Congratulations to Dr. Melissa Tonn, who was honored with the Marcus Key Lecture Series Award at SOCOEM 2024 for her exceptional service and leadership in occupational medicine. As the keynote speaker, Dr. Tonn drew from her 30+ years of experience to share valuable insights on innovations in treatment and the expanding role of occupational medicine in leadership.
Thank you, Dr. Tonn, for your unwavering dedication to advancing the profession and inspiring the next generation of leaders!
In Texas, there has been a noticeable decline in the number of MDs and DOs participating in the Designated Doctor program, with many of these roles now filled by chiropractors. Performing Independent Medical Examinations (IMEs) or Required Medical Examinations has become increasingly challenging for physicians. They often face low ratings on platforms like Vitals and Healthgrades, accompanied by scathing allegations of incompetence, perceived bias toward insurance carriers, or employer favoritism. Additionally, personal injury attorneys frequently encourage claimants to file medical board complaints, making the practice even more arduous. And let’s not forget the dreaded depositions, which are never an enjoyable experience.
Adding to the challenges, the costs associated with IME facilities and physician fees have risen significantly since 2020. Despite these obstacles, OccMD’s network stands out as exceptional. Fees are negotiated on a peer-to-peer basis, ensuring fair pricing through the expertise of our Chief Medical Officer or Medical Director.
OccMD also avoids low-quality IME vendors that rely on non-clinicians to complete the entire chronology of a case, with physicians simply dictating templated reports and answering standard questions. Unfortunately, these practices often result in subpar reports and unnecessary second IMEs due to incomplete assessments. There are too many instances where the initial IME does not place the claimant at MMI/MRC for the sole purpose of scheduling a second IME in 6 months. With OccMD managed cases, such inefficiencies are rare, as our managed cases typically require only one IME.
For OccMD IME or Peer Review, we go beyond standard evaluations, adding case-specific questions to address the unique details of the injury or claim. This includes a thorough review of accident photos, comparisons of serial imaging, and analysis of prior treatments to the affected body region. By prioritizing quality and precision, OccMD delivers reports that truly meet the needs of our clients and ensure fair outcomes.
By Melissa D. Tonn, M.D. and Bill Minick, J.D.
In the context of medical imaging interpretation, credibility is typically enhanced when the reviewer is free from potential conflicts of interest that could bias their judgment. Consider the basis for evaluating credibility in these two scenarios:
MRI interpreted by a Radiologist Blinded to the Payor:
Radiologist Paid by a Personal Injury Attorney:
It's crucial for the medical legal process to maintain practices that uphold the integrity of medical evaluations and safeguard against potential conflicts of interest, thereby preserving the credibility of the findings and the fairness of the judicial process.
Discover some of the ways OccMD improves the lives of injured workers and transforms Texas workers’ compensation and injury benefit program outcomes in this insightful six-minute webinar highlight. Join Dr. Melissa Tonn and Dr. Martin Kus as they share how OccMD accelerates medical approvals, leverages judgment beyond traditional treatment guidelines, and effectively manages MRI and IME processes.
OccMD proudly congratulates our Medical Director, Dr. Martin S. Kus, on being named the incoming President of the Southern College of Occupational and Environmental Medicine (SOCOEM). This prestigious honor reflects Dr. Kus’s leadership and dedication to advancing the field of occupational and environmental medicine.
SOCOEM, a regional component of the American College of Occupational and Environmental Medicine (ACOEM), represents the largest network of physicians specializing in workplace health. ACOEM’s mission is to promote worker health through preventive care, research, and education—goals closely aligned with Dr. Kus’s lifelong commitment to protecting and enhancing worker well-being.
OccMD’s physician-led nurse case management team and Corporate Remedies’ medical provider network team now office together on Preston Road in Dallas, continuing to provide exceptional service with the same high level of dedication and client satisfaction.
“We are highly focused on our team development, process improvement, and technologies that support the most effective workers’ comp and occupational injury programs in America,” said Karen Kyle, Director of Care Navigation, who noted that additional details about integration and innovation efforts will be forthcoming.
Why do individuals undergo unnecessary and potentially high-risk surgeries despite the risk of long-term debility or disability? This may be attributed to a range of psychological, social, and economic factors:
First, is a Poor Understanding of Medical Information: Without a clear understanding of the medical issues involved, patients may rely on simplistic or inaccurate ideas to make important decisions about their health.
Financial Incentives: The promise of financial gain can be a powerful motivator, especially for those in difficult economic situations. The potential financial reward may be seen as outweighing the risks.
Perception of Risk: People often underestimate the risks associated with surgery due to optimistic bias or because the risks are not made clear to them.
Desperation or Vulnerability: Psychological factors, like the desire for validation of pain and suffering, or the psychological need to see a tangible outcome from a legal claim, may also drive individuals to take these risks.
Influence of Others: Advice from trusted individuals, such as attorneys or even doctors who may benefit from the surgeries, can unduly influence patients' decisions.
Media Influence: Stories of large financial settlements can influence an individual’s perceptions, making surgery seem like a viable path to quick financial gain.
Litigation Culture: In some regions, there is a strong culture of litigation where financial settlements for personal injuries are common, with family or friends providing encouragement to take part in the process.
Cognitive Dissonance: After deciding to pursue a lawsuit, individuals may feel a need to justify their decision with actions that seem to confirm the severity of their condition, such as undergoing surgery.
