Episode #32 - What Does Remote Work Mean for Pain Management?

The new normal for working from home means new challenges for pain management & work-related injuries.

  • 00:10:11 - 05:10:11

    Jerrod Bailey 00:00

    What do you see? What's the reality of delivering? I mean, you're, you're practicing clinician you're doing these things. Can you give us any color on? what that's like? What's maybe broken in the process? What could be improved?


    Michael Compton 00:12

    Yeah, well, I'll say there's love bloat in the system. And I agree with Bob, that we want to move these claims faster. And it's really frustrating if I'm treating a patient that's an injured, injured worker, that we just sometimes don't get responses from the carrier. And we have to file for petitions and get their attorneys involved, to get authorization for care.


    Jerrod Bailey 00:41

    Right Welcome, everyone to reimagining healthcare, a new dialogue with risk and patient safety leaders presented by med place. We're excited to bring you conversations with top risk and patient safety thought leaders from organizations around the country, please subscribe to get the latest news and content. And if you find this episode valuable, by all means, share it with your colleagues, we want to create some meaningful dialogues in your own communities. And if you're interested in participating as a guest, please email us at speakers at med place.com. You can also check out some of our related content like articles, videos and other things at blog, dot men place.com/resources. So last time, we were joined by Heidi carpenter where we talked about outpatient occupational therapy, we got into work comp and some other areas. Today I'm joined by Dr. Michael Pompton, the founder of renew health. Welcome, Michael. Hello,


    Michael Compton 01:33

    thank you for having me.


    Jerrod Bailey 01:35

    So let me get a little bio here. Dr. Michael combs content has been licensed as a Doctor of Chiropractic registered nurse and family nurse practitioner in Arizona since 2010 2013 2015, respectively. His board certified as a Doctor of Chiropractic by the National Board of Chiropractic Examiners, Family Nurse Practitioner by the American Academy of Nurse Practitioner Certification Board, its clinical practice is focused on the treatment of patients and acute subacute, post traumatic neurological, orthopedic and pain conditions and associated long term sequela. I get that right.


    Michael Compton 02:15

    Yes. And


    Jerrod Bailey 02:17

    a common part of his practice is providing expert witness testimony and independent medical examination services for both plaintiff and defense counsel in liability and industrial injury injury claims. That's a lot you've had quite a bit of a career behind you.


    Michael Compton 02:32

    Yeah, they get everything. Yeah, well, yeah, it's been a journey, for sure. And it's, you know, I sort of just look at this as the evolution, the nature of injury medicine practice that I personally feel like, if I'm not continuously learning, then I'm not doing the best I can for my patients. And also, it's quite stimulating for me, I really like what I do. And there's a lot of these types of injuries that we see. And I just want to be on the forefront of what I can for the people that I work with.


    Jerrod Bailey 03:04

    That's great. I love that you do do so many things. Even on the medical legal front, right? There's so much more than I and I, we hear this from our physicians on our platform all the time, there's so much more dimensionality that they pick up from their area of practice, when they get involved in these kind of medical legal issues. And they get really kind of see things from other different types of lenses that you don't get trained in, in medical school on right, you don't walk out with a degree understanding some of these these other implications of practicing medicine, right? Yeah,


    Michael Compton 03:36

    I mean, that's, I'll say 100% accurate with that in my training, they came out of school, and you have to take care of patients to, you know, the level that they teach us in training and whatnot. But when you're a student, and when you're flying on your own, it's a very different ball of wax. And then you get involved in medical legal cases. Sometimes you just don't know what you know, until you know it. And that's given me a lot of insight with first if I earlier career learning, and just taking care of patients and then learning how to make causation and apportionments. And dealing with a lot of injuries, specifically, then moving into expert work and Ima we're really getting to see the case from a completely different lens. And then taking that back into my clinical practice when I'm working as a treating provider and seeing Oh, you know what, this patient has a prior neck surgery. They're here after an industrial injury or an auto or liability or whatever the claim may be. And now already understanding if I was going to imp my own case, how would I start to put this together? And I think that's really important for people that are heavily involved with injury medicine to have a global person spective of at least


    Jerrod Bailey 05:02

    that's interesting. Yeah, that that really resonates now how? So? What's the arc here? Like? How did you get started in in pain management? And then how did how did that segue into, you know, work comp and IMS and things like that. So Well, I


