The Big Four in Occupational Medicine: A Roadmap to a Fit and Productive Workplace

[00:00:00] HOST: Welcome to Fit for Duty, the podcast elevating occupational health. I'm Dr. Larry Earl, president of the National Association of Occupational Health Professionals. As guardians of workplace health, we stand at the intersection of well [00:00:20] being and success. Fit for Duty delves into hot topics, OSHA regulated exams, workers comp, drug testing and so much more.

[00:00:29] HOST: Join us for practical tips, real stories, and conversations that spark change. Whether you're a seasoned professional or passionate about healthy workplaces, Fit for Duty is your [00:00:40] roadmap to a fitter, safer, and more productive workplace. Subscribe now on all major podcast platforms. Let's shape a future where well being fuels workplace excellence.

[00:00:51] HOST: This is Fit for Duty with Dr. Larry Earl.

[00:00:58] GUEST: Welcome, John. How are you? Hi, [00:01:00] Larry. I'm doing well. Thanks.

[00:01:02] HOST: Good. Hey, uh, you know, as we start this, what I'd like to do is let's go, uh, to the way back machine to 1987 when you started, uh, Physicians Immediate Care. And I know that you had [00:01:20] some real challenges that actually led to your occupational medicine career.

[00:01:25] HOST: Tell

[00:01:25] GUEST: us about that. Yeah, so I didn't know what I didn't know, back in 87. I just knew urgent care was a good idea. I saw it in Grand Rapids, Michigan, where I was training in emergency medicine. And so, I thought it'd [00:01:40] be a nice sidelight for the ER group that I was in. I trained initially in emergency medicine.

[00:01:45] GUEST: So, we opened a clinic. Just kind of goofing around and, uh, it wasn't going well. We were losing money. We had a Class D site, okay? It was put up as a spec building by a builder who simply put the [00:02:00] building in a demographic center, but it was on a street with only 5, 000 cars a day, which, you know, that's That's deadly, right?

[00:02:08] GUEST: For urgent care, you have to have visibility. Yeah, we're looking for 20 to 30. Right, right. We were struggling mightily, and a friend of mine took me off about doing DOT physicals, [00:02:20] and so I said, you know, what's the DOT, okay? Department of Transportation. So we started doing DOT physicals because I was able to call employers, trucking companies, and say, hey, we'll do your DOT physicals for you.

[00:02:32] GUEST: And so we started getting those, and then we were getting these injuries, and the injuries were, the fees were higher, because x [00:02:40] rays were involved, recheck visits, and I realized, wow, this has potential here to dig us out of our hole that we're in. And so, serendipity, the, challenge of a very lousy location led to the development of the hybrid model, Urgent Care, OCMED, which we were one of the first groups in the country to do that.

[00:02:57] GUEST: Which then parlayed into [00:03:00] profitability and into the ability to have clinics and locations that were not pure urgent care locations. So we could do Hybrid locations where we're near industrial parks, but we have some traffic and we get urgent care and we're at comp both. And it worked quite well for us.

[00:03:15] GUEST: And so, uh, the challenge was that, near fatal mistakes. [00:03:20] And I've seen groups, you know, unfortunately there's a few fatal mistakes that you can make. a poor location is one of them, which we did, we survived. by the grace of God. So it is what it is. Yeah. Yeah.

[00:03:33] HOST: And before, so before we get into all the workers comp and occupational medicine, just in general, what advice would you give [00:03:40] other healthcare professionals who are looking to innovate in their own practice areas?

[00:03:44] HOST: Maybe they've got, you know, similar situation where, gee, I went into this location, it didn't work out. How do you figure that out?

[00:03:52] GUEST: So it's kind of like, you have to figure out how to make money. You have to figure out how [00:04:00] to. And our answer was injuries and volume. So what, I don't know what others answers could be.

[00:04:06] GUEST: I mean, some are doing trying to weave in family practice, aesthetics, orthopedics, all kinds of weight loss, you know, et cetera. So great. But the problem is you have to make money at it. So quote unquote, you know, adding [00:04:20] another service line could actually hurt you more than help you because it sucks resources.

