’re talking about sort of incidental innovation coming from, like, a larger idea or something, we will have discovered the meaning of life by that time.

Dr. John Alchemy: The meaning of impairment ratings. Yeah. Right. But it’s going to come down to those that will follow us into the space and the message is simple, if you want to correct and you want it accurate, come with us. But, if you don’t, we’re not your company. And I’ve always wanted to keep it very clear, and very simple that, if you if these are your values, correctness and accuracy, and getting a fair rating the first time, buy from us, buy our car, charge with us, whatever, but if you’re but if that’s not your game, and you’re looking for, a rating that you’ve predetermined, and you need someone to massage or somehow find that result, we’re not your company. If you’re a glutton for punishment, we are not your company.

So anyway, I wanted to wrap up just with kind of the things that we’re using to disrupt impairment ratings, and then we’ll close it up. It’s been a long podcast, but I think a lot of the generalities we’ve raised are valid, and maybe someone out there who’s has some influence in the industry or really wants to scale their business of work comp, or their footprint, is going to hear the podcast and say, yeah, that’s us, and we want to invest in those values. And become part of that RateFast DNA in the business, we do whatever aspect of work comp they’re in. So, but anyway, getting back to the arbitrary comment of the of the cottage industry impairment rater, who was looking under the hood and found themselves staring into the abyss, actually, of computer chips, and in motherboards and so forth.

Cory: It sure like looks like the Abyss when it’s your first time looking at it.

Dr. John Alchemy: Yes, it sure does. But just to kind of walk people around again, what we do is that, when we look at impairment ratings, we do not look at it a narrow set of data. In the report, we’re looking at a report, that’s run in parallel, and three different dimensions that we document and we review. And the first one that we do is something that basically, I’ve never heard anyone talk about, and that’s the data integrity, what’s the quality of the data here? How much of it is, is here? And how much is missing? I’ve never, ever seen an impairment report and impairment reviewer talk about data integrity, they say, oh, yeah, these measurements were wrong, or they’re incomplete.

But there’s never any number on it, and you never have any idea if it was a little data missing or a lot, or if it was good quality, or if it was, junk data, which we’ll see lots of times in reports. And it, yes, and then we do the standard WPI, based on the objective findings, or lack thereof. So yeah, we create the WPI, and figure that out for you. But then the last thing is that functional loss rating, and that’s really the big elephant in the room that controls all AMA Guides, ratings, is how much function has this individual lost, and it’s not always accurately reflected in the objective findings, doctor didn’t do everything they were supposed, or the dog cut off part of their data set? I don’t know.

Cory: What that’s what the we hear that from doctors all the time, we were inclined to believe them, you know?

Dr. John Alchemy: Yeah, the patient ate my data set. The other thing that we do that’s unique to us as we’ve started to classify reports, based on natural language terms, and that’s really a big deal in the industry. What does it mean when someone says that there’s some loss, there’s minor loss, there’s significant loss, those things just, have never really been documented or standardized or defined and RateFast is doing this in conjunction with all the data that comes in and of course with with the rules, and in demonstrations outlined in the AMA guides. So, it makes it powerful to be able to take a report a standard report that’s written in terms, that reports are actually written in and generate some type of impairment report from that, instead of running it through the med legal system and, getting 10 different results. And everyone claiming they’re right.

So anyway and then we take all that data, and this is really another big advantage, once you have mastered the data and have obtained it and digitized it, you can use that for other aspects of the report. And another elephant that sits in the room is impairment is apportionment. So apportionment is the stuff that’s non industrial that’s contributing to the permanent disability that’s going to be recognized in the in the settlement. And these are things like preexisting injuries, obesity, degenerative changes, arthritis, etc, etc. And I’m just saying if you like the old school, where the doctor writes down, it’s 80%, industrial and 20%, non industrial, and that’s my medical opinion, which in parentheses means that’s my guess. Yeah, you’re really, really not going to like our reports. Yeah. If that’s what you’re wanting. And we stopped guessing 10 years ago, we stopped this, but people have been guessing ever since. And they continue to guess. And it’s just like, what champ? Do you really want to get your business in? Do you want it on something that’s justified and defined? Or do you want to guess, like it’s been done in the past?

Cory: The year, the year is 2070. And us? You still have a gas car? Yeah, you’re finding you’re finding it harder and harder to find a gas station, let alone rolling reserves on the planet?

Dr. John Alchemy: So anyway at the end of the day here, I want to revisit the comment that they made on the RateFast report, the reviewing service. And just the suggestion of arbitrary, and the report is everything but arbitrary. Again, if you understand that the engine is not under the hood with an oil dipstick, but the engine is in the data and the algorithms that help that data talk to each other to make something of it.

Cory: Absolutely. And then if the thing is also, if we show you the work, if somebody says, hey, I saw this, I didn’t understand what was under the hood, I want to see the work, what you will see is what you should have done, which is the work that the entire time, we just made it more efficient. So there’s no, there’s nothing, it’s abstracted insofar as we have the, probably the quickest and most efficient method of doing it the best. But again, like, if you deconstruct that it’s the same thing that you should have been doing the entire time. Just made quicker. So yeah, and that’s kind of why it’s always fun when people challenge when people challenge it, because it’s like, oh, you want yeah, go ahead. Like this is what we used, and we hand them the AMA Guides, fifth edition.

Dr. John Alchemy: Well, in and it’s an opportunity to educate, we’re not here to, at least I’m not here to have, gotcha moments with people out, but I’m just really here to say, look, it doesn’t make any sense doing this, please join us in going forward, if you’re really committed to something that’s more accurate and correct. And getting this case settled, let’s did we forget about that along the way that this case has to be settled at some point. And this worker needs to move on with their life. That’s really what it’s all about at the end of the day.

Cory: Yeah. Workers compensation, right, but you’re trying to compensate worker fairly.

Dr. John Alchemy: Right. Yeah, and the other thing too, that came out of this this tale of two ratings was that the insurance adjuster probably spent the amount of money they spent on having this this review done on the rate fast report probably could have purchased them another four or five impairment reports from RateFast and closed that many more claims. Yeah, use that money towards something that actually moves the needle forward. As opposed to introducing, guessing and confusion into your report.

Cory: Once again, it’s one of those like those dovetail, dovetailing outwards things is you save a lot of money when you save a lot of time.

Dr. John Alchemy: And in closing, Cory, I’m just going to say I was at the science museum in San Francisco a couple of weeks ago, and I saw this shirt on someone walking around there. And it basically said it had like, the NASA insignia on it, and it said the world is not flat, we checked. And it’s kind of the same way with impairment ratings. These impairment ratings are correct. And yeah, we did check.

Cory: Yeah, absolutely. And we continue to check. So, yes, we’ve got satellites in space, we could show you the pictures. So yeah, well, so what we’ve learned here today is that there is an event horizon of sorts for which, on the other side is his vast unknown treasures of things that will just make life easier and better, especially when you’re kind of trying to, similar to the Tesla situation, when you’re in a scenario where you’re not only trying to do something better, but you’re trying to kind of clean up what’s been kind of made a mess of already. And it’s very scary for a lot of people to kind of cross that barrier. And it’s even if you, crossing that barrier doesn’t necessarily mean that you’re like, following somebody or doing something, but it just means that the doors open for you to go and, and partake in this sort of new thing. And that’s what RateFast is done. And we encourage people to come with us and take the easier route than to hang on to a jalopy that’s leaking oil and everything like that.

Dr. John Alchemy: Yeah, and just in closing, I’ll say, and I just want to be clear, everything that comes out of Elon Musk’s tweet account, or his mouth, I don’t 100% agree with.

Cory: You don’t want to have a coup in Bolivia?

Dr. John Alchemy: But they asked him in one interview, really, why are you doing all this? What’s SpaceX and the boring company and Tesla, and giant batteries, saving the world and all that stuff. And really, why are you doing this? And he said, and something that resonated with me was that, I just don’t want to think about the future and be sad.

Cory: Yes. Yeah. And I think that sometimes it takes something that simple, to be an incredible motivator.

Dr. John Alchemy: And I don’t want to think about impairment ratings and be sad. No, because I’ve been sad for a very long time thinking about them.

Cory: And there are many things to be said about with an impairment rating, because there again, there’ is a person on the other side of that, so it’s very easy to be sad about thinking somebody’s not getting out.

Dr. John Alchemy: So, Cory, maybe in closing, when we post this blog for this podcast, you could put the link on there to finding the nearest Tesla Supercharger for.

