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Last week I posted that CMS appeared to have altered the zero dollar MSA approval process. This caused a great deal of discussion and activity. This has resulted in CMS releasing the following bulletin indicating that no  changes will be made to the zero dollar MSA program until it publishes changes:

October 31, 2016 – Announcement regarding Current Workers’ Compensation Review Contractor Procedures and Request for Approval of Zero-Dollar Medicare Set-Aside Amounts

CMS recently received inquiries regarding procedural changes in the way that CMS’ Workers’ Compensation Review Contractor (WCRC) reviews proposed zero-dollar Workers’ Compensation Medicare Set-Aside Arrangement (WCMSA) amounts.  CMS determined changes had transpired without prior notification. Effective immediately, the WCRC will utilize procedures that were previously in effect.  CMS continually evaluates all policy and procedures related to WCMSA reviews and will publish any pending changes when or before they go into effect.

Therefore, we are in a “wait and see” holding pattern until CMS publishes some additional guidelines. The good news is that we can confirm CMS is approving zero dollar MSAs as expected under the current system. Sedgwick has been in touch with CMS and we will provide  feedback to CMS about how the proposed changes will adversely  affect the settlement process.

Please watch for additional updates as we continue to provide you with the most up to date information. Please feel free to leave questions or concerns here and I will do my best to answer your questions.

0d65914Michael R. Merlino II, ESQ.
SVP of Medicare compliance and structured settlements
Sedgwick

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c4e8a4e2-6152-4909-b3fa-d4591c09d421-largeIn this age of connected technology and communication, it is easy to lose track of the benefits of onsite, in person claims adjusting and investigation. In the property claims business, I have long recognized that there are still many benefits to our model which is based on in person work that simply cannot be accomplished remotely. Consider the following:

Personal touch

The moment you meet someone in person, you begin developing a personal relationship. While the seed that is planted in that first meeting may never grow, the process of going through a first party property claim is often part of a traumatic personal event. For the life span of the claim, the adjuster will be discussing the financial (and other) consequences of the loss with the insured. Even in adversarial circumstances, a skilled adjuster can build close personal relationships with insureds and consumers that can have a significant positive impact on their experience.

Accuracy

Good investigation is essential to good claims handling. The more you know about the circumstances and people involved in a loss, the more you are likely to make  good decisions about what to include in the claim, and how much to pay. Consider the contrast between a phone conversation and the conversation you would have in person in the insured’s living room? Or, contrast the information you get in an email with the information you get from walking through someone’s flood damaged home.

Thoroughness

There is a wealth of information to be gained from good field inspections. One example of how this works is that in many cases neighbors will approach and offer up details about the loss and parties involved. This is information that you will never get electronically.

Reliability

There is no better testimony than eyewitness testimony. While email exchanges create a written record, emails are brief, and easily taken out of context.  A field adjuster’s notes are a written record of their eyewitness inspection. The context is clear and can be backed up by the djuster’s testimony.

Technology may provide many opportunities to improve efficiency, but it is a mistake to overlook the effectiveness and benefits of a proper field investigation.

These four corner stones are key to our field adjusters at Vericlaim.

I would like to hear from you about your own personal experiences where field adjusting made a difference.

Stuart Ryland CPCU
Western Regional Vice President
Vericlaim

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For the past several years, we have been successful in obtaining zero dollar MSAs approved by the MSA review contractor. The case, however, had to meet very strict criteria:

  1. The case was denied;
  2. There had to be no payments for indemnity;
  3. There had to be no payments of medical; and
  4. No prior indemnity settlement;
  5. Provide some medical records (if so requested by the contractor)
  6. Signed release from the claimant

If we had those six items and the case met the CMS review thresholds then 100% of the time the zero dollar MSA would get approved. The process was working perfectly.

Over the past week, however, we obtained verbal confirmation from the review contractor that the process is changing.  In addition to the above, we are also going to have to provide one of the following:

  1. A court order indicating that the employer is absolved of further obligation to pay medical.
  2. A doctor’s note indicating that the claimant didn’t need any further treatment.
  3. Medical records from the claimant’s private doctors showing that he/she is not treating for the alleged WC injury.

This new requirement will minimize the effectiveness of the zero dollar program if (1) the verbal representations are accurate; and (2) it is implemented as described.

