Episode #33 - Areas of Opportunity in the IME Process

What issues in the IME process is technology poised to solve?

  • 00:10:11 - 05:10:11

    Jerrod Bailey 00:00

    What do you wish the attorneys would do differently in the process?


    Michael Compton 00:04

    You know, unfortunately, in all offices, there's turnover. And when somebody leaves an office, sometimes they need that, for that case manager or attorney or an individual is not properly forwarded to who's picking up, who's picking up that work. And that can be quite frustrating, because we're emailing and wondering, Well, why don't we get a response? And then we call we're like, hey, so and so hasn't responded to us? And will they be gone for two months? Okay, that would have been good.



    You know, that their email is still active. And oh, there's no auto responder,


    Michael Compton 00:44

    responder has been fed. So I think you know, having some sort of universal platform, or even a portal or some mechanism of communication.


    Jerrod Bailey 00:59

    All right. Welcome, everyone to reimagining healthcare, a new dialogue with risk and patient safety leaders presented by Medplace. 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 Medplace.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 Compton, the founder of renew health. Welcome, Michael. Hello, thank


    Michael Compton 01:52

    you for having me.


    Jerrod Bailey 01:53

    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. Yes. And 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 claims. What advice would you give to your younger self, if you were talking about going into this line of work the other the other clinicians out there that have thought about it done a little bit of that maybe haven't quite jumped all the way in?


    Michael Compton 03:01

    Yeah, with IME and expert work, I think it's important just to have some formal training, just to get a global perspective of how to do the work. And early, early on, it can be quite daunting, because you're creating your, your your workflow. And if you don't know, some of the workflow that you're going to sort of need that can give you more gray hairs than you want earlier. So I think reaching out to organizations that offer formalized training for independent medical examination work and expert work. And even just the potential even some of the state associations offer those types of services, networking with other doctors that do this type of work, sharing templates and horror stories and experiences and talking with the attorneys and the nurse case managers. I think if I was coming out of school or looking if I was just doing clinical treatment and looking to transition or grow an expert practice, that's where I would focus the vast majority of my attention.



    Yeah, cuz advice.


    Jerrod Bailey 04:19

    It's good advice. What do you wish the attorneys would do differently in the process? I'm sure many of them facilitate some great work and then I'm sure fall into some bad habits and


    Michael Compton 04:30

    communication that I think is a really difficult thing. Or my practice, we have a really robust back end that has multiple case managers and redundancies built into the system. But we have oftentimes difficulty communicating with the law office is the message, send a message and say, Hey, this is what your client is in need of. We're having difficulty getting authorization for whatever the situation may be, we need to know certain things we need to know is the claim accepted? Is liability, accepting his or partial liabilities or split? What's the deal? Do they know somebody that we don't? So communication, I think would be if that was more streamlined. That would be fantastic. The other thing is that unfortunately, in all offices, there's turnover. And when somebody leaves an office, sometimes the, the, for that case manager, or attorney or individual is not properly forwarded to who's picking up, who's picking up that work. And that can be quite frustrating, because we're emailing and wondering, Well, why don't we get a response? And then we call, we're like, hey, so and so hasn't responded to us? And will they be gone for two months? Okay, that would have been good to know that their email is



    still active, and oh, there's no auto responder,


    Michael Compton 06:04

    responder has been bad. So I think having some sort of universal platform, or even a portal or some mechanism of communication a lot of attorneys offices use, like file vine, as an example, for case management and recording all your emails something like that, that allows for a centralized location of the communication log of what's going on. So anybody can sort of pick up the slack when they when they open that file and say, Oh, looks like they're waiting on this or this or No, I did receive those records. And they're right here. And so I think that's, that's quite frustrating. We've had


    Jerrod Bailey 06:45

    the irony, is we hear the same thing on the other side, right? So yes, the attorneys like Boy, those these physicians just had, where they could be more responsive. You know, it's funny how the same problem is on both sides. And it it's really, I mean, it's from a technology perspective, it's a pretty basic problem to solve. Right. It's a work issue. And so there's, there's the technology exists to make life easier. I think it's, I think there's probably more some structural issues in the system, probably that that are contributing to it as well. But at the end of the day, I think we'll get there. We're doing


    Michael Compton 07:26

    it says, it's always a process where I was trying to poke holes in our own bag to see where we can improve. And our whole back end is undergoing Oh, complete revamping of our case management system to help remove some of the things that you know, I said about the communication and having everything centralized.


    Jerrod Bailey 07:46

    Yeah. Well, that's a good segue. I mean, you, you and your practice are relatively embracive of technology, right? And cues have a reputation for it across the board. So I think you're clinically in other places, what are you what are you dabbling in? What are you interested in? What are you using? Generally, or specifically from a technology perspective?


