RateFast Podcast: Lost in Translation?

Dr. John Alchemy goes into detail about RateFast Express’ Report by Keyword feature, which takes commonly misused terms in Workers’ Comp reports, and translates them into the proper verbiage that an insurance adjuster would expect to see, further advancing RateFast as the leader in writing accurate and efficient work comp reports!

If you’re a workers’ compensation provider, or are interested in getting started with workers’ compensation, check out our product, RateFast Workers’ Compensation Software Suite, as well as RateFast Express 3 Day Impairment Rating service.

Exciting news!

RateFast is proud to announce that The California Work Comp Report has made the list of Feedspot’s Top 30 Workers’ Compensation Podcasts You Must Follow in 2020!!! If you’re a fan of our podcast, and would like to hear more professionals speaking on the topic, make sure you visit the link above!

RateFast Express Report by Keyword

Cory Oleson (Host): Welcome back to the California Work Comp Report Podcast. It’s Wednesday, December 9, 2020 and our topic today is an incredibly powerful feature of RateFast Express, the Worker’s Comp Report by keyword.

Welcome to the California Work Comp report podcast. It’s Cory Oleson here with Dr. John Alchemy. How are you doing today, John?

Dr. John Alchemy: I’m doing great, how is your day going?

Cory: It’s going well. We’re in the season between Thanksgiving and Christmas so there’s going to be nonstop Christmas music everywhere. That’s the good thing about not having to go outside much or having to limit your time outside, is to limit your exposure to Christmas music. I love it, it’s great, it’s fun to listen to – there’s too much of it.

So today we are talking about the impairment ratings by keyword. Which is a nice add on to our last topic that we talked about, which was the RateFast Impairment Report form. The reason that we’re talking about this today is when workers comp physicians see their patients, they only get a very limited amount of time to see their patient and do the examinations necessary to write a cohesive and complete enough work comp report to send to the adjuster. Which as we know and as we’ve talked about rarely ever turns out that way because the doctor doesn’t have enough time to get all the information they need to complete the report.

So we created what we talked about last week which is the RateFast Impairment Report Form in order to kind of guide physicians examining their patients along a very easy to follow path with a concrete amount of questions they answer to give to RateFast. And then today we are honing in on how RateFast uses keywords in order to create a more accurate report. John, illuminate to me what impairment ratings by keywords is, because it’s very interesting to me.

Dr. John Alchemy: We’ve been working with clients for many years now, not only writing impairment reports, reviewing them, helping them to accurately describe the value in the whole person impairment of their claims when they’re ready for a permanent and stationary report. But what we’ve also been doing is we watch the language very carefully that providers use, the choice of words they use, and what we’re trying to do is make the experience of writing a report with RateFast software more of a natural event.

I think if you ask any doctors who only do a couple reports, or they do work comp but they just don’t really do impairment reports, it’s a very off-putting experience. It’s very daunting, there are a lot of strange words used and the words have specific meanings that often the user doesn’t really understand.

So what we’re really doing next in RateFast and what I think is going to be the next big step in the industry is in impairment rating, it’s going to be creating impairment reports by keywords. Because keywords are things that the doctor will mention in the report, the patient may mention in the history that they give to the doctor. And it’s sort of like there’s a secret language that’s going on and it’s up to us to decode it and put it into context and make it into something that’s usable. Come out the other end on the report for all the stakeholders. And one of the things that’s challenging is being able to take a look at those words and translate them into something specific.

Now the other thing, the reports when they come out, it’s important to understand that the report needs to be accurate, but that it’s clear in its claiming inside. If you’re going to read a report and it says this is a 17% whole person impairment, it needs to be clear that this data is imperfect for these reasons. And what we find is that when a report is disclaimed, it doesn’t necessarily have to be redone, it just needs to be accepted and understood by the stakeholders that this report has some elements in it that were not very well developed, and because of that the rating may or may not be affected. And that’s really what I think the big thing that we need to impress upon the stakeholders.