[00:04:25] GUEST: You can't see the volume that's coming in efficiently because you're spending too much time on. Something else, which is, which in my, in my experience, it's just my experience, nothing against family practice, but my experience from observing a number of groups for all these years, [00:04:40] try to do family practice.

[00:04:41] GUEST: They struggle with the turnaround time is so long if you can't you absolutely cannot spend 30 minutes in the room with the patient You you in an urgent care center your your fixed costs are too high. They are Too high and I think

[00:04:55] HOST: you know, one of the things I think you touched on is Not only do [00:05:00] you have to see if there's an opportunity, a market for certain services, that you might, I mean, there's all sorts of things people are adding to urgent care practice, right?

[00:05:08] HOST: All sorts of, sideline businesses. You, you've mentioned a bunch of them. You need to champion in the practice. You know, someone's got to really have a passion for doing it or it's just going to fall on [00:05:20] its face.

[00:05:20] GUEST: Yeah, absolutely. And you have to, You have to do your research. You have to do your research on the right coding and make sure what you're doing is legal and you're not going to get clawed back by VCBS or something for, for, you know, some, some algorithm for allergy testing, you [00:05:40] know, and they say, this wasn't appropriate.

[00:05:42] GUEST: Let's, we want to look at your algorithm. And if they say your algorithm. isn't appropriate for doing allergy, for, for testing these particular 200, 000 patients or whatever, they could try to claw back on you for that revenue, or worse yet, you know, run into the feds, you know, [00:06:00] so, you know, which speaks to the pain management side of, of that, of that whole equation for narcotics and stuff.

[00:06:05] GUEST: But, um, yeah, I mean, I would just say you have, you know, and some advice I got, it was about, Probably maybe 15 years ago, 18 years ago was John, you need to work on your business, not in [00:06:20] your business. And so at the time we probably had maybe 18, 20 clinics and I was working at all the new, new clinic. We had a new clinic.

[00:06:29] GUEST: I would go work there and try to make sure that everything goes. Well, and you know, that's not scalable. You have to work on your business, uh, not necessarily in your business. If you're a [00:06:40] doctor, you know, so, homework, you got to do your homework. You got to study it, learn from others, go to conferences, listen, ask questions.

[00:06:46] GUEST: I mean, you got to put the work in to, to survive, you know? And so in my case, I put the work in on ground. I pounded the pavement for work comp sales. I mean, I was out there selling, I had as many as 14 appointments [00:07:00] in one day. That's my highest

[00:07:02] HOST: to go visit to go on site

[00:07:03] GUEST: at company locations.

[00:07:04] GUEST: I told that I told them I'd be there I don't know when but I'll be they said fine cuz doctors never come visit us. So you're welcome to come anytime

[00:07:13] HOST: Right

[00:07:15] GUEST: Well, it's it's the hand they saw the hands on commitment they saw that I [00:07:20] was Truly interested and I was willing to put the work in I wasn't in like an ivory tower, you know doctor situation, you know, where I wouldn't even talk to you because right now there's a lot of employers, you know, they call to talk to the provider that's treating their work injury.

[00:07:34] GUEST: And they don't let them, the nurses are the firewall, and the nurses say, no, the doctor's busy. [00:07:40] That's utterly unacceptable in workers comp.

[00:07:44] HOST: Yeah, and we're going to jump into that, absolutely. How has the landscape of workers comp care changed since you founded Physicians Immediate Care back in 87? What are the bigger trends now?

[00:07:56] GUEST: Dramatic. Okay, I'll start with kind of a slower moving [00:08:00] one, which was safety. Absolutely, safety programs are nowadays are off the charts, nothing like it used to be. I mean, I was seeing mangled hands and fingers and just, you know, swinging batteries, crushing legs. I mean, just insanity, 37, 38 years ago on safety that it was, [00:08:20] you know, they thought they had safety programs, but they didn't have safety programs.

[00:08:23] GUEST: and so, The number of severe injuries absolutely plummeted. God bless. It's fantastic. Fatalities are way down. Serious injuries are way, way down. That is a fabulous trend. I would say, the trend of urgent [00:08:40] care is doing work comp is a trend urgent cares, because when I started, it was orthopedic groups that did it.

