Hi, everybody. I'm Dr. Jeff Jacobs. We're at the session on the ACOM Presidential Task Force on Clinic Quality and Credentialing. I see there's a lot of credentialing groupies here, so rock on. You could have been seeing Natalie two doors down, and I really appreciate it. I've been going head-to-head against her all day, and I can't win. I can't win. So anyway, do you guys want to introduce yourselves, Manny, starting with you? Sure. Thank you. Manny Berenji from VA Long Beach Healthcare System, UC Irvine Schools of Medicine and Public Health. Hi, everyone. David Corretto, Medical Director for Sutter Health in Northern California, EHS Services. Dennis Schultz, Occupational Physician with the Ascension Medical Group out of Milwaukee, Wisconsin. And I'm Jeff Jacobs. I'm the Chair of the Presidential Task Force, and I'm with Work Care. So the objectives, we're going to give you some information about accreditation bodies. We're going to talk a little bit about telemedicine, and we're going to give you some idea of what we've come to label clinics of excellence. And I don't know if they're asking people to do this anymore, but you guys don't have any disclosures, right? Yes. What, see no evil, hear no evil? Yeah. Okay. So in the summer of 2021, we were given these task force charges. We were asked to recognize quality in clinics that provide occupational medicine services, to provide an opportunity for clinics to improve themselves, but also give them a roadmap for how they could do that. We wanted to increase the brand awareness of ACOM and occupational medicine providers and to develop a new revenue stream for ACOM. I think the bottom one may be tough to achieve, but I think we've done a decent job so far in accomplishing the first three. So I want to thank all the task force members who contributed a lot of time, and their names are all here, but I wanted to really single out Julie Warding. Thanks so much. Most of the time when I've dealt with staff before, it's usually to complain. And maybe that's what you get a lot, Julie, but you totally kicked ass. Thank you. So we started this process off with listening sessions with insurers, payers, employers, clinics and clinicians, the military, third-party administrators, onsite clinics, medical center, occupational health, and telemedicine. And I'll go over what the content was. So we divided it into three topic areas, and that's the OEM provider and ACOM branding and marketing. And some of those issues are operational in nature, the scope of services, what's offered, medical record quality, communication between both the injured employee and the employer, and the payer as well, insurance companies, scheduling, timeliness of reports, patient satisfaction, and benchmarking versus other clinics. I'll tell you, as working for a TPA, we're really seeing a lot of pain from the employers that there's just so many opportunities for the employers to go, for employee's perspective applicants to go elsewhere. And if it's taking the clinics more time to just schedule, and then also to complete the exams, the employees, unfortunately for our employers, are going elsewhere. So that's a real pain point. As far as the quality roadmap, we broke it down into pain points and successes. And if you'll notice, we included operational issues like access and timeliness, service-related issues, medical quality issues and outcomes. Most of the employer group really was concerned with causation, determination, and work-relatedness. And then cost, that a lot of employers, as I recall, were a little upset at the churn of injured workers. But there are also successes as well. The clinics that had better management and accountability. I've always told the docs that I've worked with, call the employer, call the payer, because so few docs do that you just stand out. And the employers really appreciate that. Plus, if you're calling an insurance adjuster, you're getting valuable information, but you're also imparting valuable information as well. And then other things, the medical quality issues, I found out about the Navy medical matrix. And if you don't know about it, there's, well actually I didn't put the URL address, but I think you just Google, right, medical matrix, Navy, and it pops up. It's amazing. Not only do you keep us safe, but you gave us that. Thank you. And then Dr. Harn, who snuck out of here, I don't see him here, but we got some information about his organization in the UK. And then telemedicine, both employee and employer satisfaction, quality of life, cost savings. And then finally, the evaluations and outcome management. And again, a lot of it has to do with staffing, scope of services, timeliness of reports, patient satisfaction, surveys. That actually, the hyperlink is an ACOM paper that David found that has an actual vetted survey that you may want to look at it for your clinic. And then other medical quality issues, communication, disability management, adheres to guidelines, average lost time, days, et cetera, et cetera. And then cost, looking at billing versus reimbursement and telemedicine versus in-person visits. So the goals, that was the first year. The goals in year two were to develop some type of value-based evaluation tool. We tried to use the framework of the triple aim. So we're looking at patient satisfaction, outcomes, and cost. There were other things that we did look at, like a star system or a scorecard based on multiple factors, like the OEM board certification, the breadth of exams that you do, DOT exams, U.S. Coast Guard, FAA, et cetera, consulting, injury care. And then I've always said you really have to make a choice with your wallets. It's nice to have convenience, that the clinic is there where the workers are. But if they're not providing you good service, you can complain. But the only thing I found that the clinics understand, lesser performing clinics, is to take your business elsewhere. And then as far as the revenue stream, like I said, I don't know how this is going to shake out, whether this is going to be a viable thing. I know we would probably need volunteers to do the audits, et cetera. And we might be cannibalizing the Corporate