Why? Well quite simply CMS is requiring so much proof that no MSA would be needed. If the employer obtains a court order that states the employer is no longer responsible for future medical treatment or if a doctor states no further treatment is needed, then why do an MSA at all? If either of these items are available to the employer, the responsibility to pay for future medical has been extinguished. Since there is no risk of transferring an future medical expenses to Medicare, then the employer case can close the case or settle without an MSA.

The last item is interesting and it could be used in limited situations. It is possible that there exists a situation where item number three could be used to secure a zero dollar MSA, but it will probably be in limited situations.

The beauty of the current process is that it provided an avenue to obtain a zero dollar MSA where the parties were in a grey area as to whether an MSA needed to be funded or not. The proposed process, however, requires so much proof that the parties probably would never need an MSA to begin with.

Sedgwick will continue to monitor this situation as it continues to develop.

0d65914Michael R. Merlino II, ESQ.
SVP of Medicare compliance and structured settlements
Sedgwick

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mentalhealthAprilRisk managers should always be aware of injured worker opioid use across their open claims and make sure that there is persistent clinician involvement with prescribers.

I am a complex pharmacy management nurse for Sedgwick. I want to share one of the many examples I see in day-to-day support for individuals who are prescribed opioids.  One of the injured workers I was assigned to help was on several expensive medications for headaches: an opioid pain reliever, a sleeping pill, a medication for depression and a pill for erectile dysfunction.  I was overwhelmed with the list of medications and realized when taken together they posed a dangerous risk to the patient. The doctor also indicated that the patient admitted to drinking alcohol. The implications for the man’s overall health and safety were alarming.  I intervened immediately by trying to contact the physician and writing him regarding my concerns.

Next I identified an inconsistent urine drug screen, positive for opioids not prescribed and negative for the prescribed opioids and showing high alcohol levels. Shortly after that the patient had an accident during physical therapy and requested an increase in opioids. The doctor increased the medications without question. Making matters worse he also added two muscle relaxers, a stimulant due to drowsiness, and another sleeping pill.

At this point, the physician was still not responding to my continuing outreach so I sent a follow up letter outlining the health safety concerns.  After a few more days of persistent follow up on the phone, the doctor called me.  He had reviewed my letter and agreed with each of my points about the dangerous medications and the urine drug screen results. He outlined the changes he intended to make. I was overjoyed! Persistence had finally paid.

The doctor decreased the medications immediately and began the weaning process until all medications were discontinued completely. After the doctor addressed the non-compliance issues with the patient and shared his plans for the medication regimen, the patient decided to settle his claim.  Even though the road to success was long and provided many obstacles along the way, perseverance was the key to success.

Abby McBroom
RN Complex Pharmacy Management Nurse
Sedgwick

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October is fire prevention month and this year the theme is:
Don’t wait – Check the date! Replace smoke alarms every 10 years.

The National Fire Protection Association estimates that nearly two-thirds of deaths from home fires occur in properties without working smoke detectors. (1)

Genesis of fire prevention month

In May 1919, to observe past fire tragedies – such as the great Chicago fire – and to prevent future tragedies, the Fire Marshals Association of North America sponsored the first National Fire Prevention Day.  This event began an annual observance as a way to keep the public informed about the importance of fire prevention.

Thfiremonthbloge proclamation of fire prevention week

In 1920, President Woodrow Wilson issued the first national fire prevention day proclamation.  Since 1922, fire prevention week has been observed the second week of October, from Sunday through Saturday. Since 1925, every United States President has signed a proclamation declaring fire prevention week as a national observance.

The smoke detector

This year’s theme is Don’t wait – Check the date! Replace smoke alarms every 10 Years.  Generally, smoke detectors are round and approximately six inches in diameter.  There are two types of smoke detectors: optical or ionization. Smoke detectors can be individual battery-powered units that can be mounted in any location, or several interlinked powered units with battery backup that can report to a fire panel. (2)

Age matters

Smoke detectors should be replaced 10 years from the date of manufacture, which is located on the back of the alarm. The best way to remember to change out your smoke detector is to write the “change date” on the plastic housing with an indelible black marker.

Mounting is critical

Smoke detectors should ideally be mounted on the ceiling in the hallway near sleeping rooms, as well within each sleeping room above the doorway.