[00:08:45] GUEST: Orthopedics and a few hospital based programs. And I was kind of the, community based entrepreneurial urgent care. What are you? You're weird. You know, we didn't even know what you are, you know, to where it is now where urgent care is a ubiquitous, [00:09:00] completely understood, and that's a trend, another trend is.

[00:09:04] GUEST: the use of APPs as the predominant provider and center. Nothing new there, but I'll tell you what, dramatic, the most dramatic trend in all these years. And that trend is new. It's a 10 year trend. It's been going on for 10 years. It's [00:09:20] actually, it's going to start plateauing because you can't get more than 100 percent APPs in your clinic, right?

[00:09:26] GUEST: Yeah.

[00:09:26] HOST: I think we're about 85 percent now, 35, 90, somewhere in there. Right.

[00:09:30] GUEST: So that's going to flatten out. And the only need for, there's groups with nurse practitioners or their medical directors. So physicians are leadership folks [00:09:40] and that they're getting squeezed. I mean, it just is, it's happening with the private equity ownership, the, how can I say this?

[00:09:48] GUEST: focus on profits. I'm not saying that's bad. I'm not saying that's bad. I'm not saying private equity is bad. I'm just saying I'm watching with my eyes and I'm seeing physicians being squeezed out of clinic [00:10:00] positions, squeezed out even of regional medical director positions. They have not been squeezed out of chief medical officer positions yet.

[00:10:09] GUEST: So if you're a physician in urgent care, you might want to think about, you know, an MBA, or think about positioning yourself in a leadership position, making it known. You want to lead [00:10:20] providers and you need to have leadership skills. You need to have the personality and motivation, the work ethic, the ability to take phone calls and lead train training.

[00:10:29] GUEST: Oh my goodness. Training procedure, training. You have to train them how to sell lacerations, do injections, treat eye injuries. I mean, if we don't do it, we lose it. And the medical leadership, the [00:10:40] physician medical leadership, a number of them aren't interested. in acuity of care. They're just interested in, I don't know, having a job and I'm not seeing the, fire in the belly for,procedures.

[00:10:52] GUEST: You have to do them to do true occupational medicine. You have to do them. To be profitable. Your wage inflation is going to take over unless [00:11:00] you figure this out.

[00:11:02] HOST: Yeah. And so let's, let's get into some of that. Let's talk about the big four metrics. Let's dive into the big four metrics. Lost time, unnecessary recordables, intuitive work restrictions, and first comp phone calls.

[00:11:17] HOST: Can you Pat unpack each one of those and [00:11:20] let us know why they're so critical for occupational providers?

[00:11:23] GUEST: Absolutely. These, this is kind of like distilled down, you know, thousand to one distillation down to what absolutely totally matters. If you, you will fail if you don't do this, that's what, that's how important these are.

[00:11:39] GUEST: And this [00:11:40] comes from millions of visits, millions of patient visits, tens of thousands of clients. So lost time. Okay. Lost time is very expensive for employers. It changes your production ability. Some, some companies give a hit to your bottom line. They charge you 5, 000 a day for every lost [00:12:00] day. there's lost time metrics with comparative metrics against other, similar industry groups or within their own company between.

[00:12:08] GUEST: Sites, manufacturing sites, you know, who was not so good. Who was good. Who was, who gets to go up on the podium annually at the conference, you know, the convention or whatever. so there's lots of spinoffs and say, face it, these safety [00:12:20] directors, God bless them, they, they could make 80 to a hundred thousand dollars a year.

[00:12:25] GUEST: they might have may or may not have an undergraduate degree. They got training and safety and their agenda is to prevent fatalities and prevent lost time and unnecessary portables. I mean, that's their J O B. And if they're not [00:12:40] successful, they might not maintain their employment. That's a big deal.

[00:12:44] GUEST: When you live in a town with kids in high school. And they don't want to, you know what I mean? This, this is important to them. It really is. And so us medical providers, sometimes we can have a cavalier attitude. Like, look, I don't work for them. I work for the patient. Well, you [00:13:00] do, you work for everybody.