Health Achievement Award. So we'll see how that goes. So we broke it down into work groups for the second year of the realms of AHRQ health provision. And Dr. Berenji is going to be talking about that aspect as well. Thank you. All righty. Everyone still awake? That's great. Nobody's going to fall asleep. Might need to do some song and dance here. So I appreciate you all being here this afternoon. Telemedicine has been something that I've kind of just jumped right into, especially over the last few years. Just to give you all some perspective, in March of 2020, I was working at Boston Medical Center. I ran a successful work injury clinic within the Department of Orthopedics. It was my dream job. I loved working with the surgeons. And then all of a sudden, my clinic got shut down. And our entire practice converted to telehealth. Working in a safety net hospital in Boston, Massachusetts, where over 75% of your patients don't speak English, believe me, I ran into a lot of logistical challenges. So really, my goal today is to present the efforts that we made during the last few years to really enhance the platforms that we utilize for telemedicine and where do we envision things going forward. So I just kind of gave you a preview about my experience. A lot of us had to really just jump right in. We didn't have the platforms in place. We didn't have interpretive services in place. We didn't have the ability to issue respective work injury forms. I was in Massachusetts at the time. And believe me, it was a logistical nightmare. But I feel like we've learned a lot in the last three years. Wherever you happen to practice, I feel that a lot of the infrastructure that was developed is now something that we can continue to enhance. And I do feel that we're at a pivotal moment to be able to continue the work that we've already started. And really, to be able to continue to see employees in a virtual environment, meeting them where they are. A lot of times, these folks are working second, third shifts, being able to have a triage system in place and connecting these individuals to a certified occupational medicine provider is really the ideal. So, with respect to current applications in the post-pandemic era, I've envisioned these three buckets. So, large clinical practices where clearly they're still seeing folks in person, but using telemedicine as an adjunct to be able to continue to do the follow-up care. And also, for additional services, I do still see that there is utility in that. Insurance carriers. I know one of my colleagues, she's not here today, but she works at Corvall, and they've actually established this whole system where they can triage injured workers and they can disseminate that information to a provider who can do the injury care virtually. And there's actually a lot coming out in the literature on this. Employers have seen the utility of this. They find it very convenient for their respective employees, many of whom may be working in a virtual environment and they're not at a brick and mortar location. So, there is still a lot of opportunities to expand on a lot of the efforts that we've made in the last three years. So, I came up with these rules of engagement, if you will, and really to ensure that the injured worker-slash-employee has a pleasant experience throughout the entire telemedicine encounter. It really boils down to these four elements. The employee must be willing to participate. And I don't know about you all, but when I started doing the telemedicine in my practice at Boston, a lot of my patients just shut down. They couldn't communicate in this new media. So, really trying to identify the best way to communicate with your patients, perhaps having some sort of educational tool that they can use to understand the technology. I feel like this is not so much of a thing now, but clearly we need to continue to engage our patients, especially our non-English speaking patients. Secondly, really trying to utilize communication streams that are working properly. Clearly, there are a lot of things at play here. I know a lot of folks live in rural areas. Broadband service is still an issue, unfortunately, across many parts of the United States. But I'm hoping that with additional federal funding, broadband is going to be available to a lot of these folks, especially in rural areas. Thirdly, looking at the organization itself and making sure that we can maintain digital confidentiality. I know we've been talking a lot about digital privacy in the occupational health space and really being able to continue that in the telemedicine encounter is crucial. And lastly, the consultation must be able to be traceable and making sure that the data exchanges, the data transfer is done in such a way that we're protecting the employees of safeguarding the employees' information. So benefits of telemedicine, I feel it's a very useful tool. Patients can get expert care in a matter of moments. And especially, like I mentioned earlier, for second and third shift workers, it can come in really handy. And again, the folks who are living in rural areas who are working remotely, it's really nice to have this as an option for them. Limitations. So I ran into this firsthand when this came out at our medical center in Boston in 2020. I found it really difficult to do MSK exams. But there are now best practices from a variety of different health care organizations. I know Mayo Clinic has a really good MSK tool that I found very helpful in the initial stages of the pandemic when I had to follow up with my injured workers. So clearly there's a lot happening in this space. And as I mentioned earlier, connectivity issues, broadband issues, unfortunately that is still happening. But I feel that there's a lot happening nationwide to continue to push for good broadband for all people. And then lastly, digital interface issues. So depending on the health care organization that you happen to work for, it's really important to have a good IT infrastructure and making sure that there are no glitches in the system. So I'm just going to kind of relay what I've been doing the last couple of years. I've had the great fortune of