บทถอดความฉบับเต็มของ DRI Comp Conversations: Episode 24

about hard technical skills, but also 36 00:02:20.479 --> 00:02:24.759 soft skills, things like emotional intelligence and motivational interviewing and 37 00:02:24.960 --> 00:02:30.400 empathetic communication. And so the original partner, Donald Abrams, approached me. 38 00:02:30.479 --> 00:02:33.520 I brought my friend Bob Wilson in, who's been advocating 39 00:02:33.599 --> 00:02:36.879 for renaming the industry entirely from workers' compensation and workers 40 00:02:36.919 --> 00:02:40.199 recovery and actually wrote a book about that recently. And 41 00:02:40.240 --> 00:02:43.439 so we started WORKMP College in twenty twenty two and 42 00:02:43.599 --> 00:02:46.520 we've been going one hundred miles an hour since then. 43 00:02:50.599 --> 00:02:53.400 Exactly your background and career path before you started. 44 00:02:53.159 --> 00:02:58.120 Us, Well, I am a technologist by background, did about 45 00:02:58.120 --> 00:03:01.719 twenty years of software development, project management and so forth, 46 00:03:02.719 --> 00:03:06.759 and got an opportunity to develop a claims management system 47 00:03:06.800 --> 00:03:11.240 for a utilization review company in nineteen ninety nights and weekends. 48 00:03:11.400 --> 00:03:13.479 So I listened to a lot of Super Bowls on 49 00:03:13.599 --> 00:03:17.039 radio because I was working in and around my day 50 00:03:17.159 --> 00:03:20.360 job on that. And as a software developer, you can't 51 00:03:20.400 --> 00:03:23.199 build something without knowing what you're building for, and so 52 00:03:23.240 --> 00:03:28.199 I became very interested in healthcare in utilization review process. 53 00:03:28.439 --> 00:03:32.240 I'm obviously workers compensation the claims process. And then in 54 00:03:32.280 --> 00:03:36.520 twenty twenty, after guiding a choice point through Y two K, 55 00:03:36.719 --> 00:03:38.879 which actually was a legit thing, just for those of 56 00:03:39.000 --> 00:03:42.319 y'all that don't think that we made that up, but 57 00:03:42.560 --> 00:03:45.360 it was legit. And after doing that, I went full 58 00:03:45.360 --> 00:03:49.000 time into work comp and really focused kind of what 59 00:03:49.080 --> 00:03:52.919 I learned on that. In two thousand and three, I 60 00:03:52.960 --> 00:03:56.520 started to recognize the peer reviews were including a lot 61 00:03:56.560 --> 00:04:00.039 of prescription opioids and a variety of other drugs that 62 00:04:00.159 --> 00:04:03.400 didn't make sense together, and not being a clinician, just 63 00:04:03.479 --> 00:04:06.080 a logician, it didn't really make a lot of sense, 64 00:04:06.120 --> 00:04:08.319 And so I dove into it and created a product 65 00:04:08.360 --> 00:04:11.520 specifically to address, Hey, why are we prescribing all these 66 00:04:11.560 --> 00:04:14.680 opioids that the label says you shouldn't use long term 67 00:04:14.840 --> 00:04:17.319 and you definitely shouldn't be using for the kind of 68 00:04:17.360 --> 00:04:21.680 treatment that injured workers are doing, and increased the likelihood 69 00:04:21.680 --> 00:04:27.759 of having anti indepressants and anti sleep sleep aids and 70 00:04:28.600 --> 00:04:32.120 constipation aids and all that different thing. Once started, one 71 00:04:32.199 --> 00:04:35.360 drug regimen became a multi drug regimen, it was actually 72 00:04:35.399 --> 00:04:37.680 doing more harm than good to the injured worker. So 73 00:04:37.720 --> 00:04:41.839 that kind of started my the arts professor kind of moniker, 74 00:04:41.959 --> 00:04:44.000 just kind of diving in deep. I read hundreds of 75 00:04:44.000 --> 00:04:46.399 thousands of pages of medical records, looked at hundreds of 76 00:04:46.439 --> 00:04:51.319 thousands of PBM transactions, and by immersion and hanging hanging 77 00:04:51.319 --> 00:04:53.879 out with really smart people of all such sorts of 78 00:04:53.959 --> 00:04:59.040 different clinical and claims disciplines, learned on the fly and 79 00:04:59.360 --> 00:05:02.519 you know fast. For I'm in the midst of Hotel California. 80 00:05:02.560 --> 00:05:04.519 I've been in it for thirty plus years and I 81 00:05:04.560 --> 00:05:07.160 can't find the door out. And part of that is 82 00:05:07.279 --> 00:05:10.319 just because it's intellectually stimulating. Part of it's because I've 83 00:05:10.319 --> 00:05:13.639 got deep roots. Part of it is I've developed tremendous 84 00:05:13.680 --> 00:05:16.879 friendships all around the country with all sorts of different people, 85 00:05:17.720 --> 00:05:21.319 and that it's tough to shy away from that mark. 86 00:05:21.399 --> 00:05:24.120 You touched on this a little bit in your previous answer, 87 00:05:24.199 --> 00:05:27.279 but why are general healthcare trends such an important driver 88 00:05:27.439 --> 00:05:28.959 for workers' compensation claims? 89 00:05:29.759 --> 00:05:32.839 Well, healthcare costs are about sixty percent of overall total 90 00:05:32.839 --> 00:05:36.360 claims cost and work comp and so it's obviously tremendously 91 00:05:36.439 --> 00:05:37.720 important to manage that. 92 00:05:38.639 --> 00:05:42.720 And one of the things because of my evolution of. 93 00:05:44.160 --> 00:05:47.240 Arguing against the over prescribing of medications, really taking the 94 00:05:47.360 --> 00:05:49.759 easy way out and giving people pills as opposed to 95 00:05:50.000 --> 00:05:56.480 empowering them to do better. I've evolved into biopsychosocial I 96 00:05:56.879 --> 00:06:03.800 evaluated virtual reality, i evaluated medical cannabis. I've just been 97 00:06:03.839 --> 00:06:07.399 all over the board. So as we started taking pills 98 00:06:07.439 --> 00:06:10.920 away from people, they still needed something to manage their pain. 99 00:06:11.399 --> 00:06:13.759 And so I continued to evolve and take a look 100 00:06:13.800 --> 00:06:15.920 at that. And there's a lot of things that happen 101 00:06:16.000 --> 00:06:17.959 outside of COMP,

and I think we're going to talk 102 00:06:18.000 --> 00:06:20.680 about those that have a direct impact on COMP. So 103 00:06:20.800 --> 00:06:25.040 you can get a very myopic understanding of what specifically 104 00:06:25.079 --> 00:06:28.279 focuses on COMP and then get surprised by something that 105 00:06:28.360 --> 00:06:32.560 happens in general healthcare or Medicare or Medicaid, or be 106 00:06:32.720 --> 00:06:36.639 a private payer concierge care or just anything like that. 107 00:06:37.160 --> 00:06:40.439 Those trends have ultimately a trickle down effect to work comp, 108 00:06:40.480 --> 00:06:44.240 and so I've always tried to have one eye ahead. 109 00:06:44.920 --> 00:06:48.000 I have talked about issues in work comp before other 110 00:06:48.040 --> 00:06:51.319 people have and raise them as issues, and so I 111 00:06:51.360 --> 00:06:54.079 have kind of a track record of identifying issues before 112 00:06:54.079 --> 00:06:56.920 other people and not just raising the issue, but also 113 00:06:57.000 --> 00:07:00.839 identifying potential solutions and just kind of social the issue 114 00:07:00.879 --> 00:07:02.600 so that we can have a better approach to it. 115 00:07:02.680 --> 00:07:05.560 So I think it's really important to understand what's happening 116 00:07:05.639 --> 00:07:07.480 in COMP, but it's also important to keep an eye 117 00:07:07.519 --> 00:07:10.680 on what's happening outside of COMP because that typically comes 118 00:07:10.720 --> 00:07:12.360 into confidentially. 119 00:07:13.839 --> 00:07:14.120 Mark. 120 00:07:14.160 --> 00:07:17.480 One of those issues I've heard you mentioned before is 121 00:07:17.519 --> 00:07:22.600 about the shortage of physicians that we're looking at in 122 00:07:22.639 --> 00:07:27.360 this country. Can you just provide some context and explain 123 00:07:27.439 --> 00:07:29.720 a little bit about that for our listeners. 124 00:07:30.800 --> 00:07:34.120 Yeah, well, just like the general population, we're all living longer, 125 00:07:34.199 --> 00:07:41.040 we're all working longer, and that has an impact on healthcare. However, 126 00:07:41.120 --> 00:07:45.319 there's tremendous burnout from physicians and clinicians if you've looked 127 00:07:45.360 --> 00:07:48.199 at it. A lot of physicians and clinicians don't have 128 00:07:48.279 --> 00:07:51.800 their independent practice anymore. They sold out to big hospitals 129 00:07:52.279 --> 00:07:56.120 and companies because they just couldn't handle the administrative overhead. 