    Michael Compton 05:16

    started in healthcare as a chiropractor, and I knew right when I was done with chiropractic school that I wanted more tools in my belt. Chiropractic is great, but it has limitations on scope of practice and perception and where patients see you what they can do what you can do for them as a chiropractor. So I went into nursing in from nursing, I knew that I wanted to go into a dance practice, it was just, you know, part of the journey to go into vet advanced practice. And there's fellowships available for nurse practitioners and additional board certifications beyond the general training. So for me, I knew early that, you know, pain management was a big part of just general chiropractic care and musculoskeletal medicine. And I wanted to gain more tools and skills in the general treatment of patients in pain. Specifically in the injury world, you know, most of the time they have injuries from our pain, rather from an orthopedic injury. And managing those orthopedic injuries and the pain and whatnot associated with it led me to more medication management and procedural management, which ultimately got me more interested in surgery and dealing with dealing with the pain from an orthopedic perspective, I'm, well yeah, your shoulder is in pain, because you have a rotator cuff repair, we can give you medications that will help manage the pain, but really, the primary problem is you have a rotator cuff tear or whatever the case can be. So that's how I sort of just progressed, but my initial interest in pain was because I I injured myself when I was in high school and I needed pain management services and rehabilitation services. So that's where my, my interest really started. But as I became a healthcare provider, I realized that every everybody has their role, and I just wanted more tools in my belt to to be in my role. And


    Jerrod Bailey 07:22

    it's great, it sounds like sounds like that that served you well and it's created a foundation for you also to be consumed as an expert by you know, different groups in the in the space specially looks like you work with both plaintiff and defense side. So it looks like they're seeking you out at this point. To be able to, to process some of these these hard things. Let's talk about trends, like interesting things that are going on lately. Like you have a lot of people that are working from home, is that impacting sort of work related pain? Are there any trends in you know, that happened kind of during or after COVID That you're noticing? Well, so,


    Michael Compton 08:03

    the one thing I noticed with COVID, was that telemedicine was significantly more viable option, right, because people were not going anywhere, really. So I would go to my office and set my office by myself because I needed to get out of my house and and whatnot. But, you know, I just go there and see see patients at telemedicine. And I think the answer to that is yes, there has been diminished care to from a rehabilitation perspective because it's hard to do tele rehabilitation, although it's possible. It's just more challenging. It's hard to perform physical examinations, telemedicine, but still possible, and you're having to educate the patient on how to reproduce some of these orthopedic maneuvers. And you're taking the subjective response to the to the maneuver and test and even more subjectively than their response in office. So that's been a little bit challenging, but you do your best with, you know, the COVID situation at least. But I think it's also been helpful in just the general spectrum of pain care. And now the DEA has released a statement regarding ongoing controlled medication management. And I carry a fair bit of Permanent stationary lifetime award patients that are on controlled medications and need to see new monthly and they're all over the state in so one gentleman this morning and I drove three hours to come see me and now with these changes stable. I'd monitor him in different fashion. And now we can come see me once a once a quarter or once every three months or two months or whatever I whatever I need for more in person monitoring.


    Jerrod Bailey 09:49

    But what's interesting


    Michael Compton 09:51

    as far as maybe work, injuries related to people working at home I haven't seen gave them a much of an uptick in in that. I've seen a decline in car accidents for people from working. Oh, probably as


    Jerrod Bailey 10:09

    much. Well, that's some silver lining. Yeah, that's great.


    Michael Compton 10:14

    You're not having to travel, you know, when our work every day, but, you know, round trip and you know, your risk for about a collision is us.


    Jerrod Bailey 10:24

    You've probably seen more people falling off ladders from all the home improvements they've been doing.


    Michael Compton 10:29

    Yeah, and I mean, it we see things like that all the time. People tripping, following, taking their house taking down decorations and things of that nature. Now, whether or not that's a work injury is, you know, debatable depends on I suppose, what their, what their real role is, and if that's pertinent to their occupation,


    Jerrod Bailey 10:53

    there's a lot of chatter around that right now, I know even as a CEO, I, myself am paying attention to it. And like, is it real? Is it not real? The whole idea that, well, people are working from home, you've got a responsibility in some way to keep them safe, even at home. Right. And there's the lawyers, the first ones to the table to talk about the issues on both sides. But you know, yeah, I mean, I see the chatter like that. I do it just going back to when your comments you made before about technology, I mean, I'm a technology person, right? First and foremost is what I've done my whole career. So I geek out on the technology side of things. And I've seen some really interesting things. And this started 10 years ago, when I first got into the venture space, I would see, you know, sleeves, and, you know, wearable things that had sensors that could really tell you, you know, to the you know, the millimeter if the movements were correct, and you know, being able to do this idea of being able to do i Amis remotely the idea to be able to do PT remotely, all very fascinating. So if at any point, you're like, you know, Jared, you got to hear this technology, that kind of stuff is fascinating to me. So if you ever seen anything you find interesting in the space? Sure, let me know.