I could look at any report at any level of detail and I could find an error, an omission, and really you don’t have to look very far. But what’s important is when you read the report and you’re not familiar with all the fine details and references and subtext within the AMA guides, you can quickly communicate that to the person reading the report. And you can say hey, this section right here is not very strong, or this section is very strong and at the end of the day this report is an average report, it’s an excellent report – so again it’s really important that we understand the data in the report. So once we do that we can get into the concept of natural keyword impairment rating that we’re going to talk about.

Cory: Yeah, absolutely. It’s no surprise, going back to our very well traveled paths of physicians not getting the education required to do their job well just from the offset of their being no way to do that, to get the education of how to accurately do a report. The language that they use to convey the information about their patient to the insurance adjuster might not be the language that the insurance adjuster is primed to receive. Because in a certain way there is almost a – the insurance adjuster is trained to look out for certain things or have the discretion to determine if a thing is up to snuff or describes the patient’s injury well enough. And it sounds to me as though what the keywords are meant to do are mediate that language that the doctors often say, or the data that we collect from doctors, them saying this word that may be misinterpreted by the insurer is translated into a word that the insurer will recognize and therefore it will kind of lubricate that portion of the claim so everyone understands.

Dr. John Alchemy: Yeah, and it’s interesting because, and I’ll just use this as an example, when someone looks at an impairment report for an orthopedic body part let’s say a shoulder, everyone expects to see range of motion. And if range of motion isn’t in there, someone’s going to scream and holler and raise their hand. And say this can’t be an accurate report by any means because there’s no range of motion.

But on the other hand, if no one mentions the presence or absence of instability in a shoulder, no one cares, because no one really even knows that it’s supposed to be in there. And these reports are just filled with omissions and errors yet everyone has this preconceived notion of, oh if this isn’t in the impairment report, it can’t be accurate and it can’t be good, therefore can’t be accepted. And that’s absolutely incorrect.

Cory: Throwing the baby out with the bathwater.

Dr. John Alchemy: Yeah and it’s fine, we do have to do a lot of education with people but the bigger issue is, how much does this impairment number match up with the functional loss? And that’s really at the heart of the impairment reports and what the AMA guides 5th edition talks about over and over, it’s about functional loss. And having an impairment report accurately report functional loss.

One of the reasons that I wanted to do this podcast is because we had a really interesting case come into the practice a couple of weeks ago, and the situation was this. The insurance company had the option to send in this chart, they wanted an impairment rating done, and the primary treater couldn’t or wouldn’t do it, whichever, and so the adjuster and the patient are stuck in this limbo of, we need this impairment report. So the adjuster was given two options. We gave them the option of RateFast Express where you just send in the reports and RateFast Express reviews and interrogates the data, rates it based on keywords, interprets them for certain values and boundaries and stuff and writes the impairment report.

The second one is, refer it to my practice, it’s old fashioned, it’s going to take a couple of weeks to get the patient scheduled, we hope the patient shows up, they get their exam, and then the report has to be created and served and stuff. And again just to give an idea of the comparison, RateFast Express, we have your report in about 72 hours or 3 business days. Going through the grinding of the traditional ways, you’re looking at getting the report in your hand in 3 weeks. Maybe more.

But this adjuster chose to go with the old, what I called the legacy impairment rating. Make an appointment, have the doctor do the interview, do the exam, and all that stuff. So I really saw this as an interesting opportunity because I was getting the referral notes as if the adjuster had sent them to RateFast Express. But I got the exam and history myself. So what I did with this particular case is I ran the legacy and got the rating and then I also ran it just through keyword rating as if we were just doing it with RateFast Express.

And it was an interesting case because it was a hip replacement and hip replacements have a lot of additional questions.

Cory: I feel like you would want your keywords on point when you’re talking about a hip replacement.

Dr. John Alchemy: Yeah you would, you would. But RateFast, the algorithm gets stronger and stronger with the more cases that go through the system. Whether they be legacy exams or RateFast exams, and we mention now we have the Parity tool which is an internal check on a rating. So we have a pretty good system now of not only generating a rating but making sure internally it makes sense. And I’ll talk about this in a moment, but to make this long story short, I did the exam and the rating, the patient got a rating of 20% whole person impairment. And then when we did the Parity check it was off by 4% whole person impairment, which is definitely an acceptable exam.