[00:13:01] GUEST: Okay. and what I try to talk about is I'm for the truth. I'm not for the patient, the company I'm for the truth. And if the case, whatever the case is, the objectivity of the case, the clinical findings. The plan of treatment, I get people better. I don't ever compromise the quality of care under any circumstances ever, [00:13:20] but we need to be willing to sympathize and be, and listen to cooperate with these employers who, who, are in a tough spot and we have the power of the pen, which means.

[00:13:30] GUEST: Off, off duty, prescription drugs, whatever, and, and, and we, we have to think of, we owe them thought. We owe them effort and thought. So, lost [00:13:40] time. Why do they need to go off work? Why? well, if they're going to the ER and they need emergent surgery, absolutely they're off work. If they have a serious infection.

[00:13:48] GUEST: That they need to be with warm compresses, elevation at home. That's okay too. Companies don't mind a legit lost time. but when you take them off for a lumbar strain, take them off for a finger laceration.[00:14:00] you know, you have to be prepared as an occupational medicine specialist to give full justification to the employer as to why it is necessary that they must be outside of the workplace.

[00:14:12] GUEST: They must be at home. So they would say, look, they can watch security cameras. [00:14:20] They can, uh, safety manuals. They can watch safety videos. They can, um, do any number of things. In the sit down sedentary duty, they'll take them with sit down sedentary duty so that they then either are left with either accommodating those restrictions or sending the worker home if [00:14:40] they can't accommodate.

[00:14:40] GUEST: So it's on them. The last time is then on them. So it's incumbent upon them to. Develop alternate duties options for their workers if they don't want to have lost time. So, lost time is number one, for heartburn for the employers. Okay, just don't take them off work. I mean, it's like, [00:15:00] you gotta have a, just have to have a solid clinical medical reason why they must be off work.

[00:15:05] GUEST: Okay, OSHA recordables. Unfortunately, for better or for worse, this is it. We're stuck with it, right? If it requires a prescription, it's recordable. That's physical therapy. That's prescription drugs. Probably 85 to 90%, Larry, you can check me on that, [00:15:20] of unnecessary portables are prescription drugs on the first visit.

[00:15:23] GUEST: Why do they need Mobic and cyclobenzaprine on the first visit? Why, why do they need prescription drugs on the first visit? I believe in OTCs. Tylenol Plus and NSAID on the first visit and the second visit for routine strains, sprains, contusions, and workers comp. [00:15:40] Why not? Come on, why not? You know, it's good analgesia.

[00:15:44] GUEST: It's proven in the literature. It approaches T3 levels of analgesia with those two meds. I've done it myself. Thousands upon thousands, tens of thousands of bottles of that is distributed, dispensed in our clinics every year. And so, and the [00:16:00] companies absolutely love it. And I can tell you, anybody who's listening to what I'm saying, if you can be successful on the big four, the companies will worship the ground you walk on and consider you a rockstar.

[00:16:11] GUEST: I don't care if you put shoulders back in or not. Okay. They don't care if you put a shoulder back in God bless. If you do, it's fun. It's [00:16:20] great. The Big Four is it. This is it. They will love you. They will worship the ground you walk on. Your program will grow. Your program can't be unsuccessful. You can't fail.

[00:16:33] GUEST: It's impossible, almost impossible to fail. If you're really highly successful on the Big Four, [00:16:40] you will be, the word of mouth with employers alone will get you business. They'll call you and say, hey, I heard from Joe at the conference. we have a safety committee, a safety, uh, SHRM, you know, or whatever, uh, safety group organization meeting, and everyone's talking your praises.

[00:16:54] GUEST: We gotta, we gotta get you over here to give a talk to our group and we want to use you, you know, the OSHA recordable [00:17:00] group. I mean, these folks, the utilities, the energy companies and all their subcontracts, the word will pass like wildfire if you are avoiding unnecessary recordables. And, and, and axiomatic to that is.

[00:17:12] GUEST: NSAID and Tylenol. NSAID and Tylenol. Tylenol and NSAID. That's all you got to do.