    Michael Compton 12:03

    The other thing, I guess we're working from home that I've been getting a fair bit of requests for, and maybe even some challenges is that a lot of things have changed after COVID With realizing that, do you really need people to come into an office to sit in the cube and to do the job that they could do from home anyway. But having to accommodate for ergonomic workstations of sit to stand desks, one patient that has had a complication from a knee surgery, and needs to have her entire life supported. We've gone round and round with the nurse case manager for the organization that she works for. And finally, we were able to get now a one year work from home. For that that person when previously they're like, well, she can come here and we can give her support. But, you know, I think as you talk to the medical staff, associate with the organization and speak to them versus just filling out a sheet of paper that they're requesting. That's been quite helpful. But I think the biggest thing that I've gotten requests for is more ergonomic workstations. And you know, sitting is not really all that healthy for you. So sit


    Jerrod Bailey 13:20

    sitting is the new smoking, I think they're saying


    Michael Compton 13:23

    exactly. So sit to stand desks are a common thing that I will try to accommodate for folks that have back pain or musculoskeletal injuries. I think another real common thing I see with post concussion issues is screen filters, light sensitivity from the screens. So with, there's various programs that are available. But some people can't download those programs because of restrictions from their IT department. So like film, or even just glasses or modified contrast sensitivity programs that they can use on their other computer to still accomplish their, their duties.


    Jerrod Bailey 14:09

    That's great. It's good. Now I'm thinking all the things that I probably should be providing my employees. Let's talk about let's talk about some of the medical legal stuff because I think that that's such a mystery to some people, right? If you're not in the middle of it, you hear about it, you might have colleagues that are doing IVs. But what it feels like it looks like you know, when you're when you're sitting in the, in the chair doing them what? So, you know, you know, Bob was new ski here in town as an attorney representing injured workers. He was on the podcast at one point and he, you know, he acknowledged or said basically, the whole workers comp process could be improved if things just kind of move faster, right. And we're part of the technology inside of the stack to kind of move things faster. But what do you see what's the reality of delivering Amy's appear? If you're practicing clinician you're doing these things. Can you give us any color on? what that's like? What's maybe broken in the process? What could be improved?


    Michael Compton 15:09

    Yeah, well, I'll say there's love bloat in the system. And I agree with Bob Saban on, we want to move these claims faster. It's really frustrating if I'm treating a patient that's an injured, injured worker, that we just sometimes don't get responses from the carrier. And we have to file for petitions and get their attorneys involved, to get authorization for care. And it's really challenging sometimes to be able to authorize that for to get the authorizations and I try to send them back to work as soon as I can with some sort of accommodations. But I also don't know sometimes what's wrong with them because I don't have the imaging or the diagnostic studies that I need or they had their medicines haven't been approved for the therapy hasn't been approved, or they haven't even been approved to see me for a follow up visit. And so it can be quite frustrating. But with respect to ame services and what what can go faster I think with the IMEI is the adjusters are pretty quick to order IMEI is and I think sometimes rightfully so. And oftentimes those early IMEI is are mechanistic questions, is the injured worker saying that they hurt their knee? Well, maybe they did. Maybe they didn't. What was the mechanism of injury does that match? They're having compensation with Libby and now they're having back pain. They're trying to get back pain included in the claim when there's no documentation of early back pain. So I was just checking generally looked at the early records as best as possible, but give the benefit of the doubt to the patient on what they're they're recording. But we always have to go back to the mechanism of injury because he does that make sense in their claim and try to push forward with the adjuster. So I'll say the nurse case managers been super helpful in navigating through getting authorization and assistance with authorization. And we try not to get the Industrial Commission involved. But if the carriers are just not responsive, we just don't really have a choice. Because that patients knocking on our door or coming into the clinic or messaging the office saying hey, what's going on? Nobody's contacted me for the synergy that hasn't been approved. I can barely walk and eat medications. And even though can be frustrating as their treatment provider

Insights from a Practicing Pain Management Physician

Dr. Michael Compton, the founder of Renew Health, joins the Medplace podcast to discuss pain management and the independent medical exam (IME) process. He shares how work-from-home policies have shifted the types of pain management procedures that he and his collegues perform, and the consequences of this shift.

Dr. Compton also reviews the shortcomings of communication in the workers' compensation system, and he and Jerrod Bailey brainstorm ways to overcome these obstacles.


Guest - Dr. Michael Compton

Founder of Renew Health

Dr. Michael Compton has been licensed as a Doctor of Chiropractic, a registered nurse, and a Family Nurse Practitioner in Arizona since 2010, 2013, and 2015, respectively. He is board certified as a Doctor of Chiropractic (DC) by the National Board of Chiropractic Examiners, Family Nurse Practitioner (FNP-C) by the American Academy of Nurse Practitioners Certification Board; fellowship trained in pain management from the University of California, Davis, and holds board certification in pain management. He has completed surgical First Assisting training from the National Institute of First Assisting and participates in the surgical treatment and management of neurological and orthopedic injuries. He is now completing fellowships in Brain Injury Rehabilitation and Vestibular Rehabilitation. His clinical practice is focused on the treatment of patients with acute/sub-acute post-traumatic neurological, orthopedic, and pain conditions and associated long-term sequela. In addition to his clinical practice, he regularly provides clinical training as clinical faculty for post-graduate education. A common part of his practice is providing expert witness testimony and independent medical examination services for both plaintiff and defense counsel on liability and industrial injury claims.

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