130 00:07:57.000 --> 00:08:02.279 There's a variety of different sobering statistics that AAMC says 131 00:08:02.399 --> 00:08:04.720 there may be a shortage of anywhere from thirty seven 132 00:08:04.720 --> 00:08:07.160 thousand to one hundred and twenty four thousand physicians by 133 00:08:07.199 --> 00:08:11.680 twenty thirty four. Nearly six percent of physician assistance, which 134 00:08:11.680 --> 00:08:15.040 are the typically the ones that you see in doctor's offices, 135 00:08:15.120 --> 00:08:18.600 they plan to retire within five years. There's a variety 136 00:08:18.759 --> 00:08:21.759 of estimates that there could be a nurse shortage between 137 00:08:21.800 --> 00:08:24.519 sixty four thousand and two hundred thousand nurses by twenty 138 00:08:24.600 --> 00:08:28.199 thirty which isn't as far away as you thought. And 139 00:08:28.279 --> 00:08:30.439 so we got a lot of we don't have as 140 00:08:30.439 --> 00:08:33.360 many Aukmed doctors as we need. I spoke to an 141 00:08:33.360 --> 00:08:36.200 Aucmed doc and she said that we had less than 142 00:08:36.240 --> 00:08:39.320 two thousand OCMED docs for the entire country. I spoke 143 00:08:39.360 --> 00:08:41.879 to someone recently. They said it's more like fourteen hundred. 144 00:08:42.360 --> 00:08:47.279 So there's this healthcare shortage of physicians and clinicians that 145 00:08:47.519 --> 00:08:51.919 through a variety of reasons retirement, burnout, selling out to 146 00:08:52.320 --> 00:08:56.559 larger corporations and stuff, and we're not getting enough to 147 00:08:56.639 --> 00:08:57.320 replace them. 148 00:08:57.440 --> 00:08:59.159 And so that is going to. 149 00:08:59.120 --> 00:09:05.039 Create provider deserts, especially specialty deserts where you used to say, okay, 150 00:09:05.080 --> 00:09:08.440 we got an ophtalmologist within fifty miles. Now if they 151 00:09:08.480 --> 00:09:10.600 live in a rural area, they may have to drive 152 00:09:10.639 --> 00:09:14.519 two hundred miles to the nearest optalmologist, to orthopedic or neurosurgeon. 153 00:09:15.240 --> 00:09:18.559 And guess what, that not only increases the mileage reimbursement cost, 154 00:09:18.960 --> 00:09:22.000 but it also is not good for them to sit 155 00:09:22.080 --> 00:09:25.120 in a car for two hours to drive, you know, 156 00:09:25.159 --> 00:09:28.240 when they're already having problems with their back. So these 157 00:09:28.320 --> 00:09:31.320 kind of health care shortages, especially from a rural standpoint, 158 00:09:31.960 --> 00:09:33.320 is a significant issue. 159 00:09:34.240 --> 00:09:38.240 Which of these those like specialties or those areas of 160 00:09:38.279 --> 00:09:42.159 practice are are like the most impactful ones in the 161 00:09:42.159 --> 00:09:43.200 workers comp area? 162 00:09:44.919 --> 00:09:48.000 Well, I think the ones who see that the treatment 163 00:09:48.159 --> 00:09:51.759 initially are the are the hardest ones, and so I 164 00:09:51.759 --> 00:09:54.879 think OCMED docs, which are the most legit, most logical 165 00:09:54.919 --> 00:09:57.360 ones to see an injured worker right off the bat. 166 00:09:57.639 --> 00:10:01.159 The fact that we've got fourteen hundred to cover thirty 167 00:10:01.320 --> 00:10:04.120 three hundred and whatever million people that we have in 168 00:10:04.120 --> 00:10:07.399 the country right now, that is not a great ratio. 169 00:10:07.919 -->

00:10:10.960 And certainly nurses and pas are typically the ones. When 170 00:10:11.000 --> 00:10:13.440 you go to a doctor's office, you very rarely see 171 00:10:13.480 --> 00:10:16.360 an MD or do O. You're typically seeing a PA 172 00:10:16.600 --> 00:10:20.080 or nurse practitioner. I mean in a hospital, you're seeing nurses. 173 00:10:20.159 --> 00:10:26.080 So when those become less available, you're going to have 174 00:10:26.320 --> 00:10:29.879 longer wait times. The place you go to get sick 175 00:10:30.000 --> 00:10:33.120 is actually the waiting room of doctor's office, right because 176 00:10:33.159 --> 00:10:35.320 you may be there for your own issue, but you're 177 00:10:35.320 --> 00:10:38.240 surrounded by people that are sneezing and not covering, you know, 178 00:10:38.279 --> 00:10:40.799 they're touching stuff and all that kind of thing. So 179 00:10:41.639 --> 00:10:44.679 it's a bacteria farm. And the longer that you're waiting 180 00:10:44.799 --> 00:10:47.639 for that nurse practitioner or that nurse to see you 181 00:10:48.799 --> 00:10:50.320 is going to elongate everything. 182 00:10:51.720 --> 00:10:52.240 What are some. 183 00:10:52.240 --> 00:10:56.440 Things that different professionals and the worker STOMPS system particularly lawyers, 184 00:10:58.000 --> 00:11:01.559 What can we do in response to this healthcare provider shortage? 185 00:11:02.279 --> 00:11:04.759 Well, I think the first thing that everybody should do 186 00:11:05.039 --> 00:11:10.559 is to identify by by geograph, by geography, by zip code, UH, 187 00:11:10.919 --> 00:11:13.919 where your claims happen, and whether you have all the 188 00:11:13.919 --> 00:11:17.720 physicians and specialties that you need within a reasonable distance. 189 00:11:18.399 --> 00:11:20.000 They are going to be one off. There's going to 190 00:11:20.000 --> 00:11:22.559 be an injured worker in po dunk Idaho. You know 191 00:11:22.639 --> 00:11:25.679 that nobody has any you know, treatment treater close to it, 192 00:11:26.120 --> 00:11:27.840 and you just kind of have to address that with 193 00:11:27.960 --> 00:11:32.519 telehealth or some other options. But if if you're prevalent 194 00:11:32.639 --> 00:11:37.399 in the state filed Illinois area, I would dig into 195 00:11:38.679 --> 00:11:41.360 and if you don't have some specialties or you don't 196 00:11:41.360 --> 00:11:45.919 have enough front line treats and that recruit them, figure 197 00:11:45.960 --> 00:11:50.679 out alternative ways to provide treatment, whether that's new relationships 198 00:11:50.720 --> 00:11:55.639 with network UH, whether that's making sure the doctor job 199 00:11:55.879 --> 00:11:56.799 you show them love. 200 00:11:57.840 --> 00:11:58.879 If if they're the. 201 00:11:59.600 --> 00:12:03.759 Ones that have the best outcomes on assistant basis and 202 00:12:03.799 --> 00:12:06.279 you're sending a lot of injured workers there, you don't 203 00:12:06.279 --> 00:12:09.320 want them to feel like they're being taken advantage of. 204 00:12:10.480 --> 00:12:11.840 You want to make things. 205 00:12:11.559 --> 00:12:15.720 Easier, So utilization review and peer review and pre authorizations 206 00:12:15.759 --> 00:12:19.360 are certainly ways we manage cost and manage care. But 207 00:12:19.399 --> 00:12:23.519 if you've got a doctor or clinician who reliably has 208 00:12:23.559 --> 00:12:26.600 good outcomes and consistently that delivers that, don't make it 209 00:12:26.639 --> 00:12:30.440 hard reduce the pre authorizations. In fact, remove their pre authorizations. 210 00:12:30.480 --> 00:12:33.440 In some cases they've established trusts, they've shown you that 211 00:12:33.440 --> 00:12:35.639 they're going to do a good job and focus on 212 00:12:35.759 --> 00:12:38.399 function and return to work. Don't make it hard for them, 213 00:12:38.440 --> 00:12:42.799 because that's the biggest impact to people wanting to participate 214 00:12:42.840 --> 00:12:46.000 in work comp is the administrative burdens. There's a lot 215 00:12:46.039 --> 00:12:49.039 of administrative birds in healthcare. In general work comp we say, 216 00:12:49.360 --> 00:12:51.159 we tell them to hold our beer right, we make 217 00:12:51.200 --> 00:12:58.399 it even more complicated, and every juristic for California, bless 218 00:12:58.399 --> 00:13:02.279 your hearts, really complicated to do stuff there. But there's 219 00:13:02.320 --> 00:13:06.480 other states that have similar problems. So Georgia, my home state, 220 00:13:06.639 --> 00:13:12.159 is highly litigious, and that doesn't help providers either. 221 00:13:12.240 --> 00:13:13.519 So I think. 222 00:13:13.559 --> 00:13:17.240 Recognizing where your gaps are and addressing them for the 223 00:13:17.399 --> 00:13:20.320 really good doctors, show them love and make it less 224 00:13:20.320 --> 00:13:23.440 difficult for them to participate in the system, that will 225 00:13:23.440 --> 00:13:26.039 go a long way. And then finally really lean into 226 00:13:26.039 --> 00:13:31.000 telehealth Medicare embraced telehealth during COVID because we had to 227 00:13:31.000 --> 00:13:34.840 get away from in person and then they codified it permanently. 228 00:13:34.960 --> 00:13:38.159 It was temporary, it was permanent, and now telehealth is 229 00:13:38.360 --> 00:13:40.799 a legit option. I don't think work comp is fully 230 00:13:40.960 --> 00:13:44.440 embraced telehealth. That is something where you have gaps, where 231 00:13:44.440 --> 00:13:47.080 you don't have specialties and you don't need hands on 232 00:13:47.799 --> 00:13:49.559 that telehealth would be a really good option. 233 00:13:51.840 --> 00:13:56.440 What other trends should we be looking at? Any kind 234 00:13:56.480 --> 00:13:57.440 of brought to mind. 235 00:13:57.279 --> 00:13:59.879 With the shortage of doctors. I know there's been some 236 00:14:00.080 --> 00:14:03.679 kind of pushes AI being a healthcare provider.