Healthcare System Dynamics: In systems where healthcare providers benefit financially from more procedures, there may be less of a deterrent against unnecessary surgeries.
It's crucial to ensure that patients are fully informed about the risks and potential outcomes of surgical procedures and that they understand the long-term implications of their choices.
Additionally, ethical practices must be enforced within both the medical and legal professions to protect individuals from being exploited for financial gain.
OccMD, a leading medical manager for workplace injuries, is pleased to announce the appointment of Cheryl Killion, BSN, RN, CCM, as the new director of nurse case management beginning June 1.
Killion has served as a senior nurse case manager at OccMD for 12 years and is well-positioned to lead the OccMD team of nurses in the delivery of high-quality case management. Before joining OccMD, Killion served in nursing roles with Denton ISD and Medical City Healthcare. She earned a bachelor’s degree in nursing from Texas A&M University and is a registered nurse, as well as a certified case manager.
"Cheryl's dedication, expertise and commitment to our company's mission to achieve better medical outcomes have been invaluable," noted Melissa Tonn, M.D., founder and chief medical officer of OccMD.
“Over the last 12 years, I have learned so much from Dr. Tonn’s medical knowledge and direction, along with the tremendous nurses I have the privilege of working with,” Killion said. “I hope to lead by example with compassion and hard work to meet the goals of OccMD’s clients as we serve their injured workers.”
Killion succeeds Diane Holliday, who retires May 31 after 15 years of dedicated service to OccMD. “I’ve known Cheryl since 2004,” Holliday said. “I really admire her and know she will be a wonderful asset to OccMD, our nurse case managers and our clients.”
OccMD is the only physician-led nurse case management company for workers’ compensation programs and also delivers superior outcomes for Texas injury benefit programs, working with many of the most respected employers and other payors across the U.S. For more information, please visit occmd.com.
Nashville, Tenn. (April 29, 2024) -- Council Capital, a prominent healthcare-focused private equity firm, has partnered with OccMD, LLC, a physician-led medical and nurse case management company that gets better medical outcomes for injured workers at a fair cost for employers and other payors. Terms of the transaction, which closed on March 20, 2024, were not disclosed.
“We were attracted to OccMD’s differentiated business model of physician-led medical and nurse case management within the workers’ compensation and Texas injury benefit plan space,” said Grant Jackson, Managing Partner of Council Capital.
Based in Dallas, OccMD provides medical management services for organizations whose employees have complex work-related injuries or illnesses. Physician medical directors, led by OccMD Founder and Chief Medical Officer Melissa D. Tonn, MD, create and oversee evidence based treatment plans and nurse case management programs. OccMD provides timely access to, and accountability from, highly qualified specialists, which helps to promote recovery.
“For decades, we’ve seen this approach produce excellent outcomes for injured workers and billions of dollars in cost savings for employers and their insurance carriers,” said Dr. Tonn. “Our clients and their employees report high levels of satisfaction, and we are thrilled to collaborate with Council Capital on the next steps in our journey.”
Council Capital’s investment will be used to scale OccMD’s services and introduce them into more states and lines of insurance business. The firm has expanded OccMD’s board of directors and leadership team, including the addition of two of Council Capital’s CEO Council Members, who are proven veterans of workers’ compensation managed care: Chris Feeney and Dr. Kenneth Hannigan.
PMPK, LLC, an investment and consulting firm, led by Chris Feeney and Dr. Kenneth Hannigan also assisted in the transaction.
“One of the reasons we decided to partner with Council Capital was to access the wealth of healthcare and workers’ comp industry knowledge and support found in its CEO Council,” Dr. Tonn said.
ABOUT OCCMD
Based in Dallas, Texas, OccMD was founded in 2000 by Melissa D. Tonn, MD, one of the most respected and highly credentialed occupational medicine physicians in America. OccMD, LLC offers an array of workers’ compensation and injury benefit services that include medical case management, physician-led nurse case management, independent medical exams (IME), peer reviews, and medical provider networks across several states. In addition to providing daily, clinical oversight and support on occupational injuries, Dr. Tonn and her team deliver education, training and published research.
ABOUT COUNCIL CAPITAL
Council Capital is a healthcare-focused private equity firm based in Nashville, Tennessee. The firm invests in lower middle-market healthcare companies ($10-100M enterprise value) positioned on the “right side of change” in the healthcare industry, where growth aligns with increasing cost pressure and quality demands. Council Capital’s unique model supports management teams in business growth by leveraging the relationships and resources of its CEO Council, Strategic Healthcare Investors, and Value Creation Team.
The Council network, anchored by its CEO Council of 34 senior private and public sector executives who have personally invested over $140M in Council Capital funds, maintains direct relationships with payers, providers, and employers, representing more than 60% of the country’s managed care lives, numerous provider organizations, and millions of self-insured lives.
MEDIA CONTACT Helen King Patterson, King Knight Communications, 813-690-4787, helen@kingknight.com
Martin S. Kus, M.D., M.P.H., has been named as a Medical Director for OccMD, the only physician-led medical and nurse case management company, working with Texas injury benefit programs and workers’ compensation programs in many states. Dr. Kus is an experienced occupational medicine physician, professor and U.S. Navy veteran who was chosen for this role by Melissa Tonn, M.D., founder and chief medical officer of OccMD.