Don’t wait – Check the date! Replace smoke alarms every 10 years. A few minutes of prevention can result in saving your life and the lives of those you love.

If you have questions or concerns if your residence or business is properly equipped please leave us a comment or question.

References

  1. “Learn About Smoke Alarms”. USFA.FEMA.gov. 2014-06-03. Retrieved 2014-08-22.
  2. NFPA-101

Lorne Brunner, MS Forensics,  IAAI-CFI, Unified Investigations & Sciences, Inc., a Sedgwick company

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October is National Disability Employment Awareness Month (NDEAM), a time devoted to exploring disability employment issues and celebrating the many and varied contributions of America’s workers with disabilities. Reflecting the important role disability plays in workforce diversity, the national theme of this year’s NDEAM observance is #InclusionWorks. In line with Sedgwick’s commitment to fostering a diverse and inclusive workplace and supporting the full potential of people with disabilities in our society, we are proud to participate in this annual observance.

Approximately 39.9 million people in the U.S. have some kind of disability. Many disabilities—such as serious illnesses or chronic health conditions, sensory limitations, mental health issues and intellectual/cognitive disabilities—are not immediately visible or apparent. These facts and figures highlight demographic information about people with disabilities, and this historical timeline documents the individual achievements of people with a variety of disabilities, plus legislation affecting legal opportunities for equality and inclusion.

Here at Sedgwick, we well know that the ability to work gives people a sense of purpose, allows them to support themselves financially, and improves their physical and mental wellbeing. Through our daily work on behalf of customers, our colleagues play a critical role in advocating for individuals with a variety of disabilities as they navigate the health care system, family and medical leave, workplace accommodations and transitioning back to work after an injury or illness. We are in the unique position of shaping the experience of millions of Americans with disabilities; by demonstrating that caring counts, our colleagues alleviate the sense of intimidation and exclusion that consumers with disabilities may feel.

Here are just two of the many stories at Sedgwick that I am proud to share with you that demonstrate our commitment to employing individuals with disabilities.

adamfitz In 2008, when Adam Fritz was 21 years old and about to enter his senior year of college, a table slipped off a truck in front of his motorcycle and struck him, flinging him off his motorcycle and onto the freeway. He sustained a spinal cord injury and was told he’d never walk again. Working with researchers at the University of California at Irvine, he has defied the odds, taking steps in a laboratory with the help of cutting-edge technology that combines virtual reality and brain-computer interfaces. While Fritz waits for the technology to gain FDA approval and be made available for everyday use, he gets around in a wheelchair and spends three evenings a week at physical therapy to keep his body in prime shape. (Click here for more on his personal story.)

A couple of years ago, Fritz’s friend—a colleague in our Riverside, California, office—encouraged him to apply for our Industry Advancement Program (IAP). He did and was accepted. Sedgwick was able to accommodate all of Fritz’s accessibility needs at our Riverside location and make his workspace as comfortable as possible. He is now a successful claims representative handling workers’ compensation claims for a major hospital system in the San Diego area.

“I came into the claims industry as a blank slate with no experience,” Fritz said. “Going through the IAP set me up well for the position I’m in now. Because of my personal experience, I have a unique understanding of the challenges people face after an injury severe enough to change the rest of their lives. I feel for them because I know what they can expect, and I can empathize more with their situation.”

Fritz is an especially committed and hard-working colleague with tremendous hope for the future, despite his current physical limitations. That’s exactly the kind of person we want taking care of our customers.

Ibenn line with our commitment to creating employment opportunities for individuals with disabilities, this past summer Sedgwick invited Ben Halvorson, a mainstreamed high school student with Down syndrome, to work as an office support apprentice for the pharmacy management team. “Ben demonstrated the spirit of Sedgwick as he worked diligently each day,” said Cindy Jaggers, VP of national utilization review and clinical pharmacy. “He became an inspiration to us all, as he was so excited to be able to work at Sedgwick. The company’s openness to considering people with disabilities for employment opportunities is absolutely the perfect expression of our caring counts philosophy.”