Are you 237 00:14:03.759 --> 00:14:06.440 seeing that or is that something we should look out for? 238 00:14:07.399 --> 00:14:10.399 Well, I mean we've always had doctor Google at our disposal. 239 00:14:10.480 --> 00:14:13.039 Well I won't say always, but in the past twenty years, right, 240 00:14:13.559 --> 00:14:18.039 and so if and one of the things I've discovered 241 00:14:18.080 --> 00:14:21.840 through having friends who have gone through healthcare challenges, they 242 00:14:21.919 --> 00:14:26.519 get the portal notification of the MRI reading or the 243 00:14:27.320 --> 00:14:31.320 blood sample, and they see names and words and phrases 244 00:14:31.360 --> 00:14:34.080 they don't understand, so they put it put it into Google, 245 00:14:34.320 --> 00:14:36.360 and Google tells them they're basically going to die in 246 00:14:36.399 --> 00:14:39.440 two weeks, right, So then they go into the doctor's 247 00:14:39.480 --> 00:14:43.200 office and go, Okay, you know, I'm an expert on 248 00:14:43.240 --> 00:14:47.320 this because you know, Google and now AI certainly has 249 00:14:47.679 --> 00:14:50.559 exacerbated that and made it even more prevalent for people 250 00:14:50.600 --> 00:14:52.159 to do that self diagnosis. 251 00:14:52.840 --> 00:14:55.159 And a lot of it is good. It's very very helpful. 252 00:14:55.320 --> 00:14:57.840 I've used it on occasion for myself and for friends 253 00:14:57.840 --> 00:15:00.360 and family to help them kind of understand what they're 254 00:15:00.360 --> 00:15:03.000 dealing and what the options are, what the prognosis is, 255 00:15:03.000 --> 00:15:06.039 what good treatments are, and coming into an appointment with 256 00:15:06.120 --> 00:15:06.600 the doctor. 257 00:15:06.679 --> 00:15:08.000 Certainly being armed. 258 00:15:07.799 --> 00:15:10.679 With that is helpful, but it certainly puts the doctor 259 00:15:10.759 --> 00:15:14.000 or the nurse of the PAA at a disadvantage because 260 00:15:14.919 --> 00:15:19.159 now they're competing against not only know their educational knowledge, 261 00:15:19.159 --> 00:15:22.480 but the educational knowledge of five million doctors around the 262 00:15:22.519 --> 00:15:26.000 kind around the world who've uploaded their stuff into LLM 263 00:15:26.080 --> 00:15:29.039 SO chat GPT can give that injured worker insight. 264 00:15:29.440 --> 00:15:30.200 And oh, by the. 265 00:15:30.120 --> 00:15:32.200 Way, that injured worker may not be the one who's 266 00:15:32.240 --> 00:15:34.879 doing the research. It may be their spouse and that 267 00:15:35.000 --> 00:15:40.039 spouse or supporting our support system. They may have misaligned incentives. 268 00:15:40.080 --> 00:15:42.120 They may kind of like the fact that Bob is 269 00:15:42.159 --> 00:15:44.759 home all the day now when not working, and they've 270 00:15:44.799 --> 00:15:47.399 made the adjustment to two thirds of their regular income 271 00:15:47.720 --> 00:15:50.080 and they go, you know what, it's okay, let's not 272 00:15:50.120 --> 00:15:52.320 worry about getting back to work. We kind of like this. 273 00:15:52.879 --> 00:15:55.960 So you may have misaligned incentives and so it gets 274 00:15:56.000 --> 00:16:00.360 really really complicated when you force AI. AI is either 275 00:16:00.600 --> 00:16:04.639 the devil incarnate or angels sent from heaven, depend upon 276 00:16:04.759 --> 00:16:06.919 the situation in what you're trying to get out of. 277 00:16:10.360 --> 00:16:13.799 You mentioned Mark about this a couple people being at 278 00:16:13.840 --> 00:16:17.600 home together, So that made me think a little bit 279 00:16:17.639 --> 00:16:22.960 about kind of like is aging workforce and retirement? What 280 00:16:23.080 --> 00:16:25.399 kind of data and what kind of trends are you 281 00:16:25.480 --> 00:16:29.120 seeing in terms of an aging workforce and what's that 282 00:16:29.279 --> 00:16:31.639 mean for the workers comp world. 283 00:16:32.960 --> 00:16:34.600 Well, you know, in a perfect world, I would be 284 00:16:34.639 --> 00:16:37.879 retired right now. I do not live in a perfect 285 00:16:37.919 --> 00:16:41.360 world and didn't make all the great the greatest decisions, 286 00:16:41.759 --> 00:16:44.840 including starting a starting a business at sixty years old. 287 00:16:44.879 --> 00:16:49.080 But nineteen point five percent of adults age sixty five 288 00:16:49.159 --> 00:16:52.639 or older we're either employed or actively seeking work, which 289 00:16:52.720 --> 00:16:54.879 is roughly double the low point seen in the mid 290 00:16:54.960 --> 00:16:58.399 nineteen eighties. Workers fifty five and older now account for 291 00:16:58.440 --> 00:17:01.519 approximately twenty four percent of the US workforce, which is 292 00:17:01.600 --> 00:17:04.640 up from ten percent in nineteen ninety four. Workers age 293 00:17:04.720 --> 00:17:07.119 fifty five and over account for over one third of 294 00:17:07.160 --> 00:17:09.079 workplace fatalities. 295 00:17:08.440 --> 00:17:09.279 Which is interesting. 296 00:17:09.680 --> 00:17:13.079 And workers age forty five over our sixty percent more 297 00:17:13.160 --> 00:17:15.319 likely to have delayed to return to work greater than 298 00:17:15.400 --> 00:17:19.440 ninety days. So those statistics show that people are staying 299 00:17:19.440 --> 00:17:24.599 in the workforce longer, and not only they bring their 300 00:17:24.640 --> 00:17:29.079 physical and psychological cool morbidities to injuries. So a forty 301 00:17:29.119 --> 00:17:33.079 five year old probably doesn't have osteoarthritis, and so a 302 00:17:33.160 --> 00:17:37.480 mniscal tear probably is fairly easy to address. A sixty 303 00:17:37.519 --> 00:17:41.759 five year old who's still working probably does has i ostereoarthritis. 304 00:17:41.960 --> 00:17:43.880 And know, by the way, if you do an amriah 305 00:17:43.880 --> 00:17:45.920 of their back to understand what's going on with their

306 00:17:45.920 --> 00:17:48.720 little backstrain, you're going to find all sorts of degenerative 307 00:17:48.759 --> 00:17:52.000 stuff that is expected to be there, that is asymptomatic. 308 00:17:52.039 --> 00:17:53.880 But all of a sudden they go, oh, now I've 309 00:17:53.920 --> 00:17:55.720 got to pay in the back because the amri and 310 00:17:55.799 --> 00:18:00.039 the radiologists told me that there's a problem there. So 311 00:18:00.759 --> 00:18:07.079 that aging workforce brings all sorts of unique dynamics, cognitive decline, 312 00:18:07.559 --> 00:18:10.640 you know, site that they don't hear as well, they 313 00:18:10.680 --> 00:18:13.519 don't see as well, their depth perception is off. They 314 00:18:13.519 --> 00:18:16.279 don't make decisions as quickly as possible. If they're on 315 00:18:16.319 --> 00:18:18.759 a factory floor where things are moving one hundred miles 316 00:18:18.799 --> 00:18:22.079 an hour, you need somebody who's on their game and 317 00:18:22.119 --> 00:18:25.720 they're able to make snap decisions, the right snap decisions. 318 00:18:26.000 --> 00:18:29.000 From a safety standpoint, they may say, you know, I've 319 00:18:29.039 --> 00:18:31.359 been doing this for forty years. I don't really need 320 00:18:31.400 --> 00:18:33.480 to worry about looking around me when I'm driving the 321 00:18:33.480 --> 00:18:36.839 forklift because I kind of have a sixth sense until 322 00:18:36.839 --> 00:18:40.680 they run over somebody or impale a barrel of oil 323 00:18:41.319 --> 00:18:44.480 that then spills over the warehouse floor. So there's a 324 00:18:44.519 --> 00:18:47.119 lot of different things that come from an aging workforce, 325 00:18:48.240 --> 00:18:51.519 not only the stuff that they bring to the injury and. 326 00:18:51.440 --> 00:18:52.799 The recovery afterwards. 