“Martin’s experience and dedication to the field make him an optimal choice as OccMD expands to serve more companies and help injured employees receive an accurate diagnosis and the most appropriate, evidence-based treatment,” Dr. Tonn said.
Dr. Kus is providing medical direction with support and guidance from Dr. Tonn, and provides causation and extent of injury peer reviews.
Dr. Kus received his medical degree from Uniformed Services University of theHealth Sciences in Bethesda, Maryland, and a master’s in public health from theUniversity of North Carolina at Chapel Hill. He completed his residency in occupational and environmental medicine at Duke University in Durham, NorthCarolina, and an emergency medicine residency at Naval Medical Center Portsmouth in Portsmouth, Virginia.
Dr. Kus’s service in the U.S. Navy includes serving as the dive medical officer forFIRST Naval Construction in Little Creek, Virginia, where he managed primary care for 140 members of the Navy Underwater Construction teams and achieved recognition as a key contributor to NATO Operation Seabreeze in Odessa, Ukraine as the only NATO physician (2007-2008). Dr. Kus also has served as diving medical officer for SEAL Team EIGHTEEN, where he advised his commanding officer on operational medical concerns and team members’ health.
Inthe private sector, Dr. Kus has held several leadership roles in the field of occupational medicine, and he currently serves as assistant adjunct professor in the Duke University Occupational and Environmental Medicine department.
“I am honored to be at OccMD, where I can put to work my commitment to connecting with and caring for people,” Dr. Kus said. “Quality medical expertise is important in workers’ compensation and occupational injury benefit programs, and it’s humbling to be asked to work alongside Dr. Tonn, who is incredibly important to this industry because of her experience and dedication.”
Dr. Kus is licensed to practice medicine in Texas, Virginia and North Carolina. He is the vice president of Southern College of Occupational and Environmental Medicine and secretary/treasurer of Texas College of Occupational and EnvironmentalMedicine. He is a member of American College of Occupational and EnvironmentalMedicine.
Married with two sons and a daughter, Dr. Kus resides in the Houston area. Dr. Kus is a native of Lublin, Poland, and speaks Polish fluently.
We're immensely proud of Dr. Melissa Tonn's unwavering dedication to making a difference and her impactful work with Texas Woman's University's Frontiers Program, as featured in the Spring 2024 issue of Texas Woman's magazine.
Dr. Tonn's involvement with the Frontiers Program exemplifies her personal values of compassion, empowerment, and community support. Through her leadership and generosity, she's provided essential resources, including mentoring, counseling, financial aid, and emergency assistance, to help foster care students overcome barriers and achieve their educational goals. Her establishment of the Tonn Emergency Fund further demonstrates her commitment to ensuring that no student faces insurmountable challenges on their journey to success. Dr. Tonn goes above and beyond, not only providing financial support but also creating meaningful experiences for students who may not have had such opportunities otherwise.
Her passion for education and dedication to fostering a sense of belonging and inclusion inspire us all to make a difference in our communities. For more information on the Frontiers Program and how you can support foster care students' education, visit TWU's Frontiers Program.
By Melissa D. Tonn, M.D. and Bill Minick, J.D.
OccMD’s catchphrase,“The Evidence is in Our Outcomes”, is all about getting the best result for the injured worker at a fair cost to the employer. This includes minimizing the risk of and winning litigation. Here are seven tips focused on proactively avoiding litigation and being prepared if litigation later arises:
1. Begin with the end in mind. Our top goal should be delivery of evidence-based medical care to drive better medical outcomes. Ensuring accurate, evidence-based medical assessments and the provision of appropriate medical care raises employee satisfaction and minimizes the risk of legal claims.
2. Watch for red flags. Then, watch for subtle but important factors that may be telltale signs of a secondary gain agenda and pre-cursors to future litigation, like:
3. Scrutinize past and current medical records. The outcome of most litigated cases is heavily influenced by previous medical documentation. So, it’s critically important to obtain, review and understand detailed medical records. Review for common errors and inconsistencies to support both benefit claims administration and any future litigation process.
4. Understand the role of imaging in diagnosis. The common practice of directing patients to the MRI center offering the cheapest price, while assuming all imaging centers and all radiologists provide equal quality reports, is incorrect. It’s critical to consider the credibility of the imaging professionals, equipment and processes used, and freedom from potential conflicts of interest that could bias their judgment. Watch for the third part of this article series addressing “The Blinded or Paid Off Radiologist.” Also, imaging should not be ordered when the clinician cannot articulate what condition they are looking for… or “just because”. This is especially true on spine cases. Incidental findings are often attributed to the incident or event due to “anchor bias” or “confirmation bias” on the part of the clinician, focusing on a single piece of information or the medical provider seeing what they expect to see. Degenerative changes are often mislabeled as trauma-related (annular tears, fissures, disc bulges). Then, miscommunication of an inappropriate “diagnosis”, followed by a specialist referral at the direction of an attorney leads to an adverse demand and litigation when there may be no acute/occupationally-derived injury or condition.
5. Take a scientific approach. OccMD performs a scientific causation analysis on medical claims, which includes (among other things) verifying the diagnosis with epidemiological data, critically assessing the alleged incident or exposure, and a review of the validity of evidence to assess the plausibility of the injury claimed.