In reflecting on his summer internship, Halvorson wrote, “I really liked my job because it made me feel so busy. I worked so hard on the two computer monitors at my desk. I did the reports and copied email to my supervisor. I really liked to fill in whatever was needed for the group. Everyone made me feel welcome at Sedgwick. Thank you for letting me have this experience; it was really excellent!” (Halvorson’s story was featured in a Sedgwick-sponsored video for SRVS, a nonprofit provider of services for individuals with disabilities in West Tennessee.)

Differing abilities are part of the healthy diversity that not only makes Sedgwick a great company, but also brings tremendous value to our society. This month and throughout the year, we applaud our colleagues with disabilities for sharing their unique talents with us and recognize the wide-ranging achievements of individuals with disabilities.

Bob Blankenship
Group Chief of Staff
Sedgwick

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What does the Joni Mitchell song ‘Both Sides Now’ have to do with workers’ compensation regulations?

I’ve looked at life from both sides now
From up and down and still somehow
It’s life’s illusions I recall
I really don’t know life at all
-Joni Mitchell, Both Sides Now (1969)

change-management-blogThese days, when I think of regulations and regulatory compliance, I’m reminded of the Joni Mitchell song “Both Sides Now.” If you replace ‘life’ with ‘regulations’ my perspective becomes clearer. I’ve looked at regulations from both sides now…

Previously, as the chief regulator responsible for the largest self-insurance marketplace in the nation, I had to consider regulations while underwriting new self-insurers, overseeing market conduct and enforcing compliance and solvency standards for California’s 7,000+ self-insured employers and their 4.6 million covered employees.

Today, in the private sector I am regularly considering the application of and compliance with requirements of regulations across 50 states and well-over 100 different regulatory agencies.

From these two similar, but very different viewpoints, I believe I have a unique perspective when looking at regulations. Sometimes, I feel as if I’m bi-lingual when discussing the nature and impact of regulations saying the same thing and then, translating the meaning of the words into a viewpoint from one side or another, much like two different languages.

What is similar on both sides is a desire to protect the public, return injured workers to full function, eliminate unnecessary costs from the system and have an efficient system that works effectively for everyone with minimal friction. I believe most regulators and employers could agree with this; however, this is where the conversation becomes interesting. The ways to achieve these goals are viewed very differently by the regulatory and regulated communities.

The common goal shared by both sides is to protect workers and provide an effective and efficient system to advocate and support any injured worker and to quickly return them to full function and their life. The challenge is in how best to accomplish this goal, since both sides see varied paths to getting there.

The regulatory community needs to create a framework to administer and enforce the operation of the system. Additionally, regulators these days are highly focused on collecting data and metrics in order to report on progress and defend their efforts when called into question by the legislature, media, public and various stakeholders within the system. In some instances, this data adds value, informing us where improvements are needed or have been effective. However, there is a lot of data collected for data’s sake that adds little of no real value, but creates tremendous effort and cost on those required to collect and report it.

The employer community would like to provide the benefits and have the injured worker and their loved ones progress back to normalcy, yet they see continuing layer upon layer of bureaucracy as a burden that does not always directly support the goal of advocating and helping their employee. In some instances the system actually impedes this goal and effort. A question appropriately asked is “how does completing report after report actually improve an injured worker and return them to full function?” As with most large groups, almost all employers want to do the right thing, however, there are a few that attempt to game the system.

These few are used to justify the need for large parts of the system being designed to catch the few, while impacts are imposed on the many such that it can become hard at times to remember the original purpose and goal that the workers’ compensation system is designed to serve and the problem it seeks to solve.

Outside influences, benefits and service providers, the legal community, and others have opinions and want a say in how the estimated $60 billion spent each year on workers’ compensation is regulated and directed. These pressures and influences work on the system and can ultimately have an impact on how regulators oversee and regulate the system and stakeholders.

Bridging the perspectives and communications divide is challenging with each side being committed to the same goal while seeing the path to achieving it from very different perspectives. When I taught business, I always explained to my students that business was an art, not a science. A science might be more like accounting where there is one right answer; one plus one equals two. In business there are many paths that will get you to a goal, some more effectively than others, but not one single right way to tackle the objective to achieve the desired result.