Cory: Alright, John, well, thank you so much. And we will talk to you next time.

Dr. John Alchemy: We will. Thanks again Cory. See ya.

Cory: If you want to learn more about RateFast, the self driving impairment report, visit our blog at blog.rate-fast.com and take RateFast out for a little test drive at our website, www.rate-fast.com.

Vertical Impairment Rating and Case Settlement with RateFast!

When everybody has a stake in the claim, the best possible conclusion that all parties can come to is the truth. For this you need an objective party, and RateFast is that party. This month, Dr. John Alchemy explains vertical impairment rating in RateFast reports.

If you’re a workers’ compensation provider, adjuster, or case manager check out RateFast Express: the service that writes your impairment reports for you!

 

Vertical Impairment Rating and Case Settlement with RateFast!

Cory Oleson (Host): Welcome back to the California workers comp report. Today is Wednesday, August 25 2021. Back again are your hosts Cory Oleson and Dr. John Alchemy here to discuss vertical impairment rating and case settlement with RateFast.

Here we are back in the studio with the with the California Work Comp report podcast. It’s me Cory Olson and I’m here with Dr. John Alchemy. How are you today, John?

Dr. John Alchemy: Cory. Good afternoon.

Cory: So today’s topic is vertical impairment rating and case settlement by RateFast. And we’re going to talk about how RateFast has assisted in claims, and specifically one claim today and exactly how it assisted that claim and how it sort of eased the typical problems or challenges that all the stakeholders of physicians, the adjusters, the employee and the employer face in a work comp claim, how RateFast, kind of took a took a very standard case of just a problematic work comp claim, and made it fluid and better. So, John, yeah, I’m curious to know about this, about the claim that we’re speaking about today.

Dr. John Alchemy: This is a case that came across my desk maybe about three, four weeks ago, and it really impressed upon me the value of RateFast and the power of knowing a report value correctly the first time, you know, we talked about this before. You know, everyone, I think this is the system everyone envisions ideally, an efficient a correct an accurate system where workers claims can be assessed, valued and settled, you know, just going forward.

Cory: But that a system that I’m sure everybody in work comp has imagined, but not not everybody has seen yet. So that’s that’s our job is to get in front of everybody’s faces.

Dr. John Alchemy: Absolutely, you know, the biggest thing for anyone who’s been in workers compensation on any end of the stick is delay, and the friction with getting stuff done. And the impairment rating is absolutely no different. In fact, it’s sometimes even a little bit more contentious, because we’re talking now about, you know, money in the future and the permanence of the claim. And once it’s signed, you know, there’s no going back, so to speak. So this is, you know, this is a big piece of the workers comp, you know, if you cannot get your case, across the finish line, you really have not succeeded in successfully, you know, taking care of the injured worker.

Cory: Oh, absolutely. And it makes me think of, you know, when you see those, I hope you, I hope nobody has to, like watches these videos or anything, they just sort of come across my eyes from time to time, but you have those those car accidents that happen in the fog or whatever, where, you know, all you can really do is like one one car crashes, and then just then you just have miles and miles of cars behind them. And that’s kind of what I imagined happens when one workers compensation claim gets delayed, it’s just sort of like the pile begins to stack up. And so not only does delay severely affect one worker’s compensation claim, it’s sort of affects kind of all the subsequent claims in the office, because even if you put one aside, you’re gonna have to get to it later, it’s going to cost you more time. Whenever you get around to it inevitably.

Dr. John Alchemy: Yeah and these open claims, you know, they just hemorrhage money right and left, you know, a lot of it’s invisible, that you don’t see, but, you know, these injured workers have to be getting paid their, you know, temporary disability payments week after week, you know, and it’s, it’s just, you know, my every direction you look getting spent or it goes to a third party vendor, and they can’t get a hold of the patient. And now it’s six weeks later, and they never went to the therapy that they were approved for. And you have to start over. And I mean, it’s just, you know, it’s amazing that the system can function if we guess if we even call it that in its present state. It’s just a lot of paralysis.

Cory: Yeah, yeah. So, yes, and this patient that the claim that you were working on?

Dr. John Alchemy: Yeah. So, so again, just to kind of address the problems at the top of the podcast here. So we can clearly identify them. The first one is delay. The second one is friction and friction is, you know, obviously a component of delay. There’s confusion, probably the biggest piece about settlement is confusion of the correct claim value. And we’ve had multiple podcasts on, you know, people’s bias, and you know, what they think an injury is worth, before they even see the injury or read about it, and all these things, but you know, trying to understand the correct value of the two people that really need to do that are obviously the doctor of creating it, the report, but the injured worker and the insurance adjuster, then, you know, obviously have to sell it to the state and have them sign off on it. So the case, you know, can be legally settled and recognized as settled.

Cory: So many,, you know, sort of hands in it, the cookie jar or whatever that that have a say over how, you know, how much this should be, like, at least two of the parties are not, not opposed, not like diametrically opposed to each other. But, you know, it’s in one party’s interest to well, I guess, you know, if you’re the doctor to make it as fair as possible, you know, and the other party’s interest to sort of, you know, to kind of protect the capital of the, you know, the investment of the employer and things like that. So, you know, there will be friction, no matter what, and, and confusion.

Dr. John Alchemy: Absolutely, you know, and then, depending on the claim that’s gone, you know, what were their delays, you know, that the injured worker feel that they were listened to, did they get the treatment that they perceive that the doctor told them they needed, then you start to build up this distrust or this animosity between the adjuster and the injured worker and often, you know, with the doctor to the doctors get fed up, you know, dealing with this or getting utilization review call this doing five minutes, you know, that? Yeah, all that stuff. So, this trust becomes a factor.

And then finally, you know, the nuclear option, well, should I get a lawyer? And sometimes, you know, it’s a good idea, but sometimes it’s not, depending really on, you know, the claim and the complexity and, you know, multiple factors. But, you know, lawyers have to pay their bills, too. So they get a cut of your claim, obviously, and I don’t think the injured workers always think of that. And then you really lose that that direct communication with the insurance adjuster when you get represented, you know, the injured workers can’t call them directly anymore. That’s that that is that’s another wedge.

Cory: Oh, yeah. You see those things where just sort of like any legal situation where somebody you know, is trying to talk the other party, it’s at this point, and it’s, it’s at no fault to either parties, I guess, but it’s like, hey, I can’t I can’t speak with you about this anymore. You know that that window is past? It is so yeah. And I mean, it’s I think it’s just in everybody’s best interest to avoid getting to that point entirely. Even everybody except for the lawyer, of course, whose job is to do that. But yeah, I mean, yeah, introducing that, that extra stakeholder to the claim, even if it’s the patient, or if it’s the adjuster that gets that extra stakeholder, it’s still more expensive, it’s still going to take longer, you know, it’s not, it’s not the best option to have. So yeah, it’s best to avoid it, if possible.

Dr. John Alchemy: Yeah, so let’s talk a little bit about this case, it’s pretty straightforward. This guy in his mid 40s, had a non surgical elbow injury, meaning he, you know, got treatment medications, maybe tried an elbow strap. A couple of other things, let’s say some acupuncture, maybe even went on to get the MRI, and saw the surgeon just, you know, didn’t want to proceed with a surgery and or wasn’t really a surgical candidate. So, you know, maybe eight months out from the date of injury right now. And the primary trader determines that and to be at maximum medical improvement, and the patient agrees with that, too. Everything’s been done in the patient really doesn’t want to do anything more invasive.

So the primary trader used RateFast in this instance, determined that the elbow was a 6% whole person impairment based on the physical exam. And the key right here that I want everyone to listen to, is that the unique thing about impairment rating with RateFast is that your impairment rating gets double checked, it gets checked based on the physical exam and history, you know, the traditional, quote unquote chapter rating, as we’ve referred to it before the AMA, four corners rating, but then it takes a look at the data from another angle called the activities of daily living rating. And remember that 1% of whole person impairment has to equal 1% of ADL functional loss, according to the AMA Guides and somehow that gets overlooked by the stakeholders.

I don’t know where or how that ever happened. Yeah, but it has, but RateFast has not overlooked it. And we have a way of cross checking these impairment ratings to make sure that they’re within the 10% variance. And that it’s an accurate and correct ratings. So the 6% was checked, it was correct. And in the report was turned in the data integrity, which we’ve talked about before.

Cory: So it’s kind of your letter grade for how good your report was?

Dr. John Alchemy: Well, yeah, kind of. How much was there? How much was missing?