6. Don’t underestimate psychosocial factors. OccMD emphasizes the need to assess and attempt to deliver appropriate physical AND mental health services to deal with factors that can dramatically impact the trajectory of a claim, such as:
7. Close carefully. In anticipation of closing a claim, ask yourself questions, like:
Frequently reiterate this messaging within your claims team and contact OccMD if we can support you in any way.
Dallas, Texas – OccMD, LLC is pleased to announce its acquisition of Corporate Remedies, Inc. as of October 18, 2023.
For over 20 years, OccMD and Corporate Remedies have collaborated to improve medical outcomes for injured workers and lower costs for dozens of Fortune 500 and other companies across retail, food service, healthcare, and logistics sectors, as well as public entities. Working together, they have helped Texas injury benefit programs outperform every other large workers’ compensation system in America.
Under the direction of Dr. Melissa D. Tonn, OccMD provides physician-led medical and nurse case management, medical opinions, IMEs and peer reviews through specialty provider networks. This acquisition of Corporate Remedies will allow OccMD to also offer the premier, outcomes-based networks for primary care, imaging and physical therapy in Texas. With our strong clinical support, the combined OccMD and Corporate Remedies team will continue to provide personalized, highly effective customer service on occupational injury medical referrals from TPAs and employers, matching injured workers with the appropriate providers at the right time. OccMD will also be able to bundle or unbundle services in any state to meet the needs of our clients and business partners.
Pat Humphreys, founder of Corporate Remedies, commented, “I could not be happier that Dr. Tonn will continue our legacy of positive medical outcomes and combine our amazing teams of customer service professionals. This is going to be great for our clients, our people, and the workers’ compensation community.”
Dr. Tonn added, “My friendship and professional collaboration with Pat began when we ran the occupational medicine program for one of Texas’ largest healthcare systems decades ago. Integrating her strong primary care and ancillary services network and customer support with OccMD's clinical expertise and exclusive access to many top-rated specialists will enable us to sustain and improve medical outcomes, while building value for our clients.”
**About OccMD, LLC**
OccMD was founded in 2000 by Melissa D. Tonn, MD, one of the most respected and highly credentialed occupational medicine physicians in America. OccMD, LLC offers an array of workers’ compensation and injury benefit services that include medical case management, physician-led nurse case management, independent medical exams (IME), peer reviews, and medical provider networks across several states. In addition to providing daily, clinical oversight and support on occupational injuries, Dr. Tonn and her team deliver education, training and published research.
Media Contact:
Rachel Hedstrom
rachel@gentry.agency
The Tennessee Bureau of Workers’ Compensation publishes the “AdMIRable Review”. The 2023 “Shoulder Issue” examines what happens when we age and favorably draws attention to one of Dr. Tonn’s ground-breaking, peer-reviewed, research studies. Other recent studies that Dr. Tonn has contributed to can be found here.
We are thrilled to announce the promotion of Karen S. Kyle to the position of Director of Care Navigation at OccMD. Karen has more than 25 years of experience in workers' compensation systems and Texas injury benefit programs. This includes experience as a highly skilled registered nurse, as well as an owner and leader of a national managed care company.
“Throughout her career, Karen has demonstrated exceptional leadership and collaboration skills with employers, industry leaders and injured workers,” Dr. Melissa D. Tonn, founder and Chief Medical Officer of OccMD, said. “Karen has now focused her talents as a nurse case manager and knowledge of technology and workflows to help OccMD provide higher quality services for our clients and better outcomes for injured workers.”
“This new role excites me because I’m working with an amazing team of OccMD physicians and nurses, developing and implementing state-of-the art technology, and we’re going to make an even bigger, positive impact on people’s lives,” Karen noted. ”I could not be happier to part of OccMD’s medical director model that relies on evidence-based medicine, good communication and compassionate care.”
We continue our “Focus on the Injured Worker” Video Series by Dr. Tonn with two amazing, short training videos. First is a straightforward explanation of common mistakes she sees being made by providers diagnosing“concussions” (a deep dive in just 7 minutes). The second video includes tips to avoid problems with lumbar MRIs (4 minutes). Use these in your next team meeting or online training sessions for claim adjusters, nurse case managers or medical providers.
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A new study co-authored by OccMD Chief Medical Officer Melissa D. Tonn, M.D. challenges the reliability of MRI reports in diagnosing knee injuries. The study found that orthopedic surgeons could identify the injured knee correctly from MRI reports in only 61% of cases. Identifying the more symptomatic knee in adults based on MRI is unreliable and has limited accuracy, with or without information about demographics and mechanism of injury. When there is any concern regarding extent of injury to a knee in a medico-legal setting such as workers' compensation, consideration should be given to obtaining a comparison MRI of the un-injured, asymptomatic knee to improve diagnosis. Click here to read the study: The Archives of Bone and Joint Surgery
Serving as a Medical Director for many of America’s most respected brands, Dr. Tonn fields injury-specific questions every day. But before knowing how to positively impact the outcome for a particular injured worker, it’s important to think about the “big picture.”
OccMD is pleased to release this “Focus on the Injured Worker” series of one or two-minute videos that share Dr. Tonn's insights:
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Attorney referral medicine is a practice in which an injured worker’s attorney refers medical care to particular physicians or other providers for treatments and services related to the injury. The attorney may focus on medical providers more inclined to deliver services or render opinions favorable to the attorney but at the expense of the injured worker's health. For example, this can include having x-rays read by a disreputable radiologist, sending an injured worker to a chiropractor instead of an orthopedic surgeon (or other more highly qualified provider), or the provision of unnecessary, incorrect, incomplete, or more expensive treatments or services that are potentially harmful to recovery or otherwise cause serious impairment to the injured worker’s strength or ability to function.