[00:17:19] HOST: A lot of [00:17:20] folks, when they're looking at OSHA recordables, don't understand the lost time restrictions on that. you know, giving someone off over a weekend, for instance, or over a holiday actually counts as lost time if you don't return them tomorrow, right?

[00:17:36] HOST: You can only have today as lost hours of the day. [00:17:40] If they're not returned tomorrow, Even if they don't usually work that shift, I think that, that, that to me is one of the huge, sort of mistakes that folks make. So I, my point is make sure you understand the OSHA recordable criteria and in particular the first aid criteria within.

[00:17:58] HOST: the OSHA recordable [00:18:00] criteria. And, uh, you know, we have whole sessions on that and there's plenty of education available for what's an OSHA recordable in the first place. So absolutely has to be understood. So from that, okay, so we've, unfortunately we have a worker who, does need restriction, you know, does need restrictions.

[00:18:18] HOST: They, you've looked [00:18:20] at their description, hopefully their functional job description. So you know how much they have to sit, stand, walk, push, pull, carry, climb, all that. and you've determined, well, I'm going to need to play some restrictions on this. So what are intuitive work restrictions? Explain that term to

[00:18:36] GUEST: us.

[00:18:37] GUEST: Yeah. Common sense, work restrictions. [00:18:40] It drives the companies crazy when you put. No running, jumping or ladder climbing. And they go, Dr. Kaler, don't your providers, we don't do running, jumping or ladder climbing here. Okay. You know, so intuitive work restrictions means first and foremost, you have to [00:19:00] understand what exactly they do in their job.

[00:19:02] GUEST: So you are restricting what needs restricted. The idea of restriction in the first place is to give the injured body structure, relative rest. Relative rest. Rest means rest. So that could be a wrist support in full duty, because there's still a relative rest with that wrist support on. Okay? [00:19:20] And so, you have to think about it.

[00:19:22] GUEST: So why would you say one arm duty for a finger laceration? That doesn't make any sense. They'd say the other four fingers work fine. And if you put, MediRip on the finger laceration, why can't they use that finger? Especially if it's on the dorsal aspect of the finger. Ventral aspect, maybe you'll put a little dish [00:19:40] of Lumifoam on there as a protector or, you know, again, MediRip.

[00:19:44] GUEST: you have to think about it, like, okay, here's their injury. This is the body structure that's injured. How can I provide a restriction, if they need one, that gives relative rest to the particular body structure? So let's say rotator cuff, for example. It could be [00:20:00] work in your power zone, which is like the baseball strike zone.

[00:20:04] GUEST: Okay at not up here So you could say avoid over the shoulder level work. You could say work in your power zone These things make sense rather than saying no work with the right shoulder. What does that mean? No work with the right shoulder Can I [00:20:20] work? Can I go eat lunch and use a fork to eat my lunch?

[00:20:24] GUEST: You know, the classic one is no bending at the waist That's absolutely classic, non intuitive, crazy work restriction, but everybody does it. I'm talking orthopods, ocmed, urgent care, everybody. It makes no sense. [00:20:40] You, I'm, I'm flexed at the waist right now. Okay. And I'm sitting. Okay. you can't eat your lunch.

[00:20:45] GUEST: You can't get in your car without bending at the waist. So why would you ever say no bending at the waist, please? You know, you think you have to think about exactly. You know, and if you take something out of thumb spike, you know, take something [00:21:00] out of commission, you've protected the thumb. They can still do things with their hands.

[00:21:04] GUEST: So really think you gotta, yep. It's thought process to get intuitive, common sense. Appropriately applicable work restrictions.

[00:21:16] HOST: So for each of those big fours, you mentioned [00:21:20] an example of a shoulder injury. Can you give us some other specific examples that you like of how you successfully improve performance for each of those big fours?

[00:21:33] GUEST: Okay, well, lost time, they don't incur the cost of a [00:21:40] lost time claim. The patient is at work doing something productive, not watching television.

[00:21:46] GUEST: For the plaintiff's attorneys. so that improves global performance by having them perform at work instead of at home. the,unnecessary OSHA recordables that, affects their ability. I asked the [00:22:00] company once in a meeting. They're very anxious about OSHA recordables and I said, what, what exactly is an OSHA recordable worth to you?