Workers’ compensation is very much like this. There are many different paths. The question is have we taken the right one? The system has evolved over the past hundred years; is the real solution to have layers upon layers of bureaucracy and reports to track metrics and data? Does this really return an injured worker to full function, advocate for their well-being or does this just create a lot of effort to attempt to quantify the problem while adding little value? I believe fewer streamlined regulations focused on caring for the injured worker is a step in the right direction – What do you think?

Jon Wroten, senior vice president, Regulatory Compliance & Quality Sedgwick

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doctor-patient-evaluationA Sedgwick liability nurse was asked to analyze the records of a claim involving a 52-year-old man whose car was struck when our client’s truck driver fell asleep at the wheel, overturning his rig and causing damage to several cars.  Liability was not in question, but there was substantial dispute over the damages. The initial plaintiff demand of $750,000, included $140,000 in medical specials and defense counsel assessed the verdict value of $350,000-700,000 based on the severity of the accident and claimed injuries.

The plaintiff alleged that when the air bag in his car deployed, he lost consciousness and sustained traumatic brain injury, accelerating a pre-existing hearing loss and causing vestibular damage requiring surgical intervention with cochlear implants. A treating physician found that the plaintiff had a congenital disorder that caused his underlying hearing problem and suggested that his type of disorder might have placed him at greater risk for worsening in the presence of head trauma. In addition:

  • The liability nurse reviewer found nothing in the medical records to support either loss of consciousness or evidence of head trauma at the time of the accident.
  • Several months after the accident, the plaintiff reported that he was losing his balance as a result of pain in his legs. The nurse identified that the plaintiff’s orthopedic problems were pre-existing, stemming from a prior injury and pointed out that four of his pain medications were associated with dizziness, gait instability, lack of sensation in the feet, and diminished coordination. The records also contained a statement from the plaintiff to his physician indicating that he had lost his job as a result of falling asleep at work due to sedation.  Once he reduced his use of pain medications his balance improved.
  • The primary cost of the plaintiff’s claim was related to the accelerated hearing loss, but the nurse found that prior to the accident he had a lifetime of hearing loss and was already relying on lip reading and a hearing aid for communication.
  • The liability nurse was able to assist the adjuster in disputing the medical specials, citing the lack of medical indicators for the cochlear implants for his balance problems.
  • The liability nurse identified records not previously identified by the plaintiff attorney and made recommendations for types of experts that might be required should the case proceed.

By the time of mediation, the demand was in excess of one million dollars. The adjuster saved the cost of outside referral and used the nurse’s information about lack of causal links between the treatment provided and the claimed neurological, auditory and vestibular injuries to negotiate a favorable settlement.

The case settled at mediation for $285,000.  Cost to the claim file for the liability nurse review was only $440.

Liability nurse consultants are highly experienced clinicians and consultants with experience in a variety of specialty areas.  Additionally, the nurses are also licensed claims adjusters who provide great value in understanding the needs of other claims adjusters in providing details for the claim file.  Needless to say, their services are highly cost competitive especially compared to the very expensive demands of liability claims.

While we know that the liability nurse consultant may not  have  a dramatic impact on every case, their approach provides claims adjusters with a medically trained resource to assist in the analysis and evaluation of injuries allegedly sustained by injured parties—creating good outcomes and cost savings.

Please feel free to share your thoughts and questions with us; the Sedgwick liability nurse consultant team is available to help meet the needs of your organization.

April Clemens, Business Relationship Manager, Specialty Operations, Sedgwick

Diana Shick, RN Consultant Team Lead, Liability Nurse Program, Sedgwick

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According to 2015 U.S. Coast Guard statistics, May through September is  the peak period for recreational boating accidents.  Florida, Minnesota, Michigan, and California lead the nation in the number of registered boats while Florida regularly leads the nation in damage claims of over $2000—far outpacing California at a distant second. bwalburnboat

While boat and watercraft insurance is an important line for many insurers, the nature of boating can lead to large property, casualty and liability claims.  There are several areas where marine safety and vessel maintenance can significantly reduce both the incidence of claims and the dollar value of payouts.  This blog post will focus on sailboats, powerboats and personal watercraft.