Attorney referral medicine may result in a higher total dollar value for an injury claim, but result in the injured worker not receiving the attention they need. Their injury may take longer to heal or they may be put at risk of further complications. This practice frequently serves to increase the amount of damages claimed by and the compensation payable to the attorney. Referred medical providers may also offer special deals or discounts to the referring attorney to get the referral. In sum, attorney referral medicine is fraught with potential for abuse and may be unethical.
How are “letters of protection” used?
A letter of protection is an agreement between a doctor and an attorney that states the patient will not be billed for the services provided until a settlement has been reached with the responsible party. Some states have specific regulations regarding letters of protection. The American Academy of Orthopedic Surgeons (“AAOS”) also encourages its members to carefully consider the potential implications of such agreements. The AAOS suggests that members should seek legal advice when entering into any LOP agreement and ensure that the terms of the agreement are clearly articulated and understood by all parties.
Letters of protection may help injured workers receive medical care they need without having to worry about the cost upfront. But it is important – especially for injured workers – to remain vigilant about the potential abuses noted above and make every attempt to access medical care and medical management support available under the applicable workers’ compensation or injury benefit program, solely at the employer’s expense.
What is the impact of attorney referral medicine on employers?
First and foremost, attorney referral medicine can result in worse medical outcomes and slower return (or no return) to work for a valued employee. Attorney referral medicine is also intended to create an appearance that negligence of the employer caused the injury and the employer is not providing proper medical care to the injured employee – in spite of the fact that the employer may be ready, willing and able to pay for the best medical care from highly qualified providers. This practice may be less about finding the path to an optimal physical and mental recovery for the injured worker and more aimed at running up the highest claim for damages and increasing employer litigation costs to motivate a settlement more favorable to the injured worker’s counsel.
Five tips to avoid attorney referral medicine:
1. Reduce complexity by providing a simple explanation of benefits BEFORE the injury occurs, with a reminder at the time of injury that this information remains easily accessible at any time.
2. Reassure the injured worker of the employer’s commitment to pay 100% of all reasonable and necessary medical care from the best available medical providers.
3. Be responsive with good customer service that demonstrates a “we care” attitude through early communication, respect, empathy, and transparency toward the injured worker (without creating distrust by “hounding” the injured worker).
4. Earlier identification and referral of appropriate cases for medical management, creating a sense of urgency that actively engages all key parties in the recovery process.
5. Provide supportive tools and promote a sense of injured worker agency and empowerment for their own recovery by following the doctor’s instructions, rest, exercise, eating a balanced diet, timely taking prescribed medications, seeking emotional support, and maintaining a positive attitude.
Click here for more tips from ARAWC on “Employee Advocacy” that can help avoid attorney referral medicine.
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The go-to annual research report on trends in workers’ compensation benefits, costs, and coverage is published by the National Academy of Social Insurance. The 2022 NASI report was released in November. As seen in Appendix D starting at page 95, Texas workers’ compensation benefits stack up favorably when compared to other state system waiting periods, minimum and maximum benefits, etc.
Regrettably (as noted on report pages 71 and 91), NASI has not yet made an effort to understand and incorporate data on injury benefit programs maintained as an alternative to traditional workers’ compensation. These programs are maintained by tens of thousands of private employers in Texas and Wyoming, transportation companies across the U.S., many public entities in Tennessee, state universities in Alabama, and within other areas of industry. NASI’s rationale is that some of these programs provide, in addition to contractual benefit entitlements, damages that workers can receive in tort suits against employers because of negligence. “Tort suits do not meet the definition of a workers’ compensation program, since the recoveries are not based on a statutory remedy and/or because the recoveries require the employer to be negligent.” This is an unfortunate semantic from a research and transparency perspective. It is a well-known fact that for more than three decades, such injury benefit coverages have often outperformed traditional workers’ compensation systems in the key areas of benefit levels paid, faster return to work, fewer disputed claims, faster injured worker recovery, and lower employer costs.
Another glaring omission in workers’ compensation research is the need to not only compare the performance of state workers’ compensation systems, but to call out and advocate for proliferation of those system features that achieve better outcomes for injured workers. Just as it is inevitable that technology will continue to transform the world around us, the workers’ compensation industry will begin to fill in some of these blind spots in much-needed research and innovation.
If you want to learn how injury benefit programs in Texas operate, check out the “Innovation Series” from the Association for Responsible Alternatives to Workers’ Compensation. Partially in response to criticism from workers’ comp interest groups between 2014 and 2017, ARAWC (“A-Rock”) also developed and rolled out specific standards for Texas injury benefit programs in 2021. See what it takes to earn the prestigious “QCARE” designation for a Qualified Compensation Alternative for Recovering Employees.
We look forward to future NASI workers’ compensation reports and will continue to encourage other respected industry researchers (like the Workers’ Compensation Research Institute) to take a fresh look at how lessons from Texas injury benefit programs can be incorporated into higher performing workers’ comp systems. In the meantime, OccMD will continue to do just that in the medical management of injury claims in more states.
