While most of Colorado's residents reside in major cities, approximately one-sixth of the population lives in rural communities. Doctors practicing in the state's rural communities face a unique set of challenges, including how to deal with treating workers' compensation patients.
“Patients and employers typically think workers' compensation medicine is simply regular medicine delivered to an injured worker,” says Dr. Tom Denberg, senior medical director for Pinnacol Assurance. “But in fact, workers’ compensation treatment is very different.”
Primary care medicine is like an open-ended relationship in which a provider gets to know the patient’s health over time. Workers’ compensation medicine, however, focuses on treating a specific injury, helping patients recover quickly and getting them back to work.
Dr. Denberg explains that in workers’ compensation medicine, the provider is an advocate for both the injured worker as well as the employer. “It can be a delicate balancing act, as one must be fair to all parties.”
Some of the top workers’ compensation issues for rural providers are:
- Effectively separating workers’ compensation medicine from primary care treatment.
- Limited access to specialists, from surgeons and occupational health experts to mental health professionals and specially trained providers who perform impairment ratings.
- Low volumes of workers’ compensation cases, making it difficult to acquire the skills and experience needed to understand the system and its rules and guidelines.
Mitigating rural challenges
According to Dr. Denberg, there are ways to mitigate some of these challenges. First, it is important to set expectations. During the initial visit, the physician should have a candid conversation with the patient to clearly explain how their relationship and treatment will be different than regular primary care. It is key that the provider be transparent about how the employer will also be “kept in the loop.”
If the primary care doctor is not comfortable treating a longtime patient with a work-related injury, Dr. Denberg suggests referring the patient to a colleague in the practice.
A unique challenge is knowing how to have conversations with patients as soon as they reach “maximum medical improvement.” This can be especially difficult in smaller communities where relationship networks are often tighter. For example, the doctor’s and patient’s children might attend the same school. The Division of Workers’ Compensation has produced an educational video with some helpful pointers on this topic.
Tapping into Pinnacol’s resources
The team at Pinnacol Assurance is available to help rural providers. For example, when a doctor believes an injured worker can perform modified duties at work, which can lead to a speedier recovery, but the patient is not working at all, the doctor can contact Pinnacol’s Return to Work Department. The company’s return to work specialists can act as an intermediary between the patient and the employer in order to help return a patient to a transitional job, while still keeping the doctor in the loop. Pinnacol’s Return to Work department can be reached at 303.361.4798.
Separately, Pinnacol’s provider relations specialists and medical director conduct on-site provider visits to offer personal, one-on-one support for physicians and their staff. This type of high-touch, face-to-face service is unique to Pinnacol.
Sally Parkinson, who has worked with Pinnacol for 18 years, is one of the provider relations specialists. She is a member of a team that visits approximately 24 providers each month, including doctors in rural Colorado.
“We try to see all of our designated providers, no matter where they are,” said Parkinson. “And if rural doctors are having issues or problems, we will visit them more often. The face-to-face meeting is a good way to build relationships and partnerships.”
The provider relations specialists provide valuable educational training, answer questions and help solve problems.
“It’s really helpful for us to be out there to show them (rural providers) that we are there to support them,” adds Parkinson. “We let them know that we really appreciate what they do.”
Practicing in the rural medicine frontier
Some 13 years ago, Dr. Adam Mackintosh, DO, relocated to rural Colorado because he wanted to be in a community where he could meet a need. He practices family medicine at Banner Health in Sterling, CO, which is located about two hours from Denver. It’s a small municipality with a population of approximately 15,000 residents.
“Rural family medicine is one of the last frontiers that gives you the ability to practice diverse care,” says Dr. Mackintosh. “I assist patients in the healing process at all stages of their health, from infancy through the senior years.”
“Workers’ comp is not a gigantic part of my practice, but it is something that I do,” explains Dr. Mackintosh. “It’s a different field … you put on a different hat ... you have a different set of rules that you must play with.”
Recently, Pinnacol hosted a luncheon at the Banner Health clinic in Sterling to meet with the doctors and staff.
“They provided educational materials on workers’ compensation, information on how to handle it and detailed some best practices,” says Dr. Mackintosh. “Pinnacol has been very helpful in that way.”