meeting Jeff. And honestly, he's been a great advocate for this whole project. Sorry, my mom's not here. No, seriously, this man really tried to keep the momentum going on this telemedicine initiative. And really, if it wasn't for him, I feel that this project would have been dead in the water. And we're continuing to make inroads with other organizations. I recently have been able to connect with the AMA Vice President of Digital Health. And she is very interested in partnering with us to be able to advance some of our objectives, occupational health, engaging with employers, developing use cases. This is just a reference to the digital health research survey that the AMA came out with. And clearly, there is a desire to expand these digital offerings. So reimbursement. I know this is a big sticking point for a lot of us. As you all know, the public health emergency for COVID is going to be expiring next month. And unfortunately, some of the reimbursements and the reimbursement parity, I should say, is going to be coming off as well. So 2024 on, virtual visits will not be paid at the same rate as an in-person visit. So clearly, this is a major problem. And we really need to engage our lawmakers to ensure that there is going to be continuous parity for a virtual visit as well as an in-person visit. So the future of telemedicine that I envision is incorporating digital apps to obtain more quantitative information. Clearly, there's a lot happening in the remote patient monitoring space. And being able to incorporate some of that technology into occupational health delivery, to me, is something that we really need to be on the forefront of. AI, I know that's another big topic in a variety of different spaces in the insurance industry. Occupational health clearly has a lot to learn. And hopefully, we can incorporate some of these technologies in our telemedicine offerings. And then last but not least, this is just a plug for my upcoming presentation on Tuesday, where we'll be talking about Mediverse. So stay tuned. A lot happening. It's really exciting. Thanks. All right. So I'm going to be talking about the work that we did with the clinic quality subgroup. So as a recap, this was part of the presidential task force led by Dr. Jacobs. And in the first year, we had interviews with various stakeholders across the workers' compensation landscape. We met with employers, insurance carriers, TPAs. No, I'm blanking on them. But clinicians and clinics. Individual clinics, clinicians. Insurers, did you say? Yeah. So basically, all of those that have a role in the delivery of care and in promoting quality within the system. And so in year two, when this subgroup came together, we really focused around the question, what defines quality for occupational medicine? It's a pretty big question. And so we had a lot of help. And I'd actually like those that are here, if you could just stand up. Our subgroup members were Mark Taylor, Bob Bourgeois, Rupali Das, Ross Mullinax, Jeff, myself, and Julie Orting. And as you notice, we tried to make sure that we were representative of occupational medicine practice. You'll notice we have people with multispecialty group practice, private practice, solo practice, insurance carriers, and with health systems. And all of us really were charged to define, what does this question of quality with an occupational clinical practice mean? And so we wanted to start with a review of the literature, as we do when we're trying to seek more information. First, we wanted to start with the ACOM Core Competencies document in 2021. I can't say it enough. This is an excellent document that breaks down occupational and environmental medicine into 10 competencies. And within this document, it talks about the core. So what all of us who perform as either physicians or providers in occupational medicine should know how to do, and then aspirational. What are those other skill sets that folks may want to take an extra interest in or develop for their own practice? And we really use this to kind of help us understand the work that a clinic might perform in occupational and environmental medicine. We also looked at other tools that ACOM has developed over time. The big one being the Corporate Health Achievement Award. We understand that it's not entirely translatable to a clinic, but we felt that it gave a great scorecard that we could use as we were starting to think about how to measure quality in an auditable fashion. Around the way, we met with Dennis Schultz, who will be discussing AAAHC with us in a moment. And in there, there is a small section on occupational health, but also within there, they talk about what is the measures of quality for spirometry, travel medicine, immunizations, lab testing. And we felt that that was a great model at which to benchmark some of these things against. And then lastly, we had found, which Dennis was a part of in 1998, a founding document that ACOM created around occupational medicine clinic quality. And once we found this about midway through the year, it was great because it had done a lot of the work already for us. It was really at that point, updating and bringing it into kind of the contemporary nature of where we are now with the field. And so, having done this lit review, what was our next steps? Well, we wanted to identify what were the service lines that any occupational and environmental medicine clinic might be able to provide. And we'll show those on the next slide. We then wanted to make sure that we were reaching out to our subject matter experts within the college, and we identified them, and many of them are here as well. And with them, we posed three questions. One, what are five to 10 things that clinics should be doing to promote quality in this area? But then we wanted to find quality around process measures and outcome measures. What are those process measures that put into place support quality and good practice versus what are those outcome measures? What are those things that can be auditable that we could show to an employer or an insurance carrier that this clinic really sets themselves apart from someone else? And we'll get into that part of