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AFOEM CPD Session (Shared screen with speaker view)
Joanna Holland
50:54
joanna.holland@uon.edu.au
Terence So
51:21
thank you
pearlle chan
52:39
pmninchan@gmail.com
Terence So
54:20
Reminder to everyone
Terence So
54:39
Niki will have discussion sessions. To participate please unmute your microphone and speaker freely.
Joanna Holland
55:36
hi Azhar
azharnkhan
55:59
Hi Jo!!! Good Morning!!
Joanna Holland
56:17
Sitting in McDonalds Singleton
azharnkhan
56:27
Good on ya
Terence So
56:39
Hi Azhar
Terence So
56:51
please type your email here for me to send you some materials regarding todays presentation
azharnkhan
56:58
Hi Terence
azharnkhan
57:48
my email is eastmelbdoc@yahoo.com
Joanna Holland
01:44:15
Hey guys do you want to use chat to answer some of those questions in the chat session?
azharnkhan
01:44:23
Good point Tom!
azharnkhan
01:44:38
Sounds good Joanna
Joan Chen
01:44:53
thanks.
pearlle chan
01:45:56
good morning everyone
azharnkhan
01:46:08
Good morning Pearlie
Joanna Holland
01:46:28
I think the assumption from Niki is that we won't have an ability to be involved in discussion!
Joanna Holland
01:46:43
Little does she know about our virtual group....
pearlle chan
01:46:46
finally figured out how to use this haha
azharnkhan
01:46:50
Well that assumption is wrong ;-)
Joanna Holland
01:47:09
I think a key to the development of the optimal role is a shared platform
pearlle chan
01:47:11
yeh agreed
azharnkhan
01:47:12
I agree with the idea of patient centred care
Joanna Holland
01:47:34
Azhar and I worked with a self insurer, Onesteel, who had a good system
azharnkhan
01:47:34
The reality of implementing it in different settings is a challenge.
azharnkhan
01:48:06
I agree with Jo, it is easier to manage cases within a large company vs a labour hire company
azharnkhan
01:48:21
Increasingly employment is a casual in nature
azharnkhan
01:48:28
is casual in nature
azharnkhan
01:48:47
Time is a major factoe
Joanna Holland
01:48:48
What if there was a software program which could be added in to best practice, where it could automate the output/input of data into a claims management process by each of the stakeholders...dare I say, even the worker via an app
pearlle chan
01:49:22
Idon't know about your experience. but I had an aggressive case manager in the past who just literally ignored my qualifications and talked as tho I know nothing
azharnkhan
01:49:24
Using tech is helpful but not all workers a tech savvy
Joanna Holland
01:49:52
Each time we saw a worker in Onesteel for a workplace injury, an email was generated which went to (and was expected by) the workplace, insurer and superviser
Joanna Holland
01:50:07
And sometimes I sould forward a copy to the worker as well, with permissions
azharnkhan
01:50:24
Pearlie: they are usually young and inexperienced don’t even know what an OP does
azharnkhan
01:50:37
Yes communication is important (re Jo)
pearlle chan
01:50:47
tech is good but its good to see the face
azharnkhan
01:50:53
Agreed
Joanna Holland
01:50:57
I thought this worked really well - but when I tried to implement it in the big wide world with other insurers I got the same response as pearlie - either ignored or discounted
azharnkhan
01:51:15
Nowadays workers complain of a faceless process
azharnkhan
01:51:30
They are unfamiliar with the RTW process
azharnkhan
01:51:48
They can’t differentiate between IMEs and treating specialists
Joanna Holland
01:51:53
Part of the problem is that there is little recompense for a biopsychosocial model with doctors
azharnkhan
01:52:23
At the outset all parties need to be oriented about the process and the intended outcome or potential outcomes
Joanna Holland
01:52:26
What if we used teleconferencing more often - it is so easy to do these days on line
azharnkhan
01:52:47
True
Joanna Holland
01:52:48
SO if there were a platform developed, facetime could be incorporated
azharnkhan
01:52:57
The first 4 weeks are crucial
pearlle chan
01:53:05
ithink if we enter the process early a lot of psychological problem can be decreased
azharnkhan
01:53:13
Agreed Pearlie
Joanna Holland
01:53:23
Yes, the notion of triage is an important one -
azharnkhan
01:53:47
I think we need to apply some emergency med principles to Occ Med
Joanna Holland
01:54:00
Good crossfield idea Az
azharnkhan
01:54:15
Instead of the golden 24 hours we are dealing with a golden 4 weeks
pearlle chan
01:54:19
exactly
azharnkhan
01:54:43
In ED, everything should be mapped out within 8 hours
azharnkhan
01:54:55
In Occ Med, we have 12 months to deal with
azharnkhan
01:55:07
Of course not all injuries can be managed within 12 months
pearlle chan
01:55:20
eD patients are supposed to be out in 4hours
Joanna Holland
01:55:24
I wonder if you did a study about length of claim predictions between an OP, a claims manager and a NTD what the differences would be
azharnkhan
01:55:24
However we should be able to determine the RTW outcome by that time
azharnkhan
01:55:36
Re Pearlie: ideally yes
azharnkhan
01:56:01
OP has a more realistic idea vs NTD and claims manager
azharnkhan
01:56:17
I should say often
pearlle chan
01:56:18
naybe hospitals should have an OP on call??