Cory: Yes. Getting your your report back with with heavily annotated.

Dr. John Alchemy: Yeah. What did I miss what’s in the report? Okay. And, you know, this one had an integrity report of 78, you know, percent. So, you know, maybe B- but, but as good or better than many qualified medical evaluations or med legal reports. In California. And remember, this is just a PTP, primary treating physician, doing our exam, his exam, and, you know, this is a good outcome, this is a pretty solid report, you know, just taking a look at it. So, you know, the RateFast reports, they’re well documented, you’ve got all the references, it’s as good or much better than a report analysis that you’re going to get from one of these rating services that, you know, insurance companies sometimes use, I mean, it’s just head and shoulders, in technology and data crunching above anything you’re going to find. And fortunately, in this case, the adjuster recognize that, so. So the adjuster said, this is a good case, you know, send it off to the disability evaluation unit, state has to okay it, and they did no problem at all. And and here’s the amazing thing. So two weeks later, the adjuster sends the injured worker a settlement letter. And the settlement is for $7,800, payment for the injury loss and future care option. And so the patient comes into the doctor, and this is universal. Should I sign this? You know, and because the patient doesn’t really understand how all of this works.

Cory: As I’ve said before, the patient is at work, and then you take one wrong step, and then you slip. And then the next thing you know, you’re in a, you’re on the phone with somebody talking about MMIs and PTPs and QMEs and it did lawyers and all this stuff. It’s like they did you know, nobody plans for this from the from the employer from the employee perspective.

Dr. John Alchemy: Oh, not at all, you know, and you’re just trapped there. So, you know, the injured worker, that this individuals unrepresented. So, you know, they turn to the doctor and say, you know, what do you think, and this happens all the time. Now, the doctor can say, you know, legally, I think you should settle it or not, but the doctor can say, I know that the rating that was used as a basis for this calculation is correct. And if the question is, is the case settlement, correct, based on my impairment loss? The answer is yes. The doctor can say that, because all they’re talking about is the accuracy of the whole person impairment rating that they created. Now, whether or not the patient wants to do future care and stuff, that’s totally up to them. But the real question in this case was, is $7,800 the right value for? For this case? For the financial? Yes. Yeah. Then we knew it.

And we knew it was right, because it not been checked, not only once but twice. And and the treater, very confident, we can say, yeah, you know, they didn’t throw in a QME, they didn’t do all this other stuff and claim, you know, it was this or that or the other thing. And fortunately, the system worked like it’s supposed to work, a correct rating, a timely rating signed off by the state, and a check being proposed based on a correct rating, which was 6%, in this case, and the injured worker went on to sign the settlement papers, and hopefully lived happily ever after. And that’s the whole point of the podcast. We don’t get to say that very often.

Cory: I know. I was going to say what’s unfortunate here is that poor worker now has a has a terribly skewed opinion of how the workers comp system works! God forbid they have to go through or to get or somebody, somebody that they know, you know, who isn’t in the RateFast reach or whatever, which we can reach just about anywhere. But, you know, they’re the work comp system is so easy. I recommend everybody.

So, but that’s, that’s good for them. And I mean, we have a couple cases. You know, we have a very, you know, very evergreen sort of posts on our blog about one of the first successes of RateFast which is when it overturned a QME finding in court, you know and this was the QME whose observations that it overturned, you know, and so we’re sort of collecting these cases. And I mean, we’re not, we’re not doing it with any sort of, like, you know, a sadistic joy or anything like that. But no, we keep seeing these these times when, you know, RateFast as has simplified things for people and, you know, owing owing largely to, to our work and everything, but also just the fact that like, this is, this is what happens when something is broken so badly. And then somebody looks at it says, okay, all right, I’ll do it, you know? Which, yeah, oftentimes, that’s what it really takes to kind of start changing things.

Dr. John Alchemy: Yeah. Well, you know, it helps if you have an adjuster that values objective data. That values correctness.

Cory: Absolutely. Well, when you when you had mentioned that it was the, the adjuster that reached out to you that was sort of how do you say kind of a spark, in my mind is like, wow, that, you know, because because they realize the same thing as, as everybody else, like, you know, if the claim drags on, then that’s costing everybody that’s costing them, too. It’s not sensible, you know.

Dr. John Alchemy: You know, and no one really wins when that happens. Yeah. And unfortunately, that happens all too often.

Cory: Absolutely, absolutely. It’s not, it doesn’t, behoove them whatsoever to, I don’t know, I guess you could say gate keep, you know, or, whatever, you know, it’s, it’s just sort of part of the part of the whole shebang, you know, the doctor doesn’t write great reports, they have to put it away, they’re, they’re spending money, the, you know, the poor employee is just caught up in all of this, the employers waiting on the news, and, you know, just all this stuff, it’s a mess, you know, it’s the best thing that you can do is find the most efficient way to do it. And so, you know, we’re getting out there to try to find other, you know, find find people that are in need of these things, which is a lot of people.

Dr. John Alchemy: In closing above this, you know, the I always like people to have a little bit of a take on well, why is this story substantial? Or why is it significant? You know.

First of all, I want to say this is excellent customer service from the work comp system. We just talked about that. You know, but I think the bigger story here is that the stakeholders can be assured that the settlement value is accurate. And that cannot be said in other situations where you’re looking at a QME report, or the attorneys are arguing over this or that because, you know, often they’re arguing over a number and not over the substance of the case at all. And so unfortunately, you get into these things where someone throws out a number, and then it gets halfed, and then, you know, horse traded a little bit, and then that’s your settlement case, at the end of the day, it really had nothing to do with the actual value of the claim.

Cory: No, yeah. Because the value that everybody was arguing was was just wrong. It’s just yeah, it was built by by bad, hardly support, well, not hardly supported, but incomplete data, everything, it’s assuming it sort of making the assumption that everything was done, you know, the most efficient way possible, leading up to that final number, which is just right, it’s not not true. And, as we said before, if this is your first episode, listening, we’ve said this many times before, you know, we don’t, you know, we at RateFast, we believe that, you know, the ills of workers compensation isn’t on part of any one stakeholder, anyone group of stakeholders, anything like that. It’s the whole system, you know, that that’s why it works inefficiently.

And I mean, you know, at this point, there’s no one that you could particularly you know, blame or put that on or anything like that. It’s just a large, inefficient sort of monstrosity. And and so yeah, it’s not, you know, there are people who are, I guess you could say to blame when it when a when a claim goes badly, but I wouldn’t say that it’s 100% anybody’s fault. If and, you know if a claim goes badly and you know, in our experience when a claim goes badly, so yeah, yeah so it’s also sort of what we’re doing is to is to shift the focus on to what is important and luckily for everybody, you know, it’s not it’s not empty, it’s not just, this is what’s important. It’s, this is what’s important, by the way, here’s how we can help you with it. And that’s sort of what we do at RateFast.

Dr. John Alchemy: Yeah, and I think the other hidden story here is that by settling this claim in the fashion that we have described, alright, we saved the stakeholders, the injured worker and the insurance company, probably 18 months, if they had chosen to contest it. First of all, report that we all know is right, if they chose to contest it, they would have gone into the med legal QME system, it would have been at least another 18 months, on average, most, you know, QME cases have two visits or more.

You know, and so, you know, you’re looking at 18 months, and you’re looking at having saved again, this case saved, I believe, conservatively $4,000 in money, then that would have been extra cost of temporary disability payments to the injured worker, while they’re waiting for this QME, the net legal costs, which have essentially tripled, you know, this last year, and hands down really fast is, it’s better, faster, it’s cheaper for the stakeholders, and that’s the big story. It’s like, you know, this needs to happen more often, we have a platform, let’s start using it, you know, why aren’t we using it more.

So, you know, the clients and the stakeholders that use RateFast, are really getting a leg up in the whole system, because they get to know the correct rating the first time instead of, you know, going through all of these unnecessary steps into ways and basically rolling the dice with an unknown outcome, when the outcome can be known before you start, and that’s my take home.

Cory: Absolutely. And you know what, if you’re a work comp professional, and you haven’t heard about RateFast, yet, there’s a chance that one of your peers has heard about RateFast, and they didn’t tell you because they, they just want to make it look like they’re just suddenly the master.

Dr. John Alchemy: That could be happening, as far as we know.

Cory: So we’re here to blow up their case. So that you know how to do it the best and easiest that way, you could be that person while you’re here. But this is a collaborative effort to fix the wrongs that have, you know, and it takes a village to to save workers compensation.