327 00:18:52.880 --> 00:18:56.880 I think it's common sense that if someone has physical coorbidities, 328 00:18:57.279 --> 00:18:59.640 that their response to treatment is not going to be 329 00:18:59.680 --> 00:19:03.319 as good good. They've had a lot of life experiences 330 00:19:03.359 --> 00:19:06.240 associated with that. Their range of motion may not get 331 00:19:06.279 --> 00:19:09.119 back to full range of motion on their shoulder just 332 00:19:09.160 --> 00:19:11.519 because they already had kind of frozen shoulder, and then 333 00:19:11.680 --> 00:19:15.680 this particular repetitive injury cemented it for them. There's just 334 00:19:15.720 --> 00:19:17.920 so many things that comes from an aging workforce that 335 00:19:18.000 --> 00:19:20.799 we didn't have to worry about fifty years ago because 336 00:19:20.839 --> 00:19:24.200 people That's the reason why retirement age was sixty five is, 337 00:19:24.440 --> 00:19:29.799 you know, the typical American adult lived about seventy And 338 00:19:29.839 --> 00:19:32.920 that's why SOID security is going in solvent because we 339 00:19:32.960 --> 00:19:35.000 didn't anticipate people were going to be living in their 340 00:19:35.079 --> 00:19:37.440 nineties because when it was created, we only kind of 341 00:19:37.440 --> 00:19:40.119 lived a sixty sixty five. There wasn't even a concept 342 00:19:40.119 --> 00:19:42.839 of Alzheimer's in dementia fifty years ago because nobody lived 343 00:19:42.839 --> 00:19:46.240 long enough to see that evolved as a chronic disease. 344 00:19:46.599 --> 00:19:48.839 So there's just all sorts of things that are happening. 345 00:19:48.920 --> 00:19:52.720 We're living longer, which is great everybody. I wish long live, 346 00:19:53.240 --> 00:19:59.480 long life to everybody, But that longer life experience physical 347 00:19:59.519 --> 00:20:02.839 actions and reactions and injuries and stuff. They all bring 348 00:20:02.880 --> 00:20:07.160 that to the injury and that slows down recovery. It 349 00:20:07.480 --> 00:20:10.759 impacts the treatment if you're if you're obese and not 350 00:20:11.160 --> 00:20:15.039 properly treating your diabetes, guess what that surgery is going 351 00:20:15.079 --> 00:20:18.519 to have. The infections are a little more likely to 352 00:20:18.599 --> 00:20:21.440 happen and the recovery is going to be That's why 353 00:20:21.480 --> 00:20:24.960 GLP ones are really popular now to try to, you know, 354 00:20:25.000 --> 00:20:28.279 help people lose weight before surgery, because we know, if 355 00:20:28.279 --> 00:20:32.079 you're two hundred pounds overweight, giving you a total knee replacement, 356 00:20:32.319 --> 00:20:34.279 those puppies are going to be gone in five years 357 00:20:34.359 --> 00:20:37.960 because you're overweight and your knees are doing way more 358 00:20:38.000 --> 00:20:40.319 work than they should. So all of that kind of 359 00:20:40.359 --> 00:20:44.160 contributes to the cost of claims, the duration of disability, 360 00:20:44.240 --> 00:20:47.319 how quickly we get back to work, all the different 361 00:20:47.359 --> 00:20:50.359 things we have to take into account from a psychosocial standpoint, 362 00:20:51.119 --> 00:20:53.599 just so many things that make things a lot more 363 00:20:53.599 --> 00:20:56.200 complicated from a claim when you see somebody that's a 364 00:20:56.240 --> 00:20:56.960 little bit older. 365 00:20:58.039 --> 00:21:03.960 Given all of these kind of impacts both in maybe 366 00:21:04.599 --> 00:21:07.119 the development or the causing of the claim on the 367 00:21:07.119 --> 00:21:10.400 front end and also on the recovery of the claim 368 00:21:10.440 --> 00:21:13.559 on the back end, are there maybe a couple of 369 00:21:13.720 --> 00:21:18.720 things you would say, Hey, as a defense attorney, these 370 00:21:18.720 --> 00:21:23.400 are things you need to keep in mind when that 371 00:21:23.480 --> 00:21:27.960 claim comes across your desk and it's involving some an 372 00:21:27.960 --> 00:21:31.359 older employee, an older injured worker. This is what you 373 00:21:31.480 -->

00:21:32.799 need to be looking at off. 374 00:21:32.720 --> 00:21:36.880 The bat, I think causation is probably the biggest thing 375 00:21:37.000 --> 00:21:41.960 to really unravel. So, you know, did they fall down 376 00:21:42.000 --> 00:21:46.200 the stairs and break their leg because it was if 377 00:21:46.200 --> 00:21:49.680 the stairs were wet because there weren't the safety strips 378 00:21:49.720 --> 00:21:54.400 on the steps, Or was it because they're cognitively not 379 00:21:54.519 --> 00:21:58.359 as aware and have depth perception that in the age 380 00:21:58.440 --> 00:22:00.960 actually create it, or maybe they're you know, that could 381 00:22:01.000 --> 00:22:03.359 be a part of it too, but you know, you 382 00:22:03.400 --> 00:22:05.440 know that has an issue with it, you know, the 383 00:22:05.440 --> 00:22:08.640 whole degenerative thing. I think, you know, people have made 384 00:22:08.839 --> 00:22:11.960 arguments for a long time to do an MRI very 385 00:22:12.039 --> 00:22:13.920 quickly or and X ray very quickly to kind of 386 00:22:14.000 --> 00:22:16.279 understand what's going on when you're dealing with. 387 00:22:16.240 --> 00:22:17.359 An older employee. 388 00:22:17.920 --> 00:22:20.880 That MRI is going to uncover, that CT scan is 389 00:22:20.880 --> 00:22:23.319 going to uncover all sorts of stuff that has absolutely 390 00:22:23.319 --> 00:22:25.400 nothing to do with the injury, that has a lot 391 00:22:25.440 --> 00:22:28.119 to do with the recovery. So the fact that they 392 00:22:28.119 --> 00:22:31.759 have ostio or arthritis is not a work comp compensable decision. 393 00:22:31.920 --> 00:22:33.920 That has nothing to do with the fact that they 394 00:22:34.000 --> 00:22:37.279 slipped and fell in toward their meniscus, but that astio 395 00:22:37.680 --> 00:22:40.640 arthritis is going to have tremendous impact on the type 396 00:22:40.680 --> 00:22:45.160 of treatment, the pre treatment, the surgery, the post surgical treatment, 397 00:22:45.480 --> 00:22:50.079 the expectation, the expected a return to function, maybe the 398 00:22:50.160 --> 00:22:52.880 duration of disability and return to work. The fact that 399 00:22:52.920 --> 00:22:56.599 they already had degenerative issues in their knee is going 400 00:22:56.640 --> 00:23:01.480 to impact that ability. So I think from a defense standpoint, 401 00:23:01.799 --> 00:23:06.279 you really need to understand the pathology, the compensible pathology. 402 00:23:06.640 --> 00:23:10.200 So what actually was the mechanism mechanism of injury, what 403 00:23:10.319 --> 00:23:13.559 were the circumstances around that? And these are best practices 404 00:23:13.640 --> 00:23:15.599 that both of y'all do, and I'm sure a lot 405 00:23:15.680 --> 00:23:19.680 of listeners to this podcast do already. Interview people as 406 00:23:19.720 --> 00:23:23.680 soon as you possibly can after the injury, so the recollection. 