azharnkhan
01:56:27
Ideal
Joanna Holland
01:56:28
OOOO good idea Pearlie
azharnkhan
01:56:29
True
Joanna Holland
01:56:55
Maybe we should be more pro-active and give more lectures at our local hospitals
Joanna Holland
01:56:59
And GP meetings
azharnkhan
01:57:01
Exactly Jo
pearlle chan
01:57:17
yes
azharnkhan
01:57:24
GPs are specialists for life and we are specialists for worklife
azharnkhan
01:57:56
Outcomes are largely age based as well
Joanna Holland
01:58:04
I agree Az, but the reality is that most claims are managed by GPs
azharnkhan
01:58:13
True dat
Joanna Holland
01:58:28
I think it is a shame that OPs aren't utilised more by the insurers
Joanna Holland
01:58:51
DOes anyone consult to insurers out there?
azharnkhan
01:59:32
We need the college to raise the profile of OPs
Joanna Holland
01:59:32
IMagine if you had like a 'ward meeting' once a week with an insurance claims team, where they could bring some tricky cases and you could share your knowledge
azharnkhan
01:59:49
Jo that is exactly what iCare does
pearlle chan
02:00:13
thats a very good idea and we can claim MOPS points too
Joanna Holland
02:00:27
Oh really!
azharnkhan
02:00:34
I think insurers often have unrealistic outcomes about cases
Mahima
02:00:37
I agree with that JO and Azar. At icare we see a lot of claims which have been poorly managed by the GPs and when it comes to us it is “ end of the road” . Young IW in their 30s and 40s had multiple surgeries and would never be able to return to work. Still when we talk to GPs they are still has no clue how to manage these IWs. Sugeesh
Joanna Holland
02:01:33
Yes, I have seen the same thing Sugeesh.
azharnkhan
02:03:30
We need Medicare to generate an item number for complex case management
Mahima
02:03:52
must incorporate workers compensation management in Gps training!!
Joanna Holland
02:03:52
I would be interested in knowing what Niki thinks all these stakeholders have thought about OPs
azharnkhan
02:03:55
GPs shouldn’t think we are out to take their work away from them
pearlle chan
02:03:57
Suggest that to Niki
azharnkhan
02:04:27
We are trying to work alongside with them
Joanna Holland
02:04:37
OK Optimal role of the NTD
Joanna Holland
02:04:45
TRiage?
Joanna Holland
02:05:34
IME - review claims for direction?
azharnkhan
02:05:36
a) Diagnose, Triage and identify key treatment needs and identify likely prognosis
Terence So
02:05:47
at any point in time
Joanna Holland
02:05:49
good one az
Terence So
02:05:54
u can unblock your microphone
Mahima
02:05:56
clinical diagnosis, outcome based management
Terence So
02:05:57
and reach out to Niki
azharnkhan
02:06:00
b) IME: only if the case stalls
Joanna Holland
02:06:01
IME brought in at three months?
azharnkhan
02:06:06
Yup
azharnkhan
02:06:25
If there is no clear direction in the claim- not automatically
Joanna Holland
02:06:29
sure terence, will do after a bit
Mahima
02:06:38
I don’t think IME input should be “time-based”
pearlle chan
02:06:42
haha
Mahima
02:06:47
maybe only for complex cases
Joanna Holland
02:06:50
why not sug?