But what was even more interesting and let me tell you about the data and how thin it was. I basically got three pages from the primary treater, and here’s what it said: “Patient with hip pain (end of history), physical exam painful, surgical history: hip replacement.” And that was literally it. There was no 5/10 hip pain and they have ADL limits, nowhere to be found in the chart. But remember we run these things based on a combination of experience, algorithms and statistical data. And when we ran the Express report, again based on very thin data, the patient technically never had a formal “impairment report” the rating came out to the dot 20% whole person impairment.

And the thing that blew me away and made me feel both happy and depressed at the same time was that the rating done by the RateFast algorithms was within 2 points of the predicted rating whereas I said my manual one was about 4. So the algorithm had less information and did it multiple times faster than could have been done in the clinic and it was more accurate at the end of the day.

Cory: Okay, well we talked about this sometime before we did this podcast, but it’s one of those myths of tech or something to work your way out of your own job. And I think as long as you own that technology then that’s a good thing. Save yourself some work. And also just a thing to note for anyone who might be listening who’s skeptical, it’s something that we’ve talked about before about RateFast algorithms that we don’t feed it just information. It’s only fed information that works, the RateFast algorithm is only based off reports that got 98% or higher. It’s really great to know that it worked for you. I very well know what it’s like to be overwhelmed with something you enthusiastically step into before you know what you’re up against. Which is what I gather we have described a lot of work comp professionals. You step into this field, you hear that it’s going to be profitable, and then someone throws an AMA guides 5th edition at you and says to write your report. And it’s like, write a what?

And so for these people, worry not about being overwhelmed or having a stack or mountain of work to do. Even if you want to become this God of work comp report writing, and be able to know the AMA guides cover to cover and be completely accurate, you can still use RateFast Express to give you positive reports so you can look at what those reports contained with the relevancy to your patient’s injury. You can look at a report to see how to do it right.

We can give the computer 3 pieces of information and it can write a report that’s within 2 points of accuracy. As accurate as Dr. John Alchemy can do! And he’s done hundreds. So try it out, there’s no reason not to. You know what, even if you are a skeptic, that’s even more of a reason to check it out. We need stress testers to put in the most incorrect information imaginable to see if it will create a good report.

Dr. John Alchemy: You know I think the biggest challenge going forward is all of this is happening and the real question is, how archaic is the marketplace in the stakeholders going to be in accepting this thing? Because it’s not happening just in workers comp and impairment ratings. It’s happening everywhere where big data is rolling out predictions, re-correcting, rewriting, redoing it again. And there’s no difference happening in the impairment rating.

And it’s interesting because the letters that come back from the stakeholders that come back are not letters that the reports are incorrect. They’re letters that ask how moderate pain was calculated at 7.5. Or I didn’t know this could be used for apportionment, what page is that on? And so on. So we get a lot of educational questions. And make no mistake about it, these are educational questions coming from the state, the disability evaluation unit, and these people who sign off on these ratings as valid, and the insurance adjusters who are trying to basically play catch up with technology and understand why this is done because the reports are extremely comprehensive. And they’re consistent. And that’s something we haven’t seen in the industry as a tool that can be scaled, and equally applied and get stronger and stronger as we use it.

So, keyword impairment rating is definitely here to stay. It’s going to become more powerful, I think it’s going to become more of the mainstay of impairment rating and everyday rating and I think we’re going to move to a system that’s much more of a natural language input with an impairment output.

Cory: And for the skeptics, you are the people that we want to see submit reports.

Dr. John Alchemy: That’s right. And that’s what we have to say about keyword impairment rating.

Cory: Awesome. So keyword impairment rating from RateFast Express, make sure to check it out and as always if you have any questions, be sure to check it out on our usual channels left at the end of this episode.

Thank you very much again John, we will talk to you next time we do a podcast.

Dr. John Alchemy: Will do, Cory, thank you.

Cory: To learn more about workers comp reports by keyword, visit our blog at blog.rate-fast.com and give RateFast and RateFast Express a try at www.rate-fast.com.

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