State-by-State Cost Comparisons
Another helpful, easy-to-read report focused strictly on state cost comparisons is available from the State of Oregon. Since 1986, this report has analyzed workers’ compensation premium rates in all U.S. states and the District of Columbia. In 1988, the Oregon report showed that Texas employers paid the 10th-highest workers’ compensation premium rates in the nation. The latest 2022 Oregon report indicates that Texas employers now pay the 43rd-highest workers’ comp premium rates in the nation. That’s great news for Texas employers! And it didn’t happen by accident.
Key factors contributing to this dramatic improvement include:
1. Legislative reforms enacted in 1999, 2003 and 2005,
2. Workplace safety improvements, and
3. Free-Market Competition between workers’ comp and Texas injury benefit programs.
Small Texas employers tend to have low on-the-job injury frequency and be a good fit for joining the Texas workers’ compensation system at a low, fully insured cost. Many larger employers have more injury frequency and self-fund all or part of the costs. These companies tend to be a good fit for a Texas injury benefit program and the significant advantages they offer. But the choice of coverage continues to drive competition among insurance carriers and service providers that is healthy for employers, injured workers, and the Texas economy.
OccMD physician medical management and nurse case management have been the single biggest, day-to-day, consistent factor in the success of most large Texas injury benefit programs. We continue to extend lessons learned within these Texas programs to other state workers’ compensation systems. Ask us how and see why more large employers turn to OccMD’s Medical Director Model to deliver best-in-class results.
By Harvey Warren, Optimized Outcome Solutions
The question really surprised me. When I first presented the idea of educating patients to optimize them in preparation for surgery or through the challenges of injury recovery, a case manager asked, “Will they do it?” Why wouldn't an injured worker do all that they can to get better faster and stay better longer? Shockingly, there are a number of reasons I have heard over the last 18 months, none of them good. I learned along the way that patient participation in taking advantage of educational material is really a bell curve. Some patients, like me, will do everything possible to prepare for and recover from surgery – and then even write a book about it. But, at the other end of the bell curve are people who will do absolutely nothing to participate in their recovery nearly to the point of actively resisting anything that resembles help when they realize getting better requires some effort on their part. Truly, it takes all kinds. However, the vast majority along the curve is comprised of people who genuinely want to get better, they just don't know how. And, yes, they will gratefully do it.
There is precious little in the workers' compensation experience about patient education. Therefore, there is almost nothing known about whether or not injured workers will actually utilize educational material for their own enhanced recovery. Simply, the value of patient education has never been tested on a large enough scale to quantify that patients fare better when they are educated and coached through their recovery. Common sense is not yet common knowledge.
An initial test in Texas with OccMD confirmed three things:
1. “The patient is the wildcard” in the recovery process because they know little about a positive mindset, activity, rest, nutrition and their own role and value in their recovery.
2. Given the opportunity to enhance their chances for a better recovery with patient education and coaching not everyone will take the help. So, yes, some won't do it. Clearly, when an injured worker has no interest in learning how to get better faster and stay better longer, the provision of the best medical care in the world is less likely to get a worker back to good health and returned to work in the shortest possible time frame – or perhaps ever.
3. Most will do it, and those that do appear to have improved outcomes and faster recovery times.
“Will they do it” is also a difficult question on the case management end of the equation as well. Assuming that case managers agree that patient education is critical to an optimized recovery and assuming they believe that the benefits are going to be considerable for those injured workers who do commit and engage, the “will they do it?” question takes an odd turn. We have come to wonder, will case managers do it? Will employers do it? Will insurers do it? Will they provide education and coaching to enough injured workers to study and quantify the benefits and value. Will they refer enough workers to help innovate this sorely needed development that not only demonstrates care and concern for the worker but may also mitigate the very costly outcomes of failed recoveries, re-admissions and secondary surgeries. My question to the workers' compensation industry is “Will you do it?”
Workers’ comp is on auto pilot? Many employers believe workers’ compensation is not a big cost savings opportunity because state systems are slow to innovate and costs are increasing faster on other lines of insurance, like property, employer’s liability and cyber.
But economic pressures and competition for talent are driving renewed interest in better medical outcomes and cost savings.
Physician-led nurse case management is delivering results.
Melissa Tonn, M.D., president and chief medical officer of OccMD, provides a true evidenced-based approach to medically managing work injury cases. She is the most highly credentialed occupational health physician and works with a long-tenured team of nurse case managers who are directly employed by OccMD.
How does OccMD achieve better medical outcomes on tens of thousands of complex injury cases for America’s leading employers? Our Medical Director:
To learn more, go to www.occmd.com, email engage@occmd.com or call 800-248-7599.
Continuous learning is a hallmark of OccMD professionals. That dedication to the profession has resulted in Cheryl Killion, BSN, RN, and Sharon Harmon, BSN, RN, both adding “CCM” to their list of initials in recognition of their new designations as certified nurse case managers from the Commission for Case Manager Certification (CCMC).
Killion and Harmon are both seasoned registered nurses who serve their clients as senior nurse case managers with OccMD.
“The level of expertise that has allowed them to pass this certification exam enhances the ability to manage their work injury cases,” explained Diane Holliday, BSN, RN, COHN-S, chief operations officer with OccMD. In addition to work injury case management, the certified nurse case manager designation requires a breadth of expertise that also includes social work, geriatrics and other aspects of nursing, she said.