[00:22:08] GUEST: I mean, what 24 million? I said, what? Why is that? And they said, because our average bid value on a bid project, where, because they're a utility [00:22:20] subcontractor is 24 million. And if their OSHA moderate is above a certain threshold, they are. It's on a website. They look at the, the big guys, look at the websites, they're out.

[00:22:29] GUEST: No, don't send it to them. Send it to the other. And so this is, but unfortunately, this is where the hysteria comes from because when $24 million is hinging on Ibuprofen 600, you know, [00:22:40] ibuprofen 600 is $24 million. That's kind of a unfortunate situation. But that's the, that's what, that's the pond. We swim in's the reality.

[00:22:48] GUEST: Yeah. So, yeah. That's the impact of that and intuitive work restrictions is that you can actually put them back to work doing something productive instead of You know, what do we do with this restriction? We'll have to [00:23:00] put him in the office or send him home. The um, First Comp phone calls we haven't talked about yet.

[00:23:04] GUEST: That's the fourth one. Uh, that's, that's a communication issue. Before we get

[00:23:09] HOST: to that, I just want to, yeah, before we get to the phone calls, very important, but before we get there, let's just talk for a moment about, you know, number three, well, and number [00:23:20] one, you know, time, time loss versus OSHA recordables.

[00:23:24] HOST: So. So if you have any time loss, you're going to have OSHA recordable, but if you have even a transfer or a modified duty prescription, you are going to have a recordable. So you've maybe lost that risk, but you still have the [00:23:40] additional risk of being off duty. And it's not just the time loss itself, it's what happens to the patient.

[00:23:46] HOST: Talk a little bit about deconditioning and about not being in the mindset of productivity and how that delays recovery.

[00:23:57] GUEST: Well, they've done studies. they've done studies. [00:24:00] People at home don't get better as fast as people who come to work on light duty. That's, that's, that's, there's literature on that.

[00:24:07] GUEST: So what is that? Is that psychological? It's multifactorial. I mean, watching TV, laying around, I mean, doing some things around the house. I mean, it gets to be nice as opposed to getting in your car and going to [00:24:20] work. So, it's got a psychological effect. Deconditioning, absolutely. Losing range of motion, splitting things, not being active.

[00:24:29] GUEST: So, the psychological effects and the deconditioning effects, are ramifications of being at home instead of being at work. The point you made about [00:24:40] reportables,

[00:24:40] HOST: whatever you can do to keep people moving in some fashion. is going to put you way ahead. all right, well, let's tackle number four.

[00:24:46] HOST: Let's go into, phone calls, right? When do we make phone calls?

[00:24:51] GUEST: Yeah. I want to make one point before that one, that a lot of the companies I work with that are highly concerned about unnecessary recordables, they have a [00:25:00] broad full duty job description. And so when the patient comes back with light duty restrictions, if they can accommodate that worker within their full duty job description, it's not recordable.

[00:25:09] GUEST: So to your point, if they're outside their job, their regular job description, recordable for restriction, the ones, the ocean sensitive companies I work with. They've got [00:25:20] plenty of light duty in their job description to put people in and keep it all recordable.

[00:25:24] HOST: Well, I think, you know, one caveat there, one corollary, I guess it is, is that they must have performed those duties, you know, recently, like, like the actual, uh, verbiage I think is within the last week.

[00:25:39] HOST: So even if they [00:25:40] have those in their job description, they have to rotate through them to make sure they've been actively performing those duties.

[00:25:48] GUEST: Yeah, and I'm, I'm not sure of exactly how compliant they are with all that. I just know that, you know, all these years, I've never had something really hit the fan badly for an employer that I was told about, [00:26:00] like, hey, we just got crushed on our OSHA recordable log, OSHA 300 log, never, I don't know.

[00:26:05] GUEST: I know there's things out there, but. No one's ever called me up and said, you know, your philosophies about all this got us into trouble. It's never occurred. Never. But, um, on to, uh, First Comp phone calls. This is so simple and [00:26:20] unbelievable. It is so sticky. It is so appreciated. They'll worship the ground you walk on.