Dr. John Alchemy: Well said, Cory well said.

Cory: Yeah, as we’re approaching time here, is there anything else that you would like to say, John?

Dr. John Alchemy: I’m gonna keep it simple: get vertical, get RateFast.

Cory: Hey, that’s you know, that’s just like RateFast. We’re keeping it simple. Well, thanks. Thanks again, John. We’re gonna plug in where you can get RateFast and everything right after this. So yeah, once again, thank you for coming on.

Dr. John Alchemy: All right. See you next time.

Cory: All right. For more about vertical impairment rating and case settlement, visit our blog at blog.rate-fast.com and get the rate best workers compensation impairment rating service to try and rate-fast.com.

Workers’ Comp: the Central Issue in California’s Battle over Prop 22

Hector Castellanos, a full-time driver for rideshare giants Uber and Lyft, was injured in the course of work when he was struck by another car “I was hit by another driver while I was working, ended up needing the surgery and months of physical therapy, and I had to stop working for about a year,”

This issue was taken to court after Castellanos alleged that he had been promised a pay raise and increased healthcare by the company, a promise that had not been fulfilled.

Continue reading Workers’ Comp: the Central Issue in California’s Battle over Prop 22

A California Nurse Case Manager’s Guide to Discussing MMI with Patients

Dr. John Alchemy answers questions submitted by Nurse Case Managers regarding ways of discussing common work comp questions with their patients.

If you’re a workers’ compensation provider, adjuster, or case manager check out RateFast Express: the service that writes your impairment reports for you!

A California Nurse Case Manager’s Guide to Discussing MMI With Patients

Cory Oleson (Host): Welcome back to the California Work Comp report. Today is Tuesday, August 3, 2021. This is your host Cory Oleson here with Dr. John Alchemy. For today’s episode, we have a California nurse case manager’s guide to discussing MMI with their patients.

And we are live with the California workers comp report. It is me Cory, like you heard in the introduction. And I’m here with Dr. John Alchemy. How are you today, John?

Dr. John Alchemy: Good afternoon, Cory. How are you doing?

Cory: I’m doing all right, just a kind of a humid day over where I’m at. But that’s just fine.

So the topic of the podcast today is a nurse case managers guide to discussing MMI, which is maximal medical improvement with patients in California workers compensation. And we had previously done an episode on nurse case managers, that will be linked in the description. But you know, we owe it to ourselves to do a little brush up of it. And remember what what a nurse case manager is, and a couple other points about them. So John, what is a nurse case manager as in respects to California workers compensation?

Dr. John Alchemy: A nurse case manager is a nurse with obviously nursing background, it could be a licensed vocational nurse, it could be a registered nurse, it could be a telephonic nurse. But this is an individual with a medical background that is assigned to assist with an injured worker for some reason, like for instance, if it’s a catastrophic car accident, multiple injuries, they’re in a wheelchair, they need home health, they’re going to be in a rehab facility, a nurse case manager will be assigned to that to help the injured worker and the insurance company navigate the work comp system, getting them to their appointments, logistics, making sure medications get to them on time and, and all of that sort of thing.

They can be assigned to someone who has a significant social challenge. Maybe they’re homeless, I’ve had that happen before and they’re living out of their car. They don’t speak English very well, or English isn’t their first language or they can’t read. I’ve had a couple of patients that are illiterate and just, you know, can’t read anything that gets sent to them. Maybe they don’t have internet, maybe they you know, can’t even get an email. So there’s a lot of reasons why nurse case managers can get assigned, but the main take home as they’re assigned, because the injured worker needs help.

Cory: Yes, absolutely. So it doesn’t, it doesn’t necessarily mean that there’s any sort of like, legal ramifications to the claim the way that you know, if an attorney was involved or something like that, it’s simply that the patient needs help. And, you know, that would help everybody else close the claim.

Okay, so a nurse case manager assigned to a claim to help a patient get to their appointments or do other things that, you know, they’re just kind of thrust into the system all of a sudden, and, you know, oftentimes they need assistance. And so this nurse case manager, where do they come from? I mean, who assigns them? And, you know, it sounds like there’s multiple reasons that one could, you know, come on a claim, but are there, you know, specific or common reasons why a nurse case manager would would jump on the claim?

Dr. John Alchemy: Well, usually they’re assigned by the insurance adjuster, the adjuster is either become aware that there’s going to be some significant challenges in delivering or coordinating care, or, often myself, I will identify that from the primary treater. The patient comes into clinic, you know, I just can tell that they’re going to have a hard time they, you know, really need a lot of help a lot of instruction, a lot of redirection. And I’ll actually just put in a request for authorization for nurse case manager, I’ll maybe put it in there for six months or three months, or just enough to help them get through a surgery and recover and then you know, we can kind of take it from there.

So it can be a doctor. It can be the insurance company, usually. But I would say, you know, either one can assign it. And the biggest question I always get from the injured worker, because nurse case managers come to the appointments so they know what’s going on. They ask questions, they find out what the next steps are. They write reports, submit those to the insurance adjusters, the adjuster knows what’s going on. But the most common question I get from the injured worker, is this nurse case manager hear from the insurance company to spy on me?

And most common concern is that, you know, this nurse case managers hear, you know, because they’re, you know, want the insurance, they want to help the insurance company out and they don’t want to help me. And I think that’s the biggest misconception that I need to realign people’s thoughts around and let them know no, this nurse case manager is really here as an advocate for the claim. The insurance company pays everybody they pay the doctor, they pay me you know, I’m paid to take care of you. It’s we’re all paid by the insurance company. But we’re all supposed to have the goal of you know, getting you better doing what’s right and not ordering things that are going to hurt you. So we often will have to get some of the patients back on track and let them understand that, you know, having a nurse case manager is really a benefit and not a handicap in the case.

Cory: Absolutely. Absolutely. To all of the people who developed a very, very specific and lofty ideas over the last year, I can say that nurse case managers are not a sysop.

Dr. John Alchemy: Thank you for clarifying that.

Cory: They work neither for the FBI or the CIA. As far as I know.

Okay, so you’ve clarified that they don’t work for the insurance company. You also, you know, it’s natural to assume that okay, who’s this person all of a sudden, who’s going to be giving me rides or something like that? But yeah, they’re nurses just kind of got, you know, they got assigned to the claim to help.

Dr. John Alchemy: Yeah, they’re a paid advocate. And obviously, the insurance company pays pays their bills.

Cory: And that’s a good point that, you know, for work comp claims and everything the insurance companies pay you as well. And that’s, you know, any, if there’s any nurse case managers listening, who has to tackle that sort of suspicion, or like, or establish some sort of trust with their patient or anything, I think that’s a wonderful point to make, or that would just drive them insane thinking about now the doctors working for the insurance company!

Dr. John Alchemy: It really becomes clear.

Cory: Yeah, at that point, if your patient is kind of on that on that vibrational level, then there’s nothing much you could have done anyway. And, and that’s what would happen if you got me as a patient if I didn’t talk to John. So, um, so how long is the nurse case manager on the case?

Dr. John Alchemy: Yeah, so they, they run on the case, typically, until the case reaches MMI. And on our podcast, we always like to talk about maximum medical improvement or time to write the case or 12 months, no change with or without treatment, which is MMI. So they’re there to get the patient as well as they can. And then they sign off the case.

Cory: Yeah. And MMI in the words that I could only understand when I started doing this podcast was as good as you’re going to get after. Which is a very subjective thing. And the funny thing is that, you know, the, I mean, it’s not the patient that walks up and says, I’ve reached MMI. If only it were that easy. Because it’s all the other people who think that it’s the doctor that’s supposed to say that and everything but or to determine that, but, um, so now, okay, so we have our framework for what a nurse case manager is, it’s a professional nurse who has been assigned to a patient, when a claim needs help, the person who assigns them can either be from the insurance company, or the doctor themselves, or possibly even another stakeholder in the claim, if there was like an attorney involved, I guess they could recommend it.

Dr. John Alchemy: Sure, yeah. Possibly.

Cory: And they do basically, any kind of task that is required to make sure that the patient makes it to their appointments, and that their work comp claim goes smoothly, including attending the appointments, which is just part of the part and parcel with being a nurse case manager, for a work comp claim. So the next portion of our podcast here today is that we actually asked a nurse case manager, what are the most common questions that you get from your patients?