“I chose to pursue the case manager certification because it establishes that I have the experience and knowledge, and that I can meet the national standards within the case manager field,” said Killion, who has been with OccMD for 10 years.
“My motto has always been to do the right thing,” Harmon noted. “Pursuing this certification took a lot of hard work and forced me to step out of my comfort zone. Case management certification covers more than just how to take care of the injured worker; it also includes how to be more fiscally responsible for clients.”
Holliday also noted that, “As senior nurse case managers with OccMD, they have supervisory and leadership roles within our company. This new designation enhances their ability to provide mentorship and leadership to others on our staff. It is quite an accomplishment, as they have achieved a very high level in their profession,” Holliday said.
Melissa Tonn, M.D., chief medical officer of OccMD, was named a recipient of the 2022 Comp Laude® Award. This coveted industry honor highlights individuals and companies dedicated to advocating for injured workers, working to support a fair and balanced system, and simply doing the right thing.
The awards were announced October 4 at the Comp Laude Awards & Gala, an in-person ceremony at the Paséa Hotel and Spa in Huntington Beach, California. Comp Laude borrows its name from the Latin term often used in academia, “cum laude,” meaning “with honor.” Awards were presented to individuals representing different stakeholder segments of the workers’ compensation industry in 11 categories.
Attending the annual event are workers’ compensation professionals from across the country. They include claims professionals, defense attorneys, applicant/claimant attorneys, employers, risk managers, human resource professionals, safety industry leaders, medical professionals, injured workers, third party administrators (TPAs), insurance carriers, regulators, vendors and more.
The mission of Comp Laude is to change the narrative of the workers’ compensation industry to a more positive one, encouraging all stakeholders to come together with an open mind to engage in meaningful dialogue, learn more about each other and explore ways to create a more balanced system.
OccMD congratulates Dr. Melissa Tonn and all other winners, finalists and nominees on this outstanding recognition!
Better medical outcomes for injured workers will require WC system features that further support (1) accountability, particularly from medical providers, and(2) optimizing the interface between human judgment and artificial intelligence. This could also be a path to paying better benefits to injured workers, while simultaneously lowering employer costs. It’s not just a theory! First generation methods are proven and the opportunity is right in front of us.
Checkout this“Deconstructing Comp” podcast with Yvonne Guibert and Rafael Gonzalez featuring a chat with Bill Minick to learn more. Listen to the 10-minute segment starting at timestamp 22:00.
Dr. Tonn Receives National Recognition
Comp Laude Award honors Dr. Tonn’s dedication to injured workers and workers’ compensation community
Melissa D. Tonn, M.D., president and medical director of OccMD, has been selected as a 2022 Comp Laude Award finalist.
“Congratulations on being selected as a Comp Laude finalist,” noted an OccMD client upon hearing the news. “It’s well-deserved, as your passion and relentless pursuit to achieve the very best medical outcomes for injured employees is unparalleled in the industry.”
Comp Laude finalists will be honored at WorkCompCentral’s Comp Laude Awards and Gala inHuntington Beach, California, on October 4. To register or sponsor this important event celebrating the best of the workers’ comp industry, go to CompLaude® Awards and Gala | WorkCompCentral.
by Joe Etherton, PhD
Concussion is a relatively common injury that may be considered synonymous with the milder end of “mild traumatic brain injury” (mTBI). Concussion often involves temporary symptoms such as headache, light sensitivity, dizziness, problems with concentration and memory, and irritability. Impairment of cognitive performance resolves within hours-to-days for most injured workers. Even when research studies include mild TBI patients who have lost consciousness up to 30 minutes, there is no statistically significant difference between pre- and post-injury neuropsychological test performance observed by 3 months after the injury.
Unfortunately, some injured workers become convinced that the effects of their concussion remain months or even years later, and some perceive themselves as too disabled to work. “Post-concussion syndrome” is a term originally used for patients with symptoms that lasted longer than expected (say, 3 months), but in practice, some clinicians use this term for concussion-like symptoms whenever they occur. Multiple studies have found that subjective symptoms commonly associated with post-concussion syndrome (like fatigue, headache, concentration problems, irritability) are not specific to concussion and occur at essentially the same frequency in people with and without a history of concussion. In addition, scores on self-reported, post-concussion measures are more strongly related to measures of psychological distress, including anxiety, depression, and stress, than to the presence or absence of prior concussion. In other words, many of the sensations and experiences that people associate with concussion are actually features of normal life, and they are experienced to a greater degree when levels of anxiety or depressed mood are elevated.
Unfortunately, when injured workers and physicians misattribute these subjective complaints to a concussion, this often promotes sedentary behaviours and deconditioning. This lack of engagement in fulfilling or enjoyable activities further promotes depressive symptoms.
So, when you hear the word, “concussion”, remember this:
· A concussion has not occurred every time a person’s head comes into contact with another surface (e.g., whether bumping the head on a shelf when standing up or playing sports or even in an auto accident).
· The objective deficits associated with concussion usually resolve within hours-to-days. They might last for weeks, but subjective symptoms (like self-reported forgetfulness, concentration problems, or headaches) are so common in people with no history of concussion that the symptoms do not serve as a reliable indicator of whether the effects of a concussion have resolved.
· Several studies have demonstrated a “good old days” bias in which patients may significantly overestimate their pre-concussion cognitive abilities and overall health.