    Michael Compton 08:08

    Yeah, so I can categorize that a little bit more so for prostate skeletal technology and for rehabilitation and pain treatment. We're using a lot of laser therapy now and that it's been really helpful for people to recover faster, patients like it feels good. The recover significantly faster for certain types of injuries. And the if I had to pick one tool, though, for musculoskeletal management, it would be Shockwave, by far. It has so much utility, it not only musculoskeletal management, but you can use it for neuropathy. You can use it for



    calcified what is it I'm not familiar with? Shockwave


    Michael Compton 08:59

    is the best way I can describe it is like lithotripsy is high energy focused ultrasound therapy that flows a pressure wave a focused pressure wave of energy, and it will upregulate stem cell production locally in the stock of your own stem cells, endogenous stem cells improves vascularity it breaks down scar tissue. It helps break down calcium deposits. Another way to sort of describe it or sort of appreciate what I'm saying is everybody has like a product not somewhere in their neck, their middle back somewhere, right? And


    Jerrod Bailey 09:38

    you just made me aware of mine right now. So


    Michael Compton 09:41

    everybody has one or two or three, and then you go and you get a massage and they find that spot and you're like oh right there you found it makes the bleed type of it's a good hurt type of situation. And shockwave will help to reduce the tone and restriction within the muscle, and I've been using that now for three years, in my practice, all of our offices have shock wave, we'll never not have a shock wave unit in our practice. And I'd say that the I used to do a lot of trigger point injections. And I really don't even do them anymore. I mean, occasionally I'll do it sharp is so effective. And you can cover such a broader area in a very short period of time and have virtually no risk versus amazing rejection. And patients really like it, you feel immediate improvement bands. And it's just, it's fantastic. There's some other applications that are just fun, like cosmetically, it helps improve blood flow to superficial tissues. So you can do some other things with it.


    Jerrod Bailey 10:50

    Make me look younger, also, maybe,


    Michael Compton 10:52

    yeah, right. Every Age has one.


    Jerrod Bailey 10:54

    That's impressive, that sounds that you're describing. And I'm like, Oh, wonderful, you get that. And this isn't even a paid endorsement to that's, that's great. Yeah.


    Michael Compton 11:05

    And then, in our neurological world, where we do a lot of head injury work in our practice, and we use video, nest egg, Agra fee or the NG, we have a computerized posturography device that interfaces with virtual reality. So we can recreate a trauma, for example, a car accident and recreate a car accident with that individual back into that scene. If they have motion sensitivity, or dizziness or imbalance, we can put them on a device, either with or without virtual reality, and stabilize the platform that they stay that they're standing on and or destabilize it to improve their balance. And we do a lot of computerized neurological rehabilitation. Because one I want to know like, what does the data show on that into for tracking purposes? For some of these, these cases, it's really easy to say and you know, have a handwritten form that they did these types of exercises, but are they improving with those exercises, are they not improving, so the computerized systems I think are going to become cheaper and more readily available, and there'll be different spin offs of various applications that can be used. For those.


    Another device that we're we use currently is the device that goes on their head, it's sort of looks like just a little cap and it has some sensors in it, it allows us to check their range of motion in minutes records it gives us a graphic of every day versus using a goniometer or visual assessment and we can just put the device on and say you know move your head you know right rotation, left rotation flexion extension, lateral bending, pops the information right for their chart, and that took one minute or less as fast as they can move as fast as it will record it.


    And the those types of applications also have home therapy programs that will say well, you have right rotation restriction you have this or that type of situation. Lets allows the clinician to prescribe various exercises that the patient can go into their own portal and say, Okay, well, here's my home. Go about their, their exercise routine. That's what we've been doing a lot with a lot of the neurological stuff. There's no cognitive rehabilitation strategies that have the same computerized neurocognitive assessments, home applications that they can work on their neuro cognitive rehabilitation exercises, the stimulator rehabilitation exercises at home, that are all similar in the concept of the patient has a portal associated with a unique technology piece. Unfortunately, sometimes they have to have multiple portals because they're different companies. Yeah. Portals.


    Jerrod Bailey 14:04

    Nobody's made the middleware yet to kind of bring them all together. Yeah. Yeah.


    Michael Compton 14:08

    But that's, that's where we've focused a lot of our energy in, try to stay up on all of the latest, but the technologies are always changing. It's hard to implement the latest and greatest because these things can be also cost prohibitive.


    Jerrod Bailey 14:26

    Yeah. Okay. Ai, which side of the fence are you on? There's a number more than an opportunity more of a threat or hasn't even touched your industry.