[00:26:25] GUEST: It's as simple as this, okay, because they'll say, Another phone call. I gotta make another phone call. I don't have time to see the patients I am seeing. Well, it goes like this. Hey Bill, I saw Joe today here at the clinic. He's got a lumbar spine strain. Our x ray is negative. [00:26:40] It's a routine strain. We're going to go and give him light duty at 25 pounds lifting limit, back support, Tylenol and Naproxen non recordable.

[00:26:46] GUEST: I'll see him back next Tuesday between the hours of eight to two. How's that? That's great. Thank you so much for calling. That was about 15 seconds. I mean, it's just, it's that easy. And they can ask questions like, you know, [00:27:00] well, you know, do you, what do you, what do you think about him? Is he being honest?

[00:27:05] GUEST: You know, well, the finding show, and you just talk about a little bit, but by and large, and nowadays, it goes to voicemail a lot, but it's still appreciated. It's still appreciated. Even if you go to voicemail, leave it on voicemail. and that's when you tell them about the [00:27:20] recordable.

[00:27:21] GUEST: That's when you tell them about,non recordable. If there are, if for us that we had a designation in our EHR that If they're ocean sensitive, we would tell them. If they, if they're not ocean sensitive, then they don't care to know. So you don't talk about it, but

[00:27:35] HOST: I think a lot of the return to duty prescription forms and EHR [00:27:40] and forms of EHR, do track that now, if you have anything that is, you know.

[00:27:46] HOST: at least somewhat competent in documentation for work comp injuries. There usually is some provision for marking off whether it's a recordable or at least whether there's a prescription medication and time loss. And and the [00:28:00] employer can usually have enough information there to figure that out. So, yeah, should be well documented.

[00:28:08] HOST: Good. John, what are some common pitfalls that providers stumble into when dealing with these metrics with these four items? How can they avoid them?

[00:28:17] GUEST: Well, it seems to me [00:28:20] The biggest impediment is emotional. getting past the idea of, you know, I don't work for the company. Why do I, why would I care about these things?

[00:28:28] GUEST: I just treat patients. I don't want to think about these other issues. So that's, they get into trouble because they, I don't know the exact reason, whether it's mental or [00:28:40] emotional lack of engagement or laziness or lack of. Experience or what, but however it takes to get there, they need to get there. And I had a, I had a question from an Octoc1 user, just this week about how can I document the chart so I'm not the evil doctor?

[00:28:59] GUEST: [00:29:00] I mean, using the word evil, like they're, this provider is afraid of practicing this way. Because they'll be viewed as being evil by the patient. And the context of it was that the worker's low back pain had gotten better, but they had new pain elsewhere, okay? The [00:29:20] case is over, okay? Hey, sir, your back strain is so much better.

[00:29:24] GUEST: It's resolved. I'm going to go ahead and release you. And for this other pain, you should see your family doctor for that. I mean, and they're afraid of being the evil doctor, so I coached them through that. so they have to get over the emotional side of it, that the, the, the, what you're doing here is [00:29:40] seeking the truth.

[00:29:40] GUEST: You're, you're the, you're on the high ground. You need to occupy the high ground of, you're seeking the truth. So if they are malingering, you need to say so. And you, you know, be able to do an examination that demonstrates that. And Octoc1 has it in there, the validation steps on how to objectify that.

[00:29:57] GUEST: But,they can get into trouble with the [00:30:00] fixation on prescription drugs. is if they're a magic or something, something magical happens when it goes from a non prescription to a prescription. It doesn't, you know, Tylenol and naproxen are just fine OTC level prescriptions on the first two visits. first comp phone calls, it's just, there's nothing in the way of that except lack of [00:30:20] engagement.

[00:30:20] GUEST: You know, you have to be committed to the cause and the cause is doing great amount of great clinical medical care on injuries. And, and being able to be cognizant of them and be cooperative with these companies on their administrative concerns. These are administrative concerns for them, for the majority.