· Carefully consider that the wrong concussion information provided by medical professionals and claim adjusters can shape an injured workers’ mindset into a self-fulfilling prophecy, resulting in delayed recovery.
by Melissa D. Tonn, MD, MBA, MPH
In the late 1990’s, evidence-based medicine was deemed innovative and the “be-all-do-all” for delivering care to injured workers. The EBM mantra advanced in the 21st century packaged in ever-evolving, proprietary treatment guidelines marketed as the key to reducing costs and improving outcomes.
But what has EBM become? For many workers’ compensation and disability management programs, EBM has devolved into automatic approval of physical therapy on every case, and diagnostic testing and treatment up to the maximum threshold provided in a particular guideline. And because the “approved” clinics or contracted network providers represent that they practice EBM, there are no questions asked about non-EBM practice patterns. A few examples include unnecessary x-rays, add-on ice packs and pain creams, inappropriate use of advanced imaging for back pain, misapplied work restrictions, or the inattention to non-physical factors manifesting as a musculoskeletal injury.
Wait! What happened to pursuit of a timely and accurate diagnosis? There is no financial incentive for such nonsense.
If the diagnosis is not accurate, how can you apply EBM to the treatment? And if the diagnosis is not plausibly derived from the workers’ job, do we simply continue the testing and treatment, hoping no one asks the questions, “Is this a work injury?” or with every clinic visit, “Why is the diagnosis – and often, the body region – changing?”
Workers’ compensation is fee-for-service medicine that, too often, prioritizes payment for diagnostic tests and medical treatment over reasoning and accuracy. We should not reward inefficiency and excessive diagnostic workups, office visits, consultations, and unnecessary surgeries. Should there be refunds for ordering the wrong service or executing it poorly? Or will the additional charges continue to be paid, with the economic costs associated with less-than-optimal outcomes borne solely by injured workers and employers.
Maybe EBM is not a joke. Instead, the joke is in the application of EBM.
EBM must be aligned with proper economic incentives to reward timely diagnostic accuracy…and to hold those involved in the treatment of injured workers accountable for actually incorporating EBM into their clinical decision-making.
If you sprained your ankle doing yard work… or bumped your head on the kitchen cabinet…or fell taking out the trash and scraped your knee…
How many urgent care clinic visits would you seek?
Would it be six, seven, eight – or even 11 visits – with an average wait time of one to two hours? I would guess not.
Injured workers are directed to “approved” clinics with the expectation that in visit one or two, the providers will determine with some objectivity if there is an injury, and the extent of that injury based on the alleged cause. We know that the natural process of healing would result in a reduction in symptoms and an increase in functionality over time and at each visit there should be incremental progress towards recovery. This is not what is occurring.
Injured workers are being subjected to egregiously excessive, low-value clinic visits, most for seemingly minor conditions. Put yourself in their place, and question the process from their perspective.
These excessive encounters are increasing injured worker anger and frustration with the system, contributing to delayed recovery, with many ceasing to cooperate, and with some seeking counsel and advice elsewhere.
Excessive, low-value clinic visits are not consistent with evidence-based practice.
“First do no harm” is the core principle in the practice of medicine. Let’s apply that to medical management of injury cases.
So, here are four simple tips for adjusters and case managers to reduce the harm being caused by this trending pattern of practice:
1. Speed up the process. If by visit three, pain levels are not decreasing, and there is not consistent improvement in symptoms and functionality with a decrease in work restrictions, then a change in direction is indicated.
2. Staying at work is a powerful treatment modality more important than physical therapy. Remember: not every injury requires six physical therapy visits. If therapy is indicated, clinic follow-up should be on completion of that therapy. If there is no improvement, a change in direction needs to be considered.
3. Engage in empathic dialogue, timely addressing concerns. Provide consumable information and education to build the relationship and trust.
4. Insist that your clinic physicians and mid-levels use the biopsychosocial model of practice. They need to address comorbidities; work, family, and medical history; inquire when there are time gaps between the work incident and seeking treatment; review photos of vehicles when there is a motor vehicle accident; review the records from prior medical visits – and document progress, or lack there of, and question what else is going on when symptoms are increasing rather than decreasing, and functionality is decreasing rather than increasing.
Doing better for many injured workers begins with simple steps to raise performance expectations and accountability of the medical clinics and other health care providers.
This issue features:
This issue features:
For Laura Pannell, a career in healthcare meant she could help people doing something that truly made a difference.
Many published studies over the past decade recommend caution in ordering magnetic resonance imaging (“MRI”) scans for low back pain. Clinicians, especially those with family medicine training, have been slow to adapt, and injured workers pay the price with misunderstandings and worse outcomes.
OccMD adopted a family through New Friends New Life, a non-profit that restores and empowers formerly trafficked girls and sexually exploited women and their families. We work with this organization year-round as it offers access to education, job training, interim financial assistance, mental health and spiritual support to those overcoming backgrounds of abuse, addiction, poverty and limited opportunities. There is no better way to celebrate the holiday season than to help a family in need.
Melissa Tonn, MD, has contributed to several recent peer-reviewed, published research studies, like those found here in the Journal of Orthopaedics and the journal of Clinical Orthopaedics and Related Research. She now has a new study on workers’ compensation hernia injury claims in the Journal of Visceral Surgery. Dr. Tonn provides medical expertise and oversight for many of the most successful occupational injury management programs in America.