And what we’re going to do is we’re going to provide those for you today. So that you have those answers kind of in your back pocket, when, as we understand, inevitably, these questions are asked to you. So I’m going to start off with the first question here. And the first commonly asked question from patients to nurse case managers, John, is, how does the MD come up with impairment ratings? And does pain come into play?

Dr. John Alchemy: Yes, common question, how does this number get made? So we need to tell these injured workers that when you’re done, we need to figure out what your loss is, and how much you’ve lost as a result of the injury. So we have a book, we have a book in California. It’s basically a doctor’s recipe book, if you will, and it tells the doctor how to do a special exam based on the part of your body that got hurt, and come up with a percentage loss of that body part. So for instance, your whole body is worth 100%. Meaning if you’re in a coma, you’ve lost 100% of your of your person, if your arm or to be removed, unfortunately from an accident, you know, you would lose 60% of your person for that, or 40% if you lose a leg, so it’s based on a percentage of an entire person.

And, and there’s special rules, it’s a special exam. It’s not the typical exam that you might get when you’re going in for a route, recheck or even your first visit. But it’s it’s a physical exam that allows the doctor and the insurance company to take your findings, your findings alone, and put them into a context of how much you’ve been injured, and how much function you’ve lost as a result of your particular impairment. And yes, pain definitely does come into play. Pain is considered in all of the ratings and all of the body parts, pain and or symptoms. So that’s definitely part of it, what you can do, what you can do at home, what you can no longer do at home, how fast you can do it, or if you can even do it at all. All of that is placed into the context of your impairment rating.

Cory: Yes, the way that I was thinking about the AMA Guides, when you were describing it just now as I’ve never thought of it in the context of if I was talking to somebody who had never heard of them before, anything like that, and I just had the idea. The AMA Guides is is a lot like almost like a math book, where instead of the one train leaves from Chicago when train leaves from LA, you know, it’s your body.

Okay, so question number two, does the PTP or primary treating physician have to agree with the final final report recommendations? What if a qualified medical examiner or QME says says that the injury is permanent and stationary, but they want to continue treating the patient? Or vice versa? What happens if, if the insurance company says you are not permanent and stationary? But the doctor says they most definitely are, what happens? I guess in either scenario?

Dr. John Alchemy: Well, let me just clarify for everyone. So the QME is a state assigned doctor and the insurance company can call that at any time. So if your treating doctor for some reason, you know, isn’t writing clear reports, or that doesn’t clear to be a clear arc on that treatment plan and stuff. Sometimes, the insurance company will order a state qualified medical evaluator this can be ordered by patients as well. And they’re supposed to step in, you pick a specialty, and they’re supposed to step in, and basically just give an opinion. Remember, these doctors are not allowed to provide any treatment, and they’re not allowed to direct treatment, they can make treatment recommendations, but they can’t say, you know, I’m going to give you Advil, or I’m going to do shoulder surgery on you next week to fix your problem. So they’re only there as consultants.

And the insurance company can choose to, you know, follow the QME report, or they can choose to follow the PTP or a combination of both. Often what happens is a QME report comes back, the insurance adjuster will say, hey, the QME he thought that this patient needs maybe some further testing, what do you think primary treater? And the treater can say yes or no. Sometimes the QME says, oh, no, I think this person is reached maximum medical improvement, there’s nothing more to do for them. And, you know, here’s the rating value, and that can go the wrong way, too. I had a case where a QME basically gave my patient who couldn’t raise their shoulders, at or above shoulder level, they gave him a 0% impairment and said, there’s nothing else to do. This case was MMI.

And I wrote back and I said, well, I respectfully disagree. The patient hasn’t had any therapy. They’ve had no X rays. Their arm doesn’t work. So it’s like, you know, I don’t I not really quite sure what planet that QME may have done this exam on, but I’m pretty sure that it’s not maximally medically improved. And you can always tell the insurance company and the patient yeah, take this into the state have, you know, have a judge look at this. You know, if this just doesn’t make any sense at all.

Usually, it’s not that extreme, usually other reasonable recommendations, but the bottom line is, at the end of the day, the PTP has to write their own impairment report, that’s part of California Labor Code. There’s no way around it. The PTP can adopt the QME report if they think is reasonable and accurate. But they are required to come up with their own version of the patient’s whole person impairment and MMI report one way or the other and that often gets missed because a lot of treaters think, oh, this person saw QME, I’m totally excused from having to do an impairment report. Not true. Not true.

For those of us who do impairment reports for living, after you’ve seen a few QME reports, you realize that some of them are less than complete, and less than accurate sometimes. And so it’s important that if you see a mistake in the system, you have to stand up and say something and say, look, this needs to be fixed. Or there’s an error here, because if we don’t address it, now, it’s only going to come back later with an attorney. And it’s only going to take you know, longer and be more expensive and more frustrating for everyone. So I tried to get these QME reports called out early if there’s a problem, because it only benefits everyone. You know, going forward.

Cory: Yeah, if everybody if everybody’s doing their job, then it’s gonna be a smooth work comp claim. Yeah. If people aren’t doing their jobs, you’re gonna have these stakeholders just walking in the door. You’re gonna have the patient in the doctor’s office, you’re gonna have a the rep from the insurance company… No, not really, but I’m just imagining you just the whole, kind of like the Richard Scaries book of Workers Compensation, then you’ve got this sub Rosa guy outside with the binoculars looking through the window, waiting to come in.

Okay, um, all right. So question number three, do the temporary disability benefits stop when injured workers are permanent and stationary? Or they’ve reached MMI? And and if they don’t, then when do they?

Dr. John Alchemy: Yeah, that great question. And an important question, because a lot of these injured workers are dependent on the income if they can’t work. So, in general, the payments for temporary disability will go on for about two years, and at two years, they’re going to stop regardless. But as soon as the patient becomes maximally medically improved, the payments also stopped. Because the patients no longer temporarily disabled, they are permanently disabled at that point, if they can’t perform their usual and customary work.

And then the decision of accommodations need to be made. So when when the case becomes MMI, or permanent, and stationary, or PNS, whatever term you want to use for it, the employer has to decide if they can make a permanent accommodation and keep that injured worker on or if they can bring them back to work with the permanent restrictions like no lifting over 25 pounds. If they can’t, the employer can release them permanently and go out and find someone else. And then the injured worker is left with either going out and finding a job that’s within their capacity, or getting retrained in another vocation, another job.

Cory: Yes. And on to the next question, does the patient have to accept the settlement offer?

Dr. John Alchemy: Well, it’s an interesting question, because the offer is really based on the impairment rating. And the real question is, is the impairment rating accurate enough for the justification of the settlement offer? So if you think of a whole work comp claim, as like the building of a house, the impairment rating is the foundation it’s the bricks and mortar that support the entire building, if you will. And it basically says, you know, how much loss is there? Why is there loss? What are the basis for this? Where are the measurements? You know, what did you do? What are the tests, and all these things are the foundation of the claim.

So once you have the claim number, and it’s the doctor that delivers the whole person impairment, okay. And once that doctor delivers that whole person impairment, that is the piece that the injured worker needs to be confident in, that they’ve been adequately reviewed. And this is also a concern of the insurance adjuster too. Is this an adequate representation of the individual because if it’s not, you can bet someone’s going to come back and it’s going to go to court, and it’s going to get dragged out for months and years, if it’s not accurate.

So it’s in everyone’s best interest to know if the settlement offer is solid, you know, and that’s why I just plead with insurance people sometimes like, hey, do not go out hunting for a 0% whole person impairment. That is not what this is about. This is about going out and getting the accurate number to settle this claim. So it doesn’t bounce and keep coming back and keep coming back. Because, you know, the goal is to find the right value settle the claim, and have a basis to the claim settlement, as opposed to just saying, oh, I found a case with a zero. I’m going to use this one or likewise, the injured worker finds a case with 100% whole person impairment. I’m going to use this one.

And neither one of those are reasonable options, though, the real question is, what is the real accurate whole person impairment because once we have that number, it gets put into effect, a simple formula that calculates permanent disability. And those two things are probably the most easily confused by everyone in the system. It’s the whole person impairment, and then the permanent disability. And the permanent disability is nothing more than a number that is generated based on a fixed formula on age and occupation, as a main driver inside of it is the whole person impairment. And that’s what sets the price.

Cory: Yes. Okay, so we have two more questions here. But I’m going to kind of condense them together, because it’s just about the same thing, essentially. Yeah, the last question being, what if the insurance company offers a low settlement amount, but it has future medical care, versus a high settlement amount, but no future medical care? What should the person do? And why in that circumstance? And then regarding the future medical care and everything, is there a time limit on it?