    So, yeah, we've


    Michael Compton 14:36

    been using it we use Office 365 a fair bit, and we've been interfacing a lot with some of the automation tools and AI features that can be programmed into office 365. And so we haven't, I mean, I've been dabbling with the chat GPT a little bit, and that's the only one that I really use outside of Some of the features within suite 365, that can allow for automation, more so than the artificial intelligence aspect, but I think it has its role for sure. And then you'll be interesting to see how that sort of comes involved in our healthcare practice. One feature that we're working on that one of the surgeons that I work with, we're working on an AI technology right now, that will allow the CRM to map the body part that we're working on, it's for repeated application. So if there's a fracture of risks, we can have the CRM kick in X ray, and then reposition itself to give us the best view of the type of view that we're looking at. So we're running some studies right now on that. And that's using both infrared technology. And the X ray technology to rebuild inside the computer, the part of the body part, I think, give us a better film. So we sort of modeled some of this technology out of joint replacement surgery, and some of the robots that are using joint replacement that we use, but more for X ray for fracture care. That way, we don't have to reposition the patient or what have you, the machine will just move to give us the image that we need better image. So that's in the early phases, but we're


    Jerrod Bailey 16:30

    working on it. It's not amazing. It's like AI just hit this year. And I know it's it made promises 10 years ago, and it didn't deliver on and then all sudden it started deliver. And this year is just everywhere. I mean, we used it too recently, because you know, we have to be able to show our software to different folks, and you can't use real people. And so we want to chat GPT and edit rights in mind. So Miami reports for us. Nailed it. Yeah. Now, if you dig into it, the accuracy wasn't there. But just in terms of its raw abilities, be able to do things like that you can imagine that physician who is just getting into something like I mean, they don't know, yeah, there's this, there's certain things you can say and can't say, in these reports and other things, right, it's just other things are no fly zones, and things that are helpful, that make it useful, right to everyone in the process. But you wouldn't know that coming straight into it with no training. But you can imagine AI being able to QC reports coming through and being able to help much more quickly reinforce and give feedback back to the physician of how they can they can deliver as much value in that process as possible. Right. So I think those things are super interesting. I think, when you look at a lot of the things you were talking about the waiting in the authorizations, and there's so much opportunity for AI to help bridge two groups together to be able to find a position that that's available now that can provide feedback and authorization on things. There's using AI to digest medical records much more efficiently so that I'm not requiring a doctor to spend six hours combing through it just an organized rat's nest of records kind of thing. So there's a lot of opportunity there. I think that we'll see. It's happening now in this space. And I think even with us a year from now, you're going to see a lot of I just think natural efficiency.


    Michael Compton 18:29

    Yeah, that's interesting. Yeah, I think the vast majority of well, I know the vast majority of my time and dealing with my amazing expert, what is the record to review? Sometimes, you get a file that's completely unorganized, not categorized not indexed. And that's in theory, something that a computer could do it even potentially, that the records review and pull the highlights from the records and organize it into a concise fashion.


    Jerrod Bailey 19:03

    Now, what if there were key words that you knew are important? And I could just help surface? Right? Yeah, you could you could look through 10,000 pages and miss that needle in the haystack. Right? Whereas if you had AI as an assistant, then it just helps surface those important details faster. So I don't I'm excited about the future. I think it can't get any worse than what we've been through over the last 10 years. I come from other industries where when I see things like fax still used on a regular basis and healthcare makes you scratch the head a little bit, but I think I think we're entering kind of the 2.0 era of a lot of this type of work. Well, I'd say what this was pretty interesting. Anything else that you think I missed in this conversation?



    I don't know. No, nothing that I


    Michael Compton 19:54

    have specifically to add. I think you're right. I think AI is going to be a big part of our Future. And there's a lot of applications that are that are coming out and maybe seems a little bit even daunting because there's so many applications. But I think that will help streamline a lot of processes and help build in redundancies, so their workflow can move faster, and


    Jerrod Bailey 20:21

    it can get these workers back to work and get get the care deliver the way it should be. And I think there's some really, really great benefits on the other side of all of it.



    Yeah, absolutely. That


    Jerrod Bailey 20:33

    Well, Dr. Robin, this was super interesting for me, thanks for making the time. How do people find you if they listening and they



    can go to the our website


    Michael Compton 20:45

    or contact the office at 480-681-7979. And I can be reached directly through the office if needed.


    Jerrod Bailey 20:53

    Great. And we'll put this information also in the show notes, especially the website so people can find you that way. In the meantime, thanks for thanks for making the time with


    Michael Compton 21:01

    1. Absolutely. Thanks for having me.


    Jerrod Bailey 21:04

    Absolutely. For everyone else. Thanks for listening to reimagining healthcare in new dialogue with risk and patient safety leaders. Subscribe and Share if you found invaluable and if you'd like to participate as a guest. Again, just email us at speakers at Medplace.com. Make sure to follow Michael and connect with him. Will again put your information in the show notes but this was great. Thanks for walking me through it.


    Michael Compton 21:26

    Absolutely. Thank you

What can we improve in the IME process?

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 advice for medical professionals entering the medical-legal world based on his experiences.

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


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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