Establishing a Medical Protocol Presented By: Scott Hunter and Kelly Marino don’t just insure. BE SURE.

Establishing a Medical Protocol What is a medical protocol Steps to Implementing a Medical Protocol How to choose a doctor Talking to Physician Showing your job duties Setting up pharmacy protocol/programs Referrals Examples How Work comp is calculated How it helps both the company and AlaCOMP

What is a Medical Protocol? Medical protocol is a program that is setup by the employer to include: specific physician/doctor that is used in the case of an employee getting injured at work Pharmacy programs After hours physician or ER information You as an Employer have the right in Alabama to choose your doctor – sometimes this is forgotten Beneficial to the employee and the company

STEPS to Implement a Medical Protocol Picking a Doctor AlaCOMP can provide a list of recommended physicians Well-known in the community Trusted practice Established Similar hours

STEPS to Implement a Medical Protocol Visiting Physicians Office Set up a day and time to visit the office and the doctor(s) Tour the facility Meet and converse with doctor(s) Ask Questions: Patient protocol Drug Testing Meet Staff (specifically who you may be dealing with) Discuss prescription protocols Discuss Pharmacy Programs (i.e. Carlisle Medical) Discuss referrals/specialist

STEPS to Implement a Medical Protocol Visit to your facility Set up a day and time for the doctor(s) to visit your facility Give them a tour the facility Show them job duties Discuss possible injuries, past injuries, etc.

STEPS to Implement a Medical Protocol ABC, LLC MEDICAL PROTOCOL FOR WORKERS COMPENSATION INJURIES   REPORT INJURY TO: Company: ABC, LLC Phone: (123) 456-7890 Contact Person: John Doe TREATING PHYSICIAN: Doctors Office Dr. Greene 123 Apple Street Any city, AL 12345 (444) 444-4444 EMERGENCY ROOM: Weekends or night shift (where treating physician’s office is closed) ABC Hospital 5555 Office Way No City, AL 67890 (098) 765-4321 ER personnel are authorized to treat emergencies regarding the above referenced cases. In the event further treatment is necessary, the ER physician shall refer the employee back to the designated treating physician. The ER Personnel has the authority to issue enough prescription drugs to last until the next business day. Then, the emergency room physicians should instruct the employee to go back to the designated treating physician for any further prescriptions. The intent is to have all prescription management handled by one doctor. PRESCRIPTIONS The authorized treating physician shall prescribe generic drugs on prescriptions when available. Prescription cards are available through your adjuster. AlaCOMP RX Program: Once the authorized treating physician writes the prescription, the injured worker may take the prescription to the pharmacy of choice. Have the pharmacy call AlaCOMP/Business Insurance Group at (888)661-7119 to obtain authorization from the assigned claims adjuster. The injured worker can pay for the initial prescription(s) and can be reimbursed after a copy of the pharmacy receipt is submitted (to include name of medication, quantity, and prescribing physician). Medical Protocol in place Discuss the medical protocol with employees RX Pharmacy Program Discuss the Medical Treatment Declination Form Post Medical protocol information for Employees

STEPS to Implement a Medical Protocol (COMPANY NAME) MEMORANDUM TO: (Employee) FROM: Human Resource Department DATE: (Date) RE: Workers’ Compensation Medical Protocol Dear Employee: The following is the established medical protocol for workers’ compensation injuries that occur during the day and night shifts or on the weekends that are not life threatening or do not involve serious bodily injuries. Mandatory Notice: You must report all incidences of injury to your supervisor immediately. Daytime workers’ compensation accidents: Report to treating physician’s office. **Physician Name & Address** **Physician Telephone Number**   Nighttime/Weekend workers’ compensation accidents: Report to treating physician. If their office is closed, then report to Emergency Room **ER Facility Name & Address** **ER Phone Number** Emergency Needs during any shift: First report to treating physician’s office unless closed. If closed, report to ER Facility. Failure to report to the above listed medical providers may jeopardize your workers’ compensation benefits. Prior authorization must be received whenever possible. If you have any questions please contact your HR Department. Thanks, Bob Smith ABC, LLC Medical Protocol in place Letter to all Employees implementing the medical protocol

Comparison of Companies Company A (No Medical Protocol) Company B (medical Protocol in place) Worker was injured during normal business hours. Company had no medical protocol setup for employees to follow. Employee choose to use the ER and a family physician. 4 Visits for injury Time lost at work Worker was injured during normal business hours. Company setup a protocol for employees when injured on the job. Employee followed the medical protocol and went to the doctor that the company chose. 4 Visits for injury Had the option of light duty work No time lost at work These are all approximate cost and are to show the difference in having a medical protocol versus not

Comparison of Companies: difference between claim cost Company A (No Medical Protocol) Company B (medical Protocol in place) 1st Visit: ER: $3,836.19 2nd Visit: Family Doctor: $160.96 3rd Visit: ER: $352.06 4th Visit: Family Doctor: $179.38 Indemnity payment: $231.27 TOTAL: $4,759.86 1st Visit: Doctor’s Office: $152.71 2nd Visit: Doctor’s Office: $60.00 3rd Visit: Doctor’s Office: $68.52 4th Visit: Doctor’s Office: $68.52 TOTAL: $349.75 These are all approximate cost and are to show the difference in having a medical protocl versus not

How work comp is calculated Frequent losses often result in the occurrence in several loss Experience Mod: Calculated from the most 3 recent years More occurrences of losses is typically worse than one large loss Work Comp: Based on payroll, rates, losses and experience mod These are all approximate cost and are to show the difference in having a medical protocl versus not

Comparison of Companies How Losses Effect Experience Mod Company A (No Medical Protocol) Company B (medical Protocol in place) 2015 Losses: $10,000 2016 Losses: $9,000 2017 Losses: $9,000 Experience Mod: 1.17 2015 Losses: $7,000 2016 Losses: $6,000 2017 Losses: $6,000 Experience Mod: 1.09 Company A has an 8% increase over Company B These are all approximate cost and are to show the difference in having a medical protocl versus not

Why A Medical Protocol Helps everyone How it helps the insured Saves time and money One point of contact for injured employees Someone looking out for the employers and employees best interest Helps get injured employee back to work (even light duty) Provides RX programs to help injured employee getting prescriptions Reduce workers’ comp cost Helps keep a lower experience mod How it helps the workers comp company Reduces medical cost Reduces doctors offices to deal with Overall helps reduce workers’ comp to insured

RECAP What is a Medical Protocol What’s the first step to set up a Medical Protocol Why set up a Medical Protocol Taking the time in the beginning to set up a Medical Protocol can save you money in the end and overtime!

QUESTIONS & ANSWERS If you have any questions or need help setting up a MEDICAL PROTCOL please contact: Scott: scott@alalcompins.com Jim: jim@alacompins.com 334-215-8234