407 00:23:23.319 --> 00:23:24.000 Is very. 408 00:23:25.359 --> 00:23:28.759 Fresh and you don't have people six months later going well, 409 00:23:28.799 --> 00:23:30.480 I think he did this or I think I did that. 410 00:23:31.000 --> 00:23:34.720 You know, understand exactly the mechanism of injury, understand the 411 00:23:34.759 --> 00:23:39.079 circumstances around that, or were their safety issues? Was the 412 00:23:39.119 --> 00:23:43.359 employer the supervisor putting them in unsafe positions? You know, 413 00:23:43.519 --> 00:23:46.799 had had they had a history of not being aware 414 00:23:47.519 --> 00:23:51.640 of not being present at work. Is this the first 415 00:23:51.680 --> 00:23:53.480 time that they look like they were out of it, 416 00:23:53.680 --> 00:23:55.400 or have they looked like they've been out of for 417 00:23:55.400 --> 00:23:58.240 the last six months because they've been going through a divorce, 418 00:23:59.240 --> 00:24:04.240 or they're dog passed away after fifteen years, or money problems, 419 00:24:04.720 --> 00:24:08.359 or they have physical issues that they're dealing with. They're 420 00:24:08.440 --> 00:24:12.759 not treating their diabetes correctly, they're battling the weight issues, 421 00:24:12.880 --> 00:24:16.079 they're not eating nutritiously. They think a really good meal 422 00:24:16.200 --> 00:24:19.640 is taco bell at two am. That's not you know, 423 00:24:19.680 --> 00:24:21.759 that's not really a great way to either finish or 424 00:24:21.799 --> 00:24:25.359 start a day. Depend upon what's going on, so you know, 425 00:24:25.599 --> 00:24:29.119 is this a continuation a trend or is this new? 426 00:24:29.559 --> 00:24:31.640 And then be very very careful when you do. 427 00:24:31.599 --> 00:24:36.839 Diagnostics like MRI or CT scan and be aware that 428 00:24:37.039 --> 00:24:41.559 the osteo osteoarthritis has nothing to do with the injury, 429 00:24:41.839 --> 00:24:44.440 but has everything to do with the recovery. And so 430 00:24:44.720 --> 00:24:48.359 even though you may not want to accept the osteoarthritis 431 00:24:48.440 --> 00:24:52.400 at or degenerative other issues in the lower back as 432 00:24:52.519 --> 00:24:55.599 issues from a compensible standpoint, you need to take into 433 00:24:55.680 --> 00:24:58.839 account that that is going to impact their recovery. It's 434 00:24:58.839 --> 00:25:01.000 going to impact the two the work, it's going to 435 00:25:01.039 --> 00:25:04.000 impact the treatment plan that's decided upon. It's going to 436 00:25:04.039 --> 00:25:06.039 impact the cost of the claim. It's going to be 437 00:25:06.079 --> 00:25:08.319 more costly because it's going to take them longer because 438 00:25:08.319 --> 00:25:11.759 they're already working in a deficiency before the injury happened altogether. 439 00:25:12.440 --> 00:25:13.720 So I think just. 440 00:25:13.759 --> 00:25:17.400 Doing the basics, the one on ones that the really 441 00:25:17.400 --> 00:25:18.920 good defense attorneys

already do. 442 00:25:19.559 --> 00:25:20.519 Just compound that. 443 00:25:20.599 --> 00:25:23.839 But I think the microscope really is on that aging workforce, 444 00:25:24.200 --> 00:25:26.200 because there's going to be stuff that's a part of 445 00:25:26.240 --> 00:25:31.920 that injury, illness, et cetera that is not there for 446 00:25:31.960 --> 00:25:34.440 a thirty five year old that you're going to have 447 00:25:34.480 --> 00:25:35.559 to take into account. 448 00:25:36.640 --> 00:25:39.359 Mark, you talked a little bit about jlps and weight 449 00:25:39.440 --> 00:25:43.119 loss in the instance where someone might have diabetes. I mean, 450 00:25:43.119 --> 00:25:47.759 do you see JLPS impacting workers complaims in the future 451 00:25:48.000 --> 00:25:52.720 just because of the expected use of this throughout our population. 452 00:25:53.640 --> 00:25:54.839 Oh yeah. 453 00:25:54.960 --> 00:25:57.640 There was a conversation I had probably about five or 454 00:25:57.640 --> 00:26:01.119 six years ago with someone when I slid that things 455 00:26:01.279 --> 00:26:05.720 like ozempic goby, which we all can we all can 456 00:26:05.759 --> 00:26:08.920 sing in the jingles, right because they're one of every 457 00:26:08.920 --> 00:26:12.119 three commercials now is about losing weight. 458 00:26:12.960 --> 00:26:14.000 But I had this. 459 00:26:14.079 --> 00:26:18.200 Conversations like this is this is potentially a repeat of opioids, 460 00:26:18.599 --> 00:26:22.559 not that they necessarily have negative repercussions. Although this is 461 00:26:22.599 --> 00:26:27.000 another huge human trial. The COVID vaccine was a huge 462 00:26:27.039 --> 00:26:30.680 clinical human trial with millions of people taking something that 463 00:26:30.720 --> 00:26:35.119 hadn't been fully teased out from mRNA. The same thing 464 00:26:35.240 --> 00:26:38.680 with ozempic and the gop ones. There's been clinical trials, 465 00:26:38.720 --> 00:26:41.000 but nothing like one hundred and thirty million people taking 466 00:26:41.000 --> 00:26:43.279 it and figuring out what happened. So we don't have 467 00:26:43.359 --> 00:26:47.160 longitudinal studies in regards to what the impacts are. So 468 00:26:47.240 --> 00:26:50.000 that was one thing, but the other thing. The other 469 00:26:50.039 --> 00:26:53.680 two things I mentioned at that time is that the 470 00:26:53.759 --> 00:26:56.880 statistics even back then showed that if you take one 471 00:26:56.920 --> 00:27:01.119 of these drugs, you will lose weight, but chances are 472 00:27:01.160 --> 00:27:04.160 if you stop taking the drug, you'll not only regain 473 00:27:04.279 --> 00:27:08.000 all the weight that you lost, but you'll typically historically 474 00:27:08.200 --> 00:27:12.599 gain even more back. So if you engage with golp 475 00:27:12.799 --> 00:27:17.359 ones without any kind of behavioral changes, So if you 476 00:27:17.440 --> 00:27:19.359 just go, hey, we're going to take a shot

every 477 00:27:19.440 --> 00:27:21.119 day and that's going to get rid of your weight 478 00:27:21.279 --> 00:27:24.039 and that's going to be great, that's either going to 479 00:27:24.079 --> 00:27:26.920 be a lifetime expense, which is what opioids became, and 480 00:27:27.039 --> 00:27:31.559 dramatically increased reserves and reduced the ability to settle claims 481 00:27:31.880 --> 00:27:34.640 because we incorporated a drug that was not meant for 482 00:27:34.680 --> 00:27:37.240 long term use, that was used for long term just 483 00:27:37.279 --> 00:27:40.720 because it was difficult to taper for. Golp One's the 484 00:27:40.759 --> 00:27:44.799 same thing. So we're afraid that so you started it 485 00:27:44.839 --> 00:27:47.720 could be a lifetime drug. And you know, those are expensive. 486 00:27:47.799 --> 00:27:50.839 The cost have been coming down pretty rapidly over the 487 00:27:50.839 --> 00:27:53.440 past year or so, but they're still really expensive. That's 488 00:27:53.480 --> 00:27:59.000 going to balloon your reserves and your settlement strategy. If 489 00:27:59.000 --> 00:28:02.400 that is a lifetime lifestyle drug. The best way to 490 00:28:02.440 --> 00:28:05.759 do it, and I'm starting to see actually some people 491 00:28:05.799 --> 00:28:09.680 talk about this, which is good, is to incorporate behavioral 492 00:28:09.759 --> 00:28:13.480 changes along with the drug. So as you're losing weight, 493 00:28:13.759 --> 00:28:19.119 you're also eating more nutritiously, you're also better hydrated. You're 494 00:28:19.160 --> 00:28:23.720 also reducing your stress. You're also getting better sleep, you're 495 00:28:23.799 --> 00:28:28.279 also exercising. You're doing things that require no prescription from 496 00:28:28.279 --> 00:28:31.720 a doctor to do it just requires self discipline. So 497 00:28:31.920 --> 00:28:35.880 if you do golp ones for let's say, let's take, 498 00:28:35.920 --> 00:28:38.519 for example, someone is one hundred pounds overweight and they 499 00:28:38.519 --> 00:28:41.359 need a total knee replacement, it makes sense for them 500 00:28:41.400 --> 00:28:43.440 to lose as much of that one hundred pounds as 501 00:28:43.440 --> 00:28:46.440 they possibly can before the surgery, because again, if they're overweight, 502 00:28:46.519 --> 00:28:49.200 that those those metal knees are not going to last 503 00:28:49.279 --> 00:28:51.440 nearly as long as they would if you have an 504 00:28:51.480 --> 00:28:54.359 appropriate BMI. And I've had actually a friend who went 505 00:28:54.400 --> 00:28:57.480 through that and she deferred total knee replacement for six 506 00:28:57.519 --> 00:29:00.680 months while she took while she addressed her way and 507 00:29:00.720 --> 00:29:03.720 it got down to reasonable weight. So let's say you 508 00:29:03.759 --> 00:29:06.640 pay for gop ones to help them lose weight to 509 00:29:06.720 --> 00:29:10.160 get prepared for that total knee surgery, Well you also 510