Dr. John Alchemy: Good questions, excellent questions. And I think sometimes doctors, when they get this question, or insurance adjusters, or, well, probably more than nurse case manager and doctor who are in the field with the patient, when they get asked this, there’s always a tendency to, you know, want to try to give the patient your best advice. But, you know, doctors are really only supposed to give medical advice, they’re not supposed to give legal advice or settlement device or say, well, that claims too high or too low.

Now, the way I approach it, is I always take them back to the whole person impairment value. And I say, Look, this is a good value, or this value is correct, or this value is incorrect, in my opinion, and I’ve already told the insurance company about it. So I substitute money for whole person impairment, because that’s where I’m allowed to talk to the patient. And that’s where I’m allowed to do an analysis on the medical report that will ultimately determine their settlement amount.

Now, this whole thing about future medical care, and then this other concept, also known as compromise and release. So the way that this works is that you get a fixed payment for your loss based on your measurable permanent disability, which is, as I said, based on your whole person impairment, so you get an amount of money for that, that’s not going to change. But this future care means that you can continue with treatment, and the insurance company will continue to pay for it. So if I need medications for the rest of my life, or I was told I need a surgery in 10 years, if I keep my future medical care, the insurance company, theoretically will pay for that, which what what the patients don’t always understand, is that everything in the future has to go through utilization review appeals, just like everything before the whole before the MMI exam.

So that doesn’t change. So just because future care says this person is going to need a surgery in the future doesn’t mean that it’s going to be approved, because all the information has to be you know, brought up to utilization review, etc, etc. So future care simply means access to ongoing care, but it’s still under the same rules as your pre-impairment rating.

Cory: So everything’s not full smooth sailing right after you go. You can’t just get that face work you’ve been meaning to get? No, I’m kidding. Yeah, well, that’s is insanely practical advice. And I imagine that there’s so much going on in workers compensation that I imagine that the nurse case managers just might need to brush up on some of this stuff.

Dr. John Alchemy: And here’s the other road that I’ll just say, before we wrap this up, is that, you know, I think sometimes patients get this misunderstanding that, oh, I’m going to do a compromise and release, I’ll get this money in my pocket. And then I’ll just go out and get the treatment I want, you know, I’ll get that surgery done. You know, and what I caution them on is, first of all, you really need to understand what the horizon is on your treatment needs. So are you going to need treatment only for the next five years, the next two years or the next 20 years for the rest of your life, really. And then you have to remember that as a patient, you are paying retail, and as an insurance company, they are paying wholesale. So you know if they’re going to give you $8,000 In the future for you to go out and pay for your own shoulder surgery. And then they’re going to release you with no you know, with no responsibility for your future care in the future. You better go out and ask what a shoulder surgery is going to cost you have to pay out of pocket, you know, last time I checked is about 27 to $30,000 and there’s double double digit inflation in health care every year. So that it sounds like a good thing but you better check with your financial planner. Just to make sure that your numbers are correct.

Cory: Yeah, have a have some sort of exponential, use exponential when you’re planning years ahead. Well, great. So we have learned today that you know, nurse case managers are good and sometimes even necessary in moving claims forward and getting them closed, for sure. And, yeah, are there any kind of final words that you have today, John?

Dr. John Alchemy: Well, these are all great, really great practical questions, anyone who works with patients or nurse case managers, or even, you know, insurance adjusters, etc. These are just bread and butter questions this nurse case manager brought to us so I want to say thank you very much. And you know, always send in questions. And if you think that there’s a topic and a podcast you’d like to hear more about, let us know.

But just wrapping this up, nurse case managers absolutely are extremely valuable. They are advocates for the claim, they’re going to be with you until the claim is MMI. And you’ve got everything you need. They’re a great source of information for the adjusters for the doctors and the patients. And they’re really there to be used as a resource and support for the best outcome possible for the patients and that’s the way we need to think about it.

Cory: Well, thanks again for coming on John. And we will talk to you next time and nurse case managers, if you’re out there. Listen to this podcast and share it with your your nurse case manager friends, it might help them and it might help their patients.

Dr. John Alchemy: Thanks!

Cory: Thanks again for listening. For more information about our episode, visit our blog at blog.rate-fast.com and if you want your workers comp impairment reports done and your claims finally closed, visit us at rate-fast.com

Summer 2021 COVID-19 Report

In the months following the initial vaccine distribution early this year, it started to feel as though COVID-19 was soon to be a distant memory, a thing of the past. People began going outside, mask mandates were lifted, friends and families reunited. Much joy was had.

Of course, as we know having lived the past few months, this didn’t last very long.
Continue reading Summer 2021 COVID-19 Report

Factors to Consider Regarding the Future of California Workers’ Compensation

Dear reader, look into our crystal ball. It shows you the future of California workers’ compensation. All who gaze into it see something different. Some see a workers comp system running with the clarity and ease of a mountain stream. Others simply scream and run away.

In this post we will examine workers’ compensation as it is today, and see if we can use this insight to make a few educated guesses of what the future holds.

Continue reading Factors to Consider Regarding the Future of California Workers’ Compensation

RateFast Express is Free… Here’s the Catch

Gotcha. There is none.

When people have become accustomed to working in a poorly functioning system, they are naturally suspicious when something comes along which seems to have solved the problems which everyone has come to accept. In fact the skepticism often comes along with an unwillingness to change out of habit, a dangerous cycle.
Continue reading RateFast Express is Free… Here’s the Catch

RateFast Podcast: Calculating the Integral of ADL Functions in Work Comp Reports


If you’re a workers’ compensation provider, adjuster, or case manager check out RateFast Express: the service that writes your impairment reports for you!

 

Calculating the Integral of ADL Functions in Work Comp Reports

Cory Oleson (Host): Hello, and welcome back to the California Work Comp report. Today is Monday, June 14 2021. And today Dr. John Alchemy will be educating me about calculating the integrals of ADL functions in workers compensation reports.

And we are back. How are you doing tonight, John?

Dr. John Alchemy: You know, we’re back at it, Cory.

Cory: We definitely are. So today’s topic, we are talking about calculating the integral of ADL functions in impairment rating. And this is going to be one of those ones where, John, you’re going to be educating me quite a bit. I have a list of questions here. And, I am all ears for these things. So I guess we could start out with with calculating the integral of ADL functions and impairment ratings. What is it?

Dr. John Alchemy: Well, impairment ratings are driven as, as we’ve talked about before on the podcast, with regards to pain in ADL function and the pain chapter kind of drives the definition of ADL function. And that analog pain scale of 0 to 10. One of the common problems with impairment ratings is that a number often gets thrown down in the report for body part, for instance, low back pain, 7 out of 10. And they might say that it’s frequent. And then you go on to do the ADLs. You know, and the AMA Guides, table one, dash two and page four, you know, it’s got 34 ADLs. And so you go through that, you know, in good report, and you, you answer those, and you get a number some number out of 34, like, let’s say 7.

Cory: Which by the way, I jumped in without doing my job. ADLs, by the way, are activities of daily living, as defined by the AMA Guides, fifth edition, and those are the things that you do every day, which kind of if you were injured at work, you know, if those if your injury affects any of those things, and it affects your claim, and it affects ultimately your impairment rating. So that’s what ADLs are when we refer to them here. For the new for the brand new listeners, you just happened upon this word called podcast.

Dr. John Alchemy: Starting in the middle of your RateFast podcast binge, right here. Right, so ADLs. And remember, those are things at home not work. Everyone has the same activities at home, everyone has a different activity at work. So we go by the activities of daily living in the daily life. And in so you know, when you look at a number like that, in, we refer to that as a pain signature. And the pain signature is simply the 0 to 10, the frequency, the number of ADLs affected that are only painful, but don’t stop or alter the activity, and then the number of ADLs that are limited or do alter the activity of daily living, that’s what we refer to as pain signature. And so what happens is that you have to look at people’s activity and their pain in function throughout the day, of all the activities of daily living that they’re doing.

So the question comes up, that if my pain is 7 out of 10, and 7 ADLs limited, that means what is my pain across the other ADLs that are not included in the 7. And I know that those 7 are limited, because that’s consistent with a number of 7 out of 10, we define limiting pain as a 5 over 10 or higher. So we know that in that example, that I just gave, that the individual has limited ADLs. And therefore, you know, they have some ADLs that are limited, and sure enough, they have 7.