[00:30:36] GUEST: It's not like no one's saying you have to put a shoulder back in. Okay. [00:30:40]

[00:30:40] HOST: So let's talk about Octoc1. How did that idea for that come about? What specific need did you see that was missing that is now fulfilled with Octoc1?

[00:30:51] GUEST: Yeah, 150 providers and too many phone calls. Because I had to keep everybody on the railroad tracks.

[00:30:57] GUEST: I mean, these are the big four. These are railroad [00:31:00] tracks, right? It's a system, a way of doing things. And so, especially for the really large clients, I needed to take some phone calls and it was getting to be too much. And so I said, I need to put my brain on a website. I need to put, cause everybody, everything's algorithm driven, right?

[00:31:16] GUEST: You have an algorithm to treat a COVID patient. You have an algorithm to treat [00:31:20] a back strain. You know, this, then that, and you know, you go on down and no matter how you. It is. And so I created these algorithms and made 385 guidelines, supported with 400 videos within the guidelines to show and teach as it goes.

[00:31:35] GUEST: So it's kind of like a residency program on a web based platform or [00:31:40] another way to put it that you've put it before. Clinical decision support tool for clinicians to treating injuries. So it's literally a cookbook for them. And that's not demeaning in any, any, it's not demeaning at all because when you do a residency training program, If you did one, but the whole idea of a residency training program is you're working underneath [00:32:00] people and you're presenting cases to them.

[00:32:02] GUEST: So you're developing your algorithms and you have to do case presentations. And then they critique your, your presentations and ask you questions. They're building algorithms, if this, then that, what about this? And what about that? What makes you think about that? And so Octoc1 provides that algorithm [00:32:20] for all these injuries.

[00:32:21] GUEST: It's got all the medical legal danger points in it that you can't miss, right? The can't miss cases are in there. Um, it's got all the training videos, onboarding and training. For new providers and it's got the mission critical videos and core training videos for all things occupational medicine So I made it to scale [00:32:40] myself and provide then All the clinics that want to be successful and work comp is everybody's working for scale I mean, it's all about scale.

[00:32:49] GUEST: You can't I tell you I was talking to the other day and they go Oh, yeah, we have two medical groups or two medical directors to doctor the two medical directors We have 25 clinics and I say [00:33:00] that's not workable to get where you want to get because you have turnover, you have a lot of moving parts, you know, to one doctor, two doctors, you can't, it's really too hard to do all the onboarding training, give me everybody on the railroad tracks is too much work, too many charts to review, to [00:33:20] do it right, okay, to do it, you know, partway, I guess, you know, you could do with anything, but I think that, it's, for me, it was a scalable tool.

[00:33:28] GUEST: Scaled myself across and so that the providers they go right to the website first get through that had a question They can call me then if they have a question as they go through and these algorithms are my algorithms every decision point [00:33:40] They would ever think when to order an MRI when the order PT how to interpret an MRI How to interpret a post a follow up x ray on a fracture, you know, cuz I'm like, I don't know how to do fractures Of course, you don't cuz you if you never did it you so see one do one teach one all the injection videos See one, do one, teach one.

[00:33:58] GUEST: You can do it. [00:34:00] Yeah.

[00:34:01] HOST: Well, there's an instant ROI uh, on, on OCDoc1. and there's a, there's a link in the show notes, to get on OCDoc1 if you've never seen it. you got to have it for your OcMed practice, your urgent care practice. Hey, this has been the Big Four in Occupational Medicine for Provider Performance with our dear friend, [00:34:20] Dr.

[00:34:20] HOST: John Kaler. Thanks so much for joining us. This is Fit for Duty.

[00:34:27] GUEST: Thanks, John.

[00:34:30] HOST: And that wraps up this episode of Fit for Duty. Thanks for joining me today, everyone. I hope you found this conversation as engaging and informative as I did. As always, [00:34:40] building healthier, happier workplaces starts with knowledge and collaboration.

[00:34:44] HOST: So, if you enjoyed this episode, please consider subscribing to Fit for Duty. Wherever you listen to podcasts, that way you'll never miss a beat when it comes to the latest trends, best practices, and inspiring stories in occupational health until next time. Stay [00:35:00] safe, stay well, and keep elevating workplace excellence.