00:29:10.240 --> 00:29:13.519 should be prescribing with a case manager or a behavioral 511 00:29:13.559 --> 00:29:17.920 psychologist or gym membership or something. It's like, okay, we're 512 00:29:18.000 --> 00:29:21.240 going to help you change your behavior. So because we 513 00:29:21.279 --> 00:29:24.160 don't want you taking that gop one after the surgery 514 00:29:24.200 --> 00:29:28.799 as well, we want you to maintain that proper BMI 515 00:29:29.000 --> 00:29:32.160 after you do that. So, and I know historically work 516 00:29:32.200 --> 00:29:35.720 comp hasn't paid for gym memberships, or haven't paid for nutritionists, 517 00:29:35.759 --> 00:29:38.839 or haven't paid for yoga instructors, or haven't paid for 518 00:29:38.880 --> 00:29:42.480 different things like that, But the costs for the RLI 519 00:29:42.640 --> 00:29:46.079 on that to help people become empowered and to do 520 00:29:46.160 --> 00:29:50.200 what do their part in losing and maintaining a good lifestyle, 521 00:29:50.519 --> 00:29:53.640 a good healthy weight, a good nutritional value, all that 522 00:29:53.720 --> 00:29:56.880 kind of stuff there. RLI is tremendous because if you 523 00:29:56.960 --> 00:29:59.400 don't do that, they're going to rebound and then you're 524 00:29:59.400 --> 00:30:02.640 gonna have a another total knee replacement in five years 525 00:30:02.640 --> 00:30:05.079 as opposed to twenty years because they just ground that 526 00:30:05.119 --> 00:30:08.680 puppy to bits by being one hundred pounds overweight or 527 00:30:08.680 --> 00:30:10.839 one hundred and fifty pounds because they gained one hundred 528 00:30:10.839 --> 00:30:13.640 plus to fifty's that's what the statistics show. 529 00:30:14.279 --> 00:30:15.279 And the vast. 530 00:30:14.960 --> 00:30:18.119 Majority of use of those drugs now is not on 531 00:30:18.160 --> 00:30:22.440 the diabetes. I'll know that the loss of weight was 532 00:30:22.519 --> 00:30:27.720 kind of an undattended off label repercussion, and really it 533 00:30:27.799 --> 00:30:30.240 was because we saw a bunch of movie stars all 534 00:30:30.240 --> 00:30:33.920 of a sudden, you know, go from swollen to you know, 535 00:30:34.000 --> 00:30:35.480 swollen to swollen. 536 00:30:35.559 --> 00:30:38.799 Right, and so we go, how did they do that? 537 00:30:38.839 --> 00:30:39.440 And they did that? 538 00:30:39.559 --> 00:30:42.319 So the vast and that's why they're doing advertisements on 539 00:30:42.400 --> 00:30:45.960 TV all the time. They don't necessarily are appealing to 540 00:30:46.000 --> 00:30:48.680 the diabetics. They're appealing to the people that are fifty 541 00:30:48.720 --> 00:30:52.240 pounds overweight and want to do that. So my suggestion 542 00:30:52.559 --> 00:30:56.000 and admonition from five six years ago is don't just 543 00:30:56.079 --> 00:31:00.640 prescribe this blindly. Do it in conjunction with behavioral new 544 00:31:00.920 --> 00:31:04.480 behavioral changes that you can help them not only lose 545 00:31:04.519 --> 00:31:06.359 the weight, but keep the weight off, because that's how 546 00:31:06.400 --> 00:31:08.119 they're going to live longer, that's how they're going to 547 00:31:08.160 --> 00:31:10.400 have a higher quality of life, and that's definitely going 548 00:31:10.480 --> 00:31:11.880 to reduce the cost of claims. 549 00:31:13.440 --> 00:31:16.240 Are there any other off label drug issues that can 550 00:31:16.279 --> 00:31:18.000 make their way into the worker's tromp arena? 551 00:31:19.319 --> 00:31:22.799 Well, we got shrooms now, psilocybin. 552 00:31:23.160 --> 00:31:25.799 Uh, you know, we got ecstasy, we got M D 553 00:31:26.000 --> 00:31:28.720 m A, we got all sorts of psychedelics, and people 554 00:31:28.880 --> 00:31:30.559 kind of look at that and go, Okay, that doesn't 555 00:31:30.599 --> 00:31:33.200 have any place in work comp you know, granted, we 556 00:31:33.240 --> 00:31:35.119 never would have made it to the moon if if 557 00:31:35.359 --> 00:31:37.839 people in Berkeley hadn't dropped out in the sixties, right, 558 00:31:37.880 --> 00:31:39.720 I mean, you need to kind of expand your behind. 559 00:31:40.519 --> 00:31:43.799 But there's a lot of growing evidence that psychedelics have 560 00:31:43.880 --> 00:31:49.640 a tremendous, tremendously positive impact on PTSD. The VA leaning 561 00:31:49.640 --> 00:31:53.680 into that. I spoke to a medical director several years ago, 562 00:31:54.359 --> 00:31:57.559 and she suggested she was more in favor of psilocybin 563 00:31:58.240 --> 00:32:01.359 than cannabis because psilocybin is a single molecule that makes 564 00:32:01.400 --> 00:32:05.079 it much easier to study. And so I really think 565 00:32:05.160 --> 00:32:08.640 that under medical supervision. So this is not dropping acid 566 00:32:08.680 --> 00:32:11.559 on the weekend and hoping it takes care of your PTSD. 567 00:32:11.839 --> 00:32:13.160 This is doing. 568 00:32:12.920 --> 00:32:17.319 Psychedelics under medical supervision in conjunction with behavioral kind of 569 00:32:17.359 --> 00:32:20.680 behavioral therapy and other different behavioral therapies in order to 570 00:32:20.680 --> 00:32:23.440 help work your way out of PTSD. And PTSD is 571 00:32:23.440 --> 00:32:25.640 a huge thing in work up right with the increase 572 00:32:25.640 --> 00:32:31.480 of presumptions, presumptions almost automatically include PTSD for first responders, firefighters, 573 00:32:32.160 --> 00:32:34.480 a variety of different things. If you're seven to eleven 574 00:32:34.519 --> 00:32:37.240 person and got held up at gunpoint and maybe they 575 00:32:37.240 --> 00:32:40.200 shot your coworker, you're going to have PTSD more than likely. 576 00:32:40.480 --> 00:32:43.880 And so PTSD is a huge part. And sometimes there's 577 00:32:44.559 --> 00:32:49.119 a treatment resistant treatment. You know, there are drugs that 578 00:32:49.160 --> 00:32:52.359 are used to help PTSD that

not everybody responds to PTSD. 579 00:32:52.799 --> 00:32:55.880 Not everybody responds to those drugs, not everybody responds to 580 00:32:55.920 --> 00:33:00.279 behavioral So psilocybin and other psychedelics are something at is 581 00:33:00.319 --> 00:33:04.000 going to come because there's growing evidence there's growing admission 582 00:33:04.359 --> 00:33:08.279 of that. I mean think back back fifteen years about acupuncture. 583 00:33:08.599 --> 00:33:11.640 Acupuncture was like, we don't do that in the West. Well, 584 00:33:11.799 --> 00:33:14.319 now you look at New York, you look at Washington, 585 00:33:14.440 --> 00:33:20.599 you look at ODG acupuncture, medicare Va. Acupuncture is pretty 586 00:33:20.640 --> 00:33:23.480 mainstream and they're seeing a lot of evidence and they're 587 00:33:23.480 --> 00:33:27.279 seeing the science behind why acupuncture works in some circumstances. 588 00:33:27.680 --> 00:33:30.400 So I think from work comp standpoint, my mind was 589 00:33:30.480 --> 00:33:34.000 open when I said, Okay, opioids are bad, and well 590 00:33:34.039 --> 00:33:37.759 not opioids are bad. Opioids are overused, and they begat 591 00:33:37.799 --> 00:33:41.960 these crazy cocktails of other prescription drugs. What are some 592 00:33:42.119 --> 00:33:44.880 other options? And it really opened my mind to look 593 00:33:44.920 --> 00:33:49.000 at other things besides just Western medicine. So that's something 594 00:33:49.039 --> 00:33:51.880 to keep an eye on. The Other thing is cannabis. 