Risks to boats include:

  • Sinking
  • Collision with other vessels
  • Collision with fixed and submerged objects
  • Grounding; fire and explosion
  • Wind and weather
  • Hurricanes
  • Lightning strikes
  • Theft
  • Injuries
  • Damage to vessels being stored or trailered

Here are a few operation and maintenance strategies designed to reduce boating claims:

  1. The most important rules for safe boating are training and vigilance.  Many states do not require any certification to operate a boat, and some don’t even have age restrictions. All boat owners and passengers should take a boating safety course covering safe practices, safety equipment, navigation rulesand accident prevention. A list of boating safety courses and other information can be found at www.uscgboating.org
  2. Boats can sink at sea as the result of collisions and heavy weather, but they can also be done in by a lack of proper maintenance.  The two most critical areas overlooked are the hull and the engine/electrical systems, which can lead to sinking or fire and often the total loss of the boat.
  3. Boat owners should pay close attention to marina maintenance issues that may pose a risk to their boats, including overheated shore power systems, stored combustibles, unsafe welding operations or corroded fuel lines.  These issues should be reported immediately to marina management.

Forensic marine professionals are experts in recreational watercraft, yacht, commercial shipping and marina type fires. In addition to fire related incidents, forensic engineers can perform accident reconstructions, ocean engineering and code compliance inspections and reviews.  These professionals also have experience working along with maritime attorneys, marine surveyors, heavy equipment operators and other experts on large joint scene examinations.

While it is impossible to prevent all boat-related accidents and losses, you can rest easier knowing there are experts who can help with loss prevention and recovery.  Please feel free to share your questions and ideas with us. Learn more about Unified  and how we are here to meet the needs of your organization.

Patrick Hudson, PhD, PE, District Manager/Forensic Engineer
Unified Investigations & Sciences, Inc., a Sedgwick company

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Telemedicine customized for occupational injuries will provide the greatest advantage

“You have to start with the customer experience and work backwards to the technology.”  – Steve Jobs

Telemedicine, primarily audio technology, has been available to  group health providers for care for minor illnesses, follow-up care and e-prescribing for a long time. Many workers’ compensation claims administrators and managed care organizations also provide audio telehealth services in areas such as 24/7 nurse triage and prescription drug reviews.

Nowtech-and-wc video telemedicine services are evolving for group health and they are at the genesis of  production in workers’ compensation. Claims administrators and managed care organizations must thoughtfully connect specific crucial areas in order to successfully deliver quality occupational care via mobile technology and video.

We have seen for years that getting injured employees to the occupational injury care providers proven to achieve the best outcomes in workers’ compensation significantly lowers cost, time away from work and rates of litigation. High-quality healthcare is a MUST for telemedicine.

In order for telemedicine to be successful in workers’ compensation, employers need to be sure their claims administrators and managed care providers are fully prepared to deliver:

  • Technology and logistics: Through the right platform, we can ensure easy access, short wait times, provider availability and correct/efficient billing.
  • Experience and results: One of the keys to improved health and return to work in the workers’ compensation space is having access to the best-performing occupational medicine providers available around the clock. This remains true whether seeing a doctor in person or via telemedicine.
  • Network connectivity: We must ensure that the networks entering into this new approach are organized and trained to meet the needs of occupational injury providers, the employer and injured workers.
  • Fully transparent pricing/fees: Telemedicine is simply a form of healthcare enabled by technology, so the cost of services should be fully transparent.
  • Regulatory compliance: The services should be fully compliant with applicable regulatory requirements, including state reporting, compliance with telemedicine jurisdictional laws and billing for services.

By connecting these critical areas, the claims and medical cost containment services administrator will eliminate travel time, reduce lost productivity and cost associated with occupational injury care, while creating a new model with ease of access to high-quality care. Telemedicine customized for occupational health can offer a convenient avenue to provide initial and follow up occupational medicine and specialist care for injured workers which will promote higher patient satisfaction and reduce cost.

According to an article from Harvard Medical School, the average total visit time for a person seeking care for themselves, a child or another adult was 121 minutes, including 37 minutes of travel time and 84 minutes in the clinic. Yet, only 20 minutes was spent with a physician. The opportunity for great improvement is here.

We see an excellent future for telemedicine to save time and cost and to improve access to specialty care in workers’ compensation. With the logistics to deliver great service, regulatory compliance and connection to the highest-quality providers, the opportunities in this area are phenomenal. But be sure to do your homework and find the right option to make it a win!

Dr. Teresa Bartlett, SVP, Medical Quality