Joanna Holland
02:07:21
I vote for time based to ensure that we don't miss those cases that might benefit
azharnkhan
02:07:24
For example, if a rotator cuff injury has been promptly diagnosed and treated, an IME is not needed unless they have not recovered well within 6 months
Mahima
02:07:25
should be case by case
azharnkhan
02:07:28
Agreed
pearlle chan
02:07:29
the current slide does not have OP
azharnkhan
02:07:39
So telling Pearlie
Joanna Holland
02:07:55
Hmm, maybe then if not meeting timeframes generally put out by the clearing houses
azharnkhan
02:08:15
For example, if the GP keeps on giving unfit certs from the beginning without any clear indication- it needs an IME
Mahima
02:08:21
that should be IMC
Joanna Holland
02:08:25
Claims managers need to be comparing claim to clearing house times
Mahima
02:08:26
not IME then
azharnkhan
02:08:28
Pardon IMC
azharnkhan
02:08:57
The GP should id psych resilience issues
azharnkhan
02:09:27
Orebro, K10, DASS should be done in the beginning and throughout the claim
azharnkhan
02:10:08
With current legislation, they prefer that the claim should have defined outcomes within a year
pearlle chan
02:10:46
doing that so early is good and bad Azhar
Joanna Holland
02:10:51
How does everyone see the RTW person - I think they are usually the most mobile, so key
azharnkhan
02:10:59
Will they return to PIDs, modified duties, will they bee redeployed to another role or are they going to be permanently unfit
Joanna Holland
02:11:23
I can see asoftware platform prompting much of this
azharnkhan
02:11:46
If the injured worker is unable to return to original role the RTW should be honest and advise if they employer can provide work
azharnkhan
02:11:59
If not, vocational rehab should be commenced
Joanna Holland
02:12:08
What if the RTW person looks at yellow flags, if the doc doesn't and contributes that to the shared information
azharnkhan
02:12:11
Inclusive of voc assessment
azharnkhan
02:12:30
That’s why you need team mgmt
azharnkhan
02:12:49
An OP can intervene in such a situation
Joanna Holland
02:12:53
I think it is improtant for the specialists treating doctor to give feedback along these lines too.
azharnkhan
02:13:00
Agreed
azharnkhan
02:13:12
But GPs are notoriously difficult to contact
Mahima
02:13:30
I find employers are inflexible providing alternate roles within the organisations if they are unable to return to PID role ..
Mahima
02:13:52
agree Azhar
azharnkhan
02:13:57
I agree RTW, voc rehab should be involved in life insurance/super claims
pearlle chan
02:14:02
A lot of mine do not like vocational rehab.because their old job pays them better. voc rehab. make them feel the employer want to rid them
Joanna Holland
02:14:06
Agree Sugeesh. This conflict between inherent duties and modified role or modified duties is tough to crack
azharnkhan
02:14:23
Pearlie- key point
azharnkhan
02:14:53
You can’t expect someone to accept 25$ per hour vs 50% per hour job
azharnkhan
02:15:01
50$ per hr job
azharnkhan
02:15:39
Insurers try to shortchange voc rehab by not funding re-education
azharnkhan
02:15:47
re-education adequately
azharnkhan
02:17:21
Terence So: Can you ask Niki if she knew if OPs did not have a Medicare number for complex case management?
azharnkhan
02:17:42
This would facilitate cooperation between GPs and OPs
Joanna Holland
02:17:55
Workcover doesn't use medicare
Joanna Holland
02:18:02
separate issues'
azharnkhan
02:19:15
There should be an option whereby GPs can refer to OPs by themselves and it should be subsided by WC
Joanna Holland
02:20:23
Need to engage IME or insurer in doing this
Joanna Holland
02:20:32
Or claims managers
azharnkhan
02:20:54
I agree we should apply the chronic health model to difficult claims
Joanna Holland
02:21:09
But this is done sometimes, just that there are limited numbers of doctors that are able to do this in workcover - has been limited for some years now.