595 00:33:51.960 --> 00:33:54.359 I became kind of the Matthew McConaughey of work comp 596 00:33:54.640 --> 00:33:58.519 back in twenty fourteen when New Mexico said that medical 597 00:33:58.559 --> 00:34:02.119 cannabis was reasonable and ness, and I warned then that 598 00:34:02.200 --> 00:34:06.119 it was going to become an issue of risk management 599 00:34:06.200 --> 00:34:10.039 because it's very difficult to its present, but it's not 600 00:34:10.079 --> 00:34:14.880 necessarily intoxicating. So just because you test positive for it 601 00:34:14.920 --> 00:34:17.880 doesn't mean that you're impaired. And that's a real challenge 602 00:34:17.920 --> 00:34:20.920 with that, and I've been warning about that for a while. 603 00:34:20.920 --> 00:34:22.679 It's like, Okay, there's a lot of payers that have 604 00:34:22.760 --> 00:34:25.320 hung their hat on Okay, it's illegal, it's Schedule one. 605 00:34:27.440 --> 00:34:29.480 We don't have to worry about it. We just say 606 00:34:29.639 --> 00:34:31.840 it's illegal, so we don't have to pay for it. Well, 607 00:34:31.920 --> 00:34:35.480 on June twenty ninth, the DEA is having a meeting 608 00:34:35.760 --> 00:34:40.360 where they are contemplating rescheduling marijuana cannabis from Schedule one 609 00:34:40.400 --> 00:34:41.639 to Schedule three. 610 00:34:41.639 --> 00:34:43.639 And not just for medicinal purposes. 611 00:34:44.119 --> 00:34:46.320 And by the time people listen to this podcast, that 612 00:34:46.440 --> 00:34:49.320 meeting may have already happened and the results might be there. 613 00:34:49.440 --> 00:34:53.119 We're recording it just prior to it. My anticipation is 614 00:34:53.159 --> 00:34:55.840 that they're going to say that every cannabis, all the 615 00:34:55.880 --> 00:34:58.360 forms of cannas, not just medical, but everything is going 616 00:34:58.400 --> 00:35:00.599 to be Scheduled three. That's going to open the up 617 00:35:00.760 --> 00:35:04.519 research from a US standpoint, We're going to really finally 618 00:35:04.599 --> 00:35:07.639 understand whether it's actually good for chronic pain or anxiety 619 00:35:07.679 --> 00:35:10.639 or sleep disorders, some different things. But the payers that 620 00:35:10.719 --> 00:35:14.000 have been hanging their hat for fifteen years that are 621 00:35:14.079 --> 00:35:16.719 ten years that it's illegal and therefore we don't have 622 00:35:16.760 --> 00:35:18.639 to worry about it. You're going to have to change 623 00:35:18.639 --> 00:35:22.239 your team. There was one payer I recall in Maine 624 00:35:22.400 --> 00:35:26.480 that the injured worker actually was taking less prescription drugs. 625 00:35:26.679 --> 00:35:29.119 It was costing them twelve hundred dollars less per month. 626 00:35:29.880 --> 00:35:33.039 He said that the cannabis was helping him in dealing 627 00:35:33.039 --> 00:35:35.960 with his chronic pain and anxiety and depression and sleep disorder. 628 00:35:36.280 --> 00:35:37.880 They could took it all the way to the main 629 00:35:37.960 --> 00:35:41.159 Supreme Court because their corporate culture is we don't like weed, 630 00:35:41.760 --> 00:35:43.519 and so they took it up to court, even though 631 00:35:43.519 --> 00:35:46.280 they were saving money and the injury worker was getting 632 00:35:46.360 --> 00:35:50.159 better treatment that was less dangerous to him. They took 633 00:35:50.280 --> 00:35:52.559 the main Supreme Court, and the Main Supreme Court said, yeah, 634 00:35:52.599 --> 00:35:54.440 it's illegal to federal level, so you don't have to. 635 00:35:54.800 --> 00:35:58.079 So it's somewhat of a pyrrhic victory. They did not 636 00:35:58.360 --> 00:36:02.840 accept savings from US dollar standpoint and better actual clinical 637 00:36:02.880 --> 00:36:05.960 outcomes for that injury worker because their corporate culture said, 638 00:36:05.960 --> 00:36:08.239 we don't do weed. Well, now they're going to have 639 00:36:08.280 --> 00:36:11.360 to revisit that if it does become Schedule three it's 640 00:36:11.400 --> 00:36:15.440 not illegal. Well, there as complicated as far as whether 641 00:36:15.440 --> 00:36:17.719 it's illegal or not. But Schedule three takes it out 642 00:36:17.760 --> 00:36:20.880 of the Schedule one, which has all sorts of so banking, 643 00:36:21.400 --> 00:36:24.280 all sorts of different things. Cannabis. There's already a big 644 00:36:24.320 --> 00:36:26.960

cannabis and that's been for the past ten years. All 645 00:36:27.000 --> 00:36:29.960 these huge companies, big tobacco, always wanted to being the 646 00:36:30.000 --> 00:36:33.840 cannabis industry. They're actively seeking because they got vaping, they 647 00:36:33.960 --> 00:36:37.079 got the perfect they already have the built in manufacturing 648 00:36:37.119 --> 00:36:40.239 of being doing that. Big pharma. Oh my god, they 649 00:36:40.639 --> 00:36:44.519 would sell their well, I won't say that. They would 650 00:36:44.679 --> 00:36:47.920 love to be in the cannabis industry. So the once 651 00:36:47.960 --> 00:36:51.199 Schedule three happens, all bets are off, and you know 652 00:36:51.519 --> 00:36:55.679 of variety. Most of jurisdictions have either legalized medical and 653 00:36:55.840 --> 00:37:00.280 or recreational. And then you've got CBD and CBG, which 654 00:37:00.320 --> 00:37:04.679 is it's very very complicated, right, So that is something 655 00:37:04.800 --> 00:37:07.840 if the meeting on June twenty ninth happens, if the 656 00:37:07.960 --> 00:37:10.880 outcome is what I expect, by the time you listen 657 00:37:10.920 --> 00:37:13.320 to this, you may be dealing with a whole different 658 00:37:13.320 --> 00:37:16.320 reality about how you interact with cannabis in your workplace 659 00:37:16.679 --> 00:37:19.920 and certainly from a treatment standpoint for injured workers. 660 00:37:20.840 --> 00:37:23.639 That's really interesting, Mark. I want to touch on one 661 00:37:23.719 --> 00:37:26.760 last thing, and you mentioned this with regards to GLP 662 00:37:26.960 --> 00:37:31.679 ones in terms of the mental health side of that 663 00:37:32.280 --> 00:37:34.679 as a wrap around with the treatment, and you touched 664 00:37:34.679 --> 00:37:39.719 on it too with PTSD in terms of treatment. But 665 00:37:40.679 --> 00:37:45.039 in terms of just generally health trends with mental health 666 00:37:45.119 --> 00:37:52.119 coverage and treatment in claims more generally, there's certainly in 667 00:37:52.719 --> 00:37:57.079 the time that I've been practicing, there's more openness and 668 00:37:57.199 --> 00:38:01.960 acceptance in terms of mental health discussing it, treating it. 669 00:38:03.280 --> 00:38:07.480 How are you seeing it trend wise? How are states 670 00:38:07.840 --> 00:38:14.559 treating mental health claims within systems for coverage purposes across 671 00:38:14.599 --> 00:38:15.199 the country. 672 00:38:16.440 --> 00:38:17.280 Well, it's interesting. 673 00:38:17.679 --> 00:38:20.039 On my journey the opioid's one of the first things 674 00:38:20.079 --> 00:38:24.360 I ran across was behavioral psychology. So I started advocating 675 00:38:24.400 --> 00:38:27.519 for COTGN of behavioral therapy in twenty eleven. When I 676 00:38:27.559 --> 00:38:30.480 did my first presentation on that, I thought I was 677 00:38:30.519 --> 00:38:33.039 gonna do so with snakes in my head because nobody 678 00:38:33.079 --> 00:38:35.880 wanted to look at me. They didn't want to admit that, 679 00:38:36.719 --> 00:38:38.599 they didn't want to open Pandora's box. 680 00:38:38.679 --> 00:38:41.119 The whole phrase was just because. 681 00:38:40.800 --> 00:38:43.360 Something happened to them and their childhood doesn't impact the 682 00:38:43.360 --> 00:38:47.480 compensibility of this claim. What we've understood is what actually 683 00:38:47.519 --> 00:38:51.159 did happen to them as a child does impact the resilience, 684 00:38:51.559 --> 00:38:56.320 does impact their response to authority, does impact their ability 685 00:38:56.360 --> 00:38:59.960 to recover and desire to recover. Their locust of control 686 00:39:00.719 --> 00:39:04.280 is external. They're expecting other people to take care of 687 00:39:04.320 --> 00:39:05.880 all their problems instead. 