So the problem comes up often that the number tends to not be properly scaled across the individual’s full day. And that’s what the integral is about integrals. For those of you who have ever taken calculus, it’s all about calculating an area under a curve. And if you think about your day as activities, you know, that you can can’t do certain activities as a subset, you can really think of that day as a curve of when you can and can’t do things in a split line. And that’s what we’re talking about. We’re talking about further adjusting the accuracy of reports to better reflect an individual’s limitation on their activities of daily living. That’s what this whole feature and concept is about.

Cory: Okay, yeah. So you know, the injury that you’ve incurred, mixed with The myriad factors of how the body works, and also the things that you do in day to day life, you know, it can affect the amount of pain or the amount of, you know, kind of impairment or what have you, like physical not in the work comp, sense, but the, the amount of actual, like physical impairment that you have on your activity of daily living, which can vary throughout the day. And it’s it. And it sounds very important to know all these things. But why is it important to know these things, John?

Dr. John Alchemy: Well, you know, in the old system, when this is not done, ratings may be at risk for being overrated, meaning that the amplification of what’s written in there is being carried across all 34 ADLs for your pain, as opposed to just the ones that have been identified. So, you know, the calculations of the pain signature are used in various areas throughout the AMA Guides. And they’re used often, when there’s a range of ratings to be done, you have to bring in the ADLs. And you have to be able to calculate them as a scalar. Or something measurable, that has a measurable range in order to pick is this rating going to be 10? Or is it going to be 13% whole person impairment. And that’s done over and over and over and all the chapters of the AMA Guides. And if you don’t hit that number, right, your rating is going to be too high, or it’s going to be too low.

Cory: And then you’re going to you’re going to experience of what happens. And the reason that RateFast is a company to begin with is a you know, a disputed work comp claim, which slows down your whole process, and it makes it not really start over but it feels like you start over things. So I’m sure I’m sure it feels like it.

Dr. John Alchemy: Well, that’s really the whole mission of everything we’ve done and why RateFast was created was simply to get an accurate report and, you know, get these claims to a value that’s accurate and consistent, and that can be reproduced i I don’t want to go into all the details and the frustrations that that the people in this space deal with on trying to get an accurate report. But it I think just suffice to say that we’re working extremely hard to make it better and better. Every day, every report we do.

Cory: Yeah, absolutely. The binge listener will have plenty to hear about that. If they’re going through our archived episodes.

Dr. John Alchemy: Yes, they will. Yes, they will.

Cory: Great. Well, so, um, we know that, you know, calculating the integral of ADL functions is sort of calculating how any one activity of daily living is affected by the injury throughout the day. And we also know that it’s important because you know, not accurately calculating that and also not calculating the correct body part will result in sort of variations and fluctuations in the claim, which is going to set off, you know, alarms for the insurance adjuster who, you know, will may dispute your report, and then it will slow things down, and which is the tragedy of workers comp as we know it. So, the next question is, how does calculating the integral of ADL functions and impairment rating work?

Dr. John Alchemy: Yeah, that’s definitely a mouthful.

Cory: I think I just like saying it.

Dr. John Alchemy: It is it is fun to say I obviously. The way I best explain it, to people who are unfamiliar either with what an integral is, or what, what the calculation is set out to doing is that if you have, like, let’s say you have a cantaloupe, and you know, you got to cut the cantaloupe skin off the cantaloupe meat, right? So you can cut off the exterior of the cantaloupe. And let’s say eight cuts around, you know, the curve of the cantaloupe. Now, if you do that in eight cuts, and you look at your cantaloupe, your piece of cantaloupe is going to be kind of small. And if you look at a profile of the skin on the cantaloupe, you’re gonna see the edge of the skin, and then you’re gonna see a lot of cantaloupe attached to it. And that’s really the crude way that a lot of ratings are done right now, they kind of hack if you will, the exterior off or do a very blunt type of assessment. And the calculation is something what you’re left with something less than what it really should be, and I’m not saying the number should be higher or lower. I’m just saying the number should be different and more accurate.

Cory: I see what you’re saying. So yeah, cutting you’re cutting the skin. So what you’re gonna have at the end is – wait which one is cantaloupe? The green one is? Yeah, because honeydew is the orange one.

Dr. John Alchemy: No, no, I think you got that backwards. We got some we have an orange cantaloupe and a green honeydew.

Cory: Oh.

Dr. John Alchemy: That’s a different podcast.

Cory: Yeah! So when you say you’re skinning the entire cantaloupe, so you kind of have an octagon, an octagonal kind of shape. And then you have all of this, you know, cantaloupe that’s leftover and these big slices of skin that you took off. So you, you’re missing a lot of the meat of the fruit.

Dr. John Alchemy: Yeah, you’re throwing it out. Yeah. And it’s in, it’s just not being considered, right. So. So it’s kind of just like, it’s just like serving up an impairment report to one of the stakeholders, because at the end of the day, they’re going to get their little ramekin of fruit in front of them. Right. But that’s all they see. And they don’t know how much meat was left on that skin. Yes. Because that’s back in the kitchen. They’re not checking that out. Yeah. Yeah. So all they see is what’s in front of them. And I guess we could maybe make an analogy that they’re like, hey, this portion is too small, or this portion is too big, you know that, but they’re not quite sure. And that’s really what happens, you know, in reality, you know, one of the stakeholders is going to say, I don’t know how this calculation was done, but I think it’s wrong. You know, and, and that’s the problem we’re dealt with, because these things are, you know, not down to the highest science that they could be, shall we say, and RateFast is there to raise the bar, and make sure that everyone gets the report that they deserve.

Cory: Absolutely, and as much cantaloupe is they can get.

Dr. John Alchemy: That’s right. There’s a spectrum here, you know, and the integral, basically what we’re doing, if you think in your brain, okay, instead of taking eight cuts on this cantaloupe, I’m going to take 80 cuts. And instead of taking 80 cuts, I’m going to take 800 cuts, and instead of 800 cuts, I’m going to take 8000 cuts, and ultimately you push that towards infinity. And so your slices get smaller and smaller, which means the precision, and the fruit that’s left and the skin that’s removed, just becomes basically pushed to near zero, as far as the error rate and the and the reflection of the ADL loss, which is our cantaloupe in this in this discussion.

Cory: Yeah. And then, you know, as, as we’ve discussed before, the process of workers comp is laborious, and there are quite a few things for the work comp professional to do, which they simply don’t have time to do. So if you’re a work comp professional, and you’re trying to figure out the, you know, you’re trying to make as many cuts as you can with the time that you have allotted. But unfortunately, it doesn’t always work out that way. Because there’s the real life, things that that happen. Um, and, you know, as much as one would like to be able to make these infinite cuts, you know, you don’t have time to do it.

So sometimes you have to outsource or you, you know, you may consider outsourcing to somebody who is capable of doing that, who spends, who not only knows how the heck to cut a cantaloupe, but has also created a system, you know, which allows them to kind of share that ability with others, and that’s, in this metaphor, I’m talking about RateFast the service that we offer. So, you know, I think that the calculating the integral of ADL functions and impairment rating, which I could pare that down to say account calculating the integral functions. That is what we do and what we do well, so, you know, for the, for the binge listener, who has also worked called professional who is frustrated or temporarily embarrassed or however you want to say that. Yeah, consider RateFast.

So, we have somewhat discussed what the rating implications are for getting it wrong. But I guess we can elaborate on that a little bit. What are the rating implications of, you know, doing these calculations and everything and how will that, how will that benefit report?

Dr. John Alchemy: So the at the ADL, you know, functions and the ADL checklist and the pain is used in multiple parts, as I mentioned at the opening of the podcast, it’s used anywhere that there’s a possible range in impairment rating, which are many tables. In the AMA Guides, it’s used, for instance, in calculating the nerve deficit, if you’re calculating a peripheral nerve loss, you know, for carpal tunnel, for instance, or if you’re doing the range of motion, you know, lumbar spine calculations, and you have some radiculopathy, you have to use it to calculate the step three, nerve impairment, you know, so it goes into the recipe frequently, and often throughout the AMA Guides.

And so, you know, it’s all over the AMA Guides, and I can’t stress enough, you know, that if you are putting in the wrong value, you’re going to be getting out the wrong rating. And what I commonly see in reports for this type of thing is, you know, there’s, there’s a range to pick from, and the user usually picks the high range, the highest or the lowest, because it’s easy. Sometimes they’ll pick some number in between, but it’s really interesting, because in my experience, there’s never really any explanation why they pick the number in between, you know, it’s that they just pick it, but in a RateFast report, you know, you’re not going to have to guess, you know, did this person pick, you know, 50? Or did they pick 10, you’re gonna see numbers like 37, and 44, you’re gonna see real numbers based on the real experience of the individual being rated, you know, and that’s, that’s what really brings for me brings to life these impairment ratings, and makes them applicable.