Joanna Holland
02:21:28
I don't think workcover recognise usefulness of OPs
azharnkhan
02:21:31
It is not financially rewarding for them
azharnkhan
02:21:55
The macro picture is that we need to develop a better awareness of what OPs do
azharnkhan
02:22:15
At medical school, within GP training
Joanna Holland
02:22:17
FOr example, psychiatrists are seen as the expert in psychological claims, but really they have nfi about psych rtw stuff
azharnkhan
02:22:56
In essence we are dealing with a policy issue
azharnkhan
02:23:49
I think that psychologists need to know that optimally it is best for workers to return to work
azharnkhan
02:24:28
If it is not possible or feasible, they need to be proactive in identifying that
Joanna Holland
02:25:14
terence, I have moved to somewhere queter
azharnkhan
02:25:33
Hi Jo what are we going to say to the team?
pearlle chan
02:25:34
Azhar I think itsa good idea that GPs have direct access to OP dealing with the case rather than doing all the contacting as they do not have time for that
azharnkhan
02:26:26
Agreed- I think each claim should be assigned a consulting OP (based upon triage evaluation)
Joanna Holland
02:28:29
TD diagnosis, treatment plan, prognosis of treatment, and triage
Joanna Holland
02:29:06
IME review when not meeting expected plans based, able to be brought in by insurer
pearlle chan
02:29:27
I will elect Jo to present to Niki
Joanna Holland
02:30:27
claims manager to supervise the process and ensure progress of claim
azharnkhan
02:30:56
(1) Triage, identify appropriate treatment options, identify likely outcome (2) Good communication with all parties, (3) review treatment response, triage again, review outcome, (4) identify when medical treatment is complete and when the voc rehab begins and identify final outcome
azharnkhan
02:31:06
Agreed?
Joanna Holland
02:32:28
rtw coordinator to be the mobile person with the worker
Joanna Holland
02:32:37
meh, looks like she wants to move on
azharnkhan
02:32:43
Nah
azharnkhan
02:32:50
We still present out proposals
azharnkhan
02:33:00
present our proposals
pearlle chan
02:35:15
I think she forgot we existed
Joanna Holland
02:35:42
I don't think Niki is used to presentations which include on line participants
Joanna Holland
02:35:51
Plus there looks to be a lot to cover
Joanna Holland
02:36:07
and a lot of guys in the room
pearlle chan
02:36:14
Agreed
Terence So
02:36:40
there is a full room of about 25 participants
Joanna Holland
02:37:51
ya gotta love an algorithm
Joanna Holland
02:38:51
dropdown menu with an optional 'other'
azharnkhan
02:39:28
I agree- human interface is key
azharnkhan
02:39:43
tech should be an adjunct
azharnkhan
02:41:22
Have a nice weekend everyone
Joanna Holland
02:42:39
hey terence, can you please pass my email on to chris colquohoun - joanna.holland@coalserviceshealth.com.au
Joanna Holland
02:44:09
i work with coal mines insurance, which is the workcover insurer - perhaps I can translate his icare approach to the management of claims up here
Terence So
02:46:01
okay no worries
Joanna Holland
02:51:27
oh i just realised it is joanna.holland@coalservices.com.au drop the workd health
Joanna Holland
02:52:47
at a grass roots level, ie gp engagement level, i think the ease of the online platform is key
Joanna Holland
02:53:16
An online 'case file' that everyone can contribute to, which is attached to best practice
Joanna Holland
02:53:44
3,4 and 5
Joanna Holland
02:55:35
Biggest barrier to a lot of GP communication is security of medical information. Avant and AMA still recommends using fax, unless really secure systems.
pearlle chan
02:56:21
Great love that to a certain extent. How secure is this online platform and what will the employee think and does the employee also have access?
Joanna Holland
02:56:48
I was just thinking that, pearlie - it would certainly eliminate the mistrust
pearlle chan
02:57:24
Sure
Joanna Holland
02:58:04
in terms of psychological claims, being talked about as a third party is particularly damaging
Joanna Holland
02:58:25
ok what about everyone give numbers on line
Joanna Holland
02:58:31
345
Mahima
02:58:54
3,4 and 7
Joanna Holland
02:59:10
or maybe what isn't done at the moment, ie 1,4,7
Joanna Holland
02:59:21
while we wait for 3 to come along
pearlle chan
03:01:21
3,4,and6
pearlle chan
03:05:39
well done Jo
Mahima
03:05:49
good job