688 00:39:05.519 --> 00:39:07.440 Of owning what they need to do. 689 00:39:08.039 --> 00:39:10.920 And so there has been a softening of that in 690 00:39:10.960 --> 00:39:13.400 our industry and understanding that we have to take into 691 00:39:13.480 --> 00:39:15.880 account the whole person. We don't have to say the 692 00:39:15.880 --> 00:39:20.559 whole person is compensable, but ignoring the fact that they 693 00:39:20.559 --> 00:39:25.199 had adverse childhood experience, or that they have a bad 694 00:39:25.320 --> 00:39:30.039 socioeconomic circumstance around them where or they've grown up with 695 00:39:30.159 --> 00:39:33.440 a distrust of authority, and so when a physical therapist 696 00:39:33.559 --> 00:39:37.159 or a doctor tells them to do something, they immediately 697 00:39:37.199 --> 00:39:39.960 distrust it because that's how they've grown up. All of 698 00:39:40.000 --> 00:39:43.400 that has a tremendous impact on their response to care, 699 00:39:43.920 --> 00:39:48.559 response to interaction, response to communication. They're always looking for 700 00:39:48.599 --> 00:39:51.280 the negative. They are glass half empty as opposed to 701 00:39:51.360 --> 00:39:54.679 glass half full. So claims a gesture may do everything 702 00:39:54.679 --> 00:39:57.960 they can to have empathetic communication, but that injury worker 703 00:39:58.039 --> 00:40:02.599 because of how they grew up thematically distrust them. So 704 00:40:02.800 --> 00:40:05.639 that's part of it. The other part is COVID broke 705 00:40:05.679 --> 00:40:08.000 a lot of people, and I think we saw that 706 00:40:08.280 --> 00:40:11.159 in crime statistics. We saw that in the increase in 707 00:40:11.199 --> 00:40:16.079 the use of antidepressants and alcohol very early on in COVID. 708 00:40:16.920 --> 00:40:19.840 We have seen the Surgeon General three or four years 709 00:40:19.840 --> 00:40:23.519 ago talked about the epidemical loneliness. We've certainly seen that 710 00:40:23.559 --> 00:40:27.920 in social media, where people cannot interact eyeball to eyeball. 711 00:40:28.159 --> 00:40:31.760

Almost all dating is done on apps, and the algorithms 712 00:40:31.840 --> 00:40:34.800 on the apps are not necessarily meant for you to 713 00:40:34.840 --> 00:40:38.760 find a lifelong partner. They're meant for you for that 714 00:40:39.920 --> 00:40:42.239 experience to explode so you come back to the dating 715 00:40:42.280 --> 00:40:45.320 app and use it again. So all of that has 716 00:40:45.559 --> 00:40:49.559 directly and emphatically impacted our mental health. We are in 717 00:40:49.719 --> 00:40:53.679 much worse mental health shape than we in. COVID had 718 00:40:53.679 --> 00:40:56.880 a lot to do with that, and as mentioned before, 719 00:40:57.239 --> 00:41:00.880 that has a lot to do with not the compensable 720 00:41:00.920 --> 00:41:03.480 part of the work comp claim, but the response to 721 00:41:03.480 --> 00:41:06.400 the work comp claim, which has a direct impact on 722 00:41:06.519 --> 00:41:10.559 the total cost of claim, the duration of disability, obviously, 723 00:41:10.599 --> 00:41:13.599 the amount of indemnity benefits, the size of the reserve 724 00:41:13.679 --> 00:41:16.119 that you have to set, whether you can settle or not. 725 00:41:16.599 --> 00:41:19.599 So the longer this takes because we just focus on 726 00:41:19.639 --> 00:41:23.559 the biomedical and not the biopsychosocial, we're shooting ourselves in 727 00:41:23.599 --> 00:41:27.360 the foot. And so the industry has increasingly understood that 728 00:41:27.400 --> 00:41:30.880 we have to take that into account, not determined as compensable, 729 00:41:31.360 --> 00:41:34.039 just take it into an account and adjust our communication, 730 00:41:34.639 --> 00:41:41.480 adjust our ability to interact with them. So it's not 731 00:41:41.840 --> 00:41:47.199 accepting psych as a compensable diagnosis, it's admitting that psych 732 00:41:47.480 --> 00:41:52.559 has a dramatic impact on the resiliency and the recovery, 733 00:41:52.599 --> 00:41:55.480 which has a direct financial impact on the total cost 734 00:41:55.519 --> 00:41:58.679 of claims. So fortunately there's been a lot of progress 735 00:41:58.760 --> 00:42:01.639 in Shane, you mentioned this, I mean twenty eleven. Literally, 736 00:42:02.519 --> 00:42:04.880 you know, people just did not want to look me 737 00:42:04.880 --> 00:42:07.000 in the eye when I mentioned conon behavioral therapy and 738 00:42:07.039 --> 00:42:10.360 the fact that fear avoidance and perceived insice and a 739 00:42:10.440 --> 00:42:12.840 variety of things like that had an impact of direct 740 00:42:12.880 --> 00:42:15.519 impact on claims. Now we know it, and now we're 741 00:42:15.559 --> 00:42:18.599 building that into claim systems. We're doing all sorts of 742 00:42:18.639 --> 00:42:21.719 communication and training on that, So I think we're good. 743 00:42:22.119 --> 00:42:25.079 The bad news is that with the mental health challenges 744 00:42:25.119 --> 00:42:28.920 of injured workers is a different layer of the onion 745 00:42:28.960 --> 00:42:30.360 that we have not been used to. 746 00:42:30.320 --> 00:42:30.960 In the past. 747 00:42:31.440 --> 00:42:34.480 And so whether it's PTSD or whether it's just the 748 00:42:34.519 --> 00:42:37.840 fact that they got competent here they didn't have a 749 00:42:37.880 --> 00:42:41.480 catastrophic injury, but they absolutely curl up into a ball 750 00:42:41.559 --> 00:42:44.079 and don't do anything and never get back to work, 751 00:42:44.280 --> 00:42:47.000 whereas someone with the same exact situation got back to 752 00:42:47.039 --> 00:42:50.760 work very quickly. The difference wasn't the injury. The difference 753 00:42:50.840 --> 00:42:53.119 was what was going on inside their head and what 754 00:42:53.280 --> 00:42:56.000 was going on at home that had an impact on 755 00:42:56.039 --> 00:42:57.880 their resilience and ability to recover. 756 00:42:58.480 --> 00:42:59.599 So I think we need. 757 00:42:59.440 --> 00:43:02.800 To lean in again, not determining compensibility, just taking it 758 00:43:02.800 --> 00:43:07.039 into consideration that these things are impacting their response to 759 00:43:07.239 --> 00:43:10.159 our care and our communication and adjust accordingly. 760 00:43:12.079 --> 00:43:14.599 Mark, You've given us a lot to think about. And 761 00:43:15.320 --> 00:43:17.039 if our listeners want to contact you. 762 00:43:17.119 --> 00:43:20.360 Or learn more about the programs offered at workcop College, 763 00:43:20.519 --> 00:43:21.800 how can they contact you. 764 00:43:22.719 --> 00:43:23.800 Well, you can go. 765 00:43:24.199 --> 00:43:26.280 We were smart enough to name our company after the 766 00:43:26.320 --> 00:43:29.639 website or vice versus, so it's very easy. It's Workcompcollege 767 00:43:29.679 --> 00:43:32.840 dot com all one word. My email address is very 768 00:43:33.440 --> 00:43:37.639 simple as well, mpew at workcopcollege dot com. And I'd 769 00:43:37.679 --> 00:43:40.480 also love to connect with you on LinkedIn. I carpet 770 00:43:40.519 --> 00:43:43.559 bomb the industry on a regular basis with content from 771 00:43:43.599 --> 00:43:46.079 all sorts of different perspectives. So if you're not connected 772 00:43:46.119 --> 00:43:49.519 with me on LinkedIn, Mark Pew. I was an early adopter, 773 00:43:49.599 --> 00:43:51.679 so I didn't have to put numbers in letters after 774 00:43:51.719 --> 00:43:54.880 my name. It's just simply M. A. R Kpew. But 775 00:43:54.920 --> 00:43:56.360 I'd love to continue the discussion. 776 00:43:58.199 --> 00:44:00.639 Well, thank you so much, Thank you Mark. 777 00:44:00.719 --> 00:44:18.639 This has been awesome. Thank you. Appreciate the invite. 778 00:44:04.400 --> 00:44:04.440 H