And, you know, consistent across all the patients, because really, what we’re talking about is, this is the thumbprint of the individual, you know, no one else will have an impairment rating, just like this particular individual that’s being rated, because they’re experiencing their pain and their symptoms, and they’re affecting their ADLs in a very unique way. So all we’re doing is we’re translating that uniqueness and that individual experience into a numerical value, which is what the AMA Guides really strives to do.

Cory: Yes, and we’re calculating it against a real life data, you know, data that is taken to be calculated, where, you know, it’s so common that the data is kind of, you know, ball parked, you know, given a ballpark estimate, which is just not it’s just not right for the patient, who’s whose compensation is affected by the calculations that are made for the doctor, by the doctor. It’s not right for the doctor who may have to put up with a disputed report, which, you know, drags on longer than needed, and, you know, gets him, him or her caught up in it. Or, you know, the staff writing a, you know, redundant report all these things. So, and, yeah, and it’s not great for the adjuster, who has to just play phone tag all day.

Dr. John Alchemy: No, it’s no, it’s not. And remember, the stakeholders also have to sell this to the state, they have to get, you know, someone to sign off to say that this is an accurate rating. And, you know, if that goes into the disability valuation unit in California, you know, and your rating isn’t detailed enough, or isn’t well reasoned enough, you know, they’re going to say, this doesn’t work, you know, and if we have one priority and work comp, it’s settlement, and it’s getting people their benefits, it’s getting them the right benefits. Okay, and making sure that they get the right report.

Now, we’ve talked in some earlier podcasts about data integrity, that’s something else, how much data am I working with, with this report? You know, and how much how close is it to a perfect report or an imperfect report? That’s another issue. What we’re talking about here is getting that that secret sauce of the ADLs, and that pain signature, as tight and as accurate as possible to be reflected in the result in the rating.

Cory: Mm hmm. Absolutely. Yeah. Um, workers comp doesn’t have to be difficult. It’s not, you know, it’s not designed so that it’s a contentious series of, you know, problems that a committee of people who are, you know, kind of representing a different party entirely have to You know, be be embattled about with each other and with themselves. You know, it can work easier, it just needs to. There just needs to be the correct tools and the correct time and everything like that. And sometimes that is not available for everybody. So that’s what we tried to do.

Dr. John Alchemy: Well and the bigger problem is is that you know, from make another analogy here is that we’re having people try to build these reports by using a screwdriver to drive a nail, and a hammer to turn a screw. I mean, it’s very difficult, it just doesn’t work very well. And the product just is not very good when when it’s all done. So, you know, we put the right tools with the, with the right kind of work. And it’s easy for us, because it’s all we do. And we’re totally set up to do it. So, you know, putting reports in the hands of people that maybe have some challenges with comprehensive understanding of the way that the AMA Guides work, in addition to trying to understand how to prepare the data to go into the rating in the first place. That’s, as far as I’m concerned, one of our major limitations in the system, and why it’s so frustrating to get a decent report in front of people.

Cory: Yeah. So we mentioned how this is a different thing from the data integrity, which is, you know, the data integrity is basically it’s, it’s almost like, the way that I think about it, at least is a like a, like a grade, like you get a test or you take a test and you get your grade back. Except, you know, we’re not testing you. We’re called information that you get from your patient. There’s nothing additional than that. But you know, it’s just telling you how good the data was. And similarly, the thing that is similar with this that we’re talking about today, is that it also appears on your work comp report that you get back from RateFas. And so the question about that is, where will these calculations appear on the report that you get from RateFast?

Dr. John Alchemy: So each reporting rate fast has a section for each body part that’s being rated. And at the very top, we placed this information before the rating even begins to get discussed, because people need to know if the you know, rating has been adjusted in some way. But they have to be able to at least trace the steps of the rating and how the data is taken in how it’s adjusted before it’s processed.

And then of course, at the bottom of the report, you get your final whole person impairment. So it’s interesting because not all rating signatures have to undergo an adjustment, some of them are actually correct when they’re taken in the native form from the injured worker. But often more times than not, they are not, and they need to be recalculated, put in to the put into the function, and then adjusted so then the rating can begin properly and accurately.

So you’re going to see something at the top of your RateFast Report to the effect of the functional rating signature has been adjusted for full activity spectrum for lumbar spine, you know, the adjusted values are 3 out of 10 100% of the time, and for activities of daily living pain only. So it might be something like that. But it’s going to be posted up there, if it’s not posted, it wasn’t adjusted. It didn’t need to be adjusted. So we put it right up at the top because it’s such a key ingredient. And the numbers are everything in these impairment reports. So if there’s an adjustment that’s done, the reader will be notified right there in the report at the very top.

Cory: Yeah, a lot of these. So, RateFast is a product that has come, you know, it is a cumulative effort of you know, a lot of you John, the, you know, the workers comp professional as well as mathematicians, and, you know, programmers, developers, things like that, and we’ve come up with this system. So a lot of these things that we discuss in the episodes. You know, it’s kind of a, like a peek behind the curtains.

And you know, not everything is labeled in the report, the way that it’s labeled in say the title of the podcast or something, but it’s definitely there. And then these podcasts and the other material that we have on our blog is sort of telling you where it is, where to look for it, where to see it. And that is how we that is how we stay transparent as a company as well, which is, you know, one of our biggest interest because I mean, if we were, you know, this this sort of ominous specter of sorts then how trustworthy would it be as you know, as a company that take takes the patient data and just magically does some numbers with it. So, it’s important for, you know, the person that’s listening and the person that uses RateFast to know how these things work and where to find them in the report.

So, John, at a glance, how, you know, what, what can our listeners walk away with today regarding the calculating the integral of ADL functions in apparent rating, and also with cutting cantaloupes?

Dr. John Alchemy: Oh, well, a couple of things on the cantaloupe, one, you have to have the knife and you need to have the right tool and number two, you have to know how to use it. So RateFast gives you gives you both of those skills. But the bigger thing I think any listener to this should walk away with is that there are a lot of unobvious things in the AMA Guides and getting a correct reading, things that are not openly discussed or thought about or directed in the AMA Guides. It basically says don’t do this, you know how you do it is not stated anywhere. And the problem is, is that there are a lot of areas for incorrect interpretation, improper calculations if they’re done at all. And and the non standardization of the reports that we struggle with, which is again, why RateFast was created to standardize these reports, make sure all the stakeholders get the correct report and get that settlement done. So these are non obvious things that RateFast is addressing for the stakeholders. With every report we do with every update we do with every, you know, new improvement in the system that we run.

Now, the other thing that people forget about is once you have something unobvious that has been solved or put into the recipe, or that’s now being calculated, we believe we’re doing a huge benefit for the stakeholders in society. Yeah, because getting reports settled correctly and fast, are efficient ways to save money for all the stakeholders. The injured worker gets their proper settlement right away, the employer gets to figure out if their employees coming back and what the injury cost is going to be their costs and their premiums. And the insurance company, of course, they get to settle a claim much faster. And they doesn’t have to get dragged through all these legal processes in months and months of you know, QMEs and having the case redone, and recalculated and telling their story again, and all of the problems that go with that. So truly time is money. And time is probably the greatest resource and benefit that RateFast has to offer to all the stakeholders in the work comp space.

Cory: Absolutely, absolutely. And before we sign off today, John, I’ve got just one more thing for you. You know why? You know what melons don’t often get married?

Dr. John Alchemy: Am I gonna regret this Cory?

Cory: Because they can’t elope. I had that one in the chamber the whole day.

Dr. John Alchemy: You mercifully saved it for the end.

Cory: Exactly. Exactly. So thanks again, John. And we will see you next time.

Dr. John Alchemy: Awesome. Thanks, Cory. We’ll talk later. Thanks for listening.

Cory: For more about calculating the integral of ADL functions in workers compensation reports visit our blog at blog.rate-fast.com and give rate fast to try at rate-fast.com.

RateFast Podcast: Automation in Workers’ Compensation

This article is a transcription of an episode of the RateFast podcast, which you can listen to by searching “RateFast” in iTunes or the iOS podcast store.

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