the discussion a little bit later as well. From this, we drafted a checklist modeled on the AAAHC format, and it's a really clear format on how they provide the description for each service line. First, there's a paragraph that is kind of the why this is important. So, it defines the service with a sentence or two of why this is important to promote quality. And then within it, in a bulleted checklist, it lays out these are the steps that you should be thinking about from a process standpoint, with at the end discussing outcome measures where they do apply. And then also we provided reference for these documents as well. And again, as a committee, we were really charged with really thinking deeply about process versus end outcome measures. And so what were those service lines? We looked at hearing conservation, spirometry, point-of-care testing or lab testing, on-site imaging, MRO or substance abuse program management, immunizations, travel medicine, independent medical examinations, workers' comp injury care, this was a big bucket, wellness programs, and then its own topic was specialty examinations, which we'll hold on for right now. So who did we reach out for these various things? So just want to call out Raul Mirza for hearing conservation, Mary Townsend, Danish Sulz for lab testing, Youssef Syed in the pain management section for on-site imaging, our MRO section and Kristen Pasnack at MROCC, Kristen Syed at the Duke travel medicine program, they have an excellent program, which I can speak to if there's questions later, Doug Martin for IMEs. For injury care, we spoke to Kurt Hegman, Jennifer Christian, Catherine Miller, and Richard Pauly-Doss. Wellness programs, Sanjita Kushak. When we looked at specialty programs, we broke them up into certifications, FMCSA, FAA, RAIL, Maritime, Oil and Gas UK, Commercial Divers, OSHA Surveillance, Law Enforcement, and FPA, and you'll see some of our esteemed colleagues in the college that were able to opine on these. Catherine Fagan here was very helpful for OSHA Surveillance along with Paul Papenak, Tony Allman and Bob Bourgeois for Commercial Divers, Eric Schaub and Bob Bourgeois for Maritime Medicine, Laura Gillis for RAIL, David O'Brien for FAA, and of course Danny Sammo and Fabrice Cernacki for Law Enforcement and NFPA. And so at the end of this, we were able to come up with, and they're still in rough draft form, unfortunately they are not ready for go live at the time of this presentation, but we created documents for all 12 of these service lines in the style of AAAHC, which is that introductional paragraph with process metrics and where applicable the outcome metrics. What we found through this process is that process measures predominate. And while they are indirect, they support efficient systems for clinics to deliver quality and defined services. And I really want to credit Ross and our Navy colleagues for emphasizing this piece that it's really hard to get outcome measures for a lot of this type of work, but if you set up the system to allow our physicians and providers to succeed, then you know that at the end, you might have a chance at really defining and presenting the quality of your clinic. Also there's the recognition that there's other certifying bodies that have done a lot of this work for us, and so where applicable, maybe an MRO certification stands as that measure of quality. Same with FDOT, FAA, Oil and Gas UK, and CAOC for hearing conservation, among others, and there's many out there. Where we are next as we finalize these documents is we are generating SMART goals for those without certification. So where the certifying bodies do not exist, we really want to think mindfully about what those KPIs, key performance indicators, or SMART goals might be for a clinic. And that's the work that's ongoing at this moment. But this really speaks to the broader question of how could this subgroup work be used? And as I think about this, it really is on a continuum, and I'm presenting that continuum here. On what would be your left side, we have reference on the ACOM website. So something that if a clinic or an individual wanted to learn more about, they could just look this up and say, you know, ACOM thinks this is good. This is what we should be doing in our clinic. Could this develop into potential centers of excellence for those clinics that actually have put these process measures in place and have a way to objectively measure the work that they do? Could this lead into certification or credentialing? Or the highest bar here is accreditation. And I think it's important to call out that there is a semantic difference when you look at the difference between certification, credentialing, and accreditation. And as you'll see on the arrow at the bottom, this requires increased collaboration with other entities and potentially increased work in terms of staff time, ACOM time, and discussion with these other entities. For example, it could be AAA AHC. So I'm going to leave it at that in terms of how are we thinking about this work? How should it be used? How could it be used? And we want to hear more about your thoughts in the Q&A session. Thank you. Very well done. So the title here is AAA AHC and Occupational Health Accreditation, but what it really should be, that's the wrong title, is ACOM Deja Vu All Over Again. Go backwards 25 years or so. Leadership in ACOM was looking for ways to promote, identify, and recognize quality in clinical practice and clinics. What'd they do? They developed, they assigned a task force. That task force was charged with creating guidelines and standards which could be used for some program and recognition. They weren't sure exactly what at the time. In addition, they joined an organization called AAA AHC, which is the Accreditation Association for Ambulatory Healthcare, a relatively young accrediting body made up of a variety of organizations with like-wishes-minded approach. They wanted a peer-to-peer process that did quality, and they wanted to have input in how the standards were put together, and that was AAA AHC. So what happened? Well, I was the chair of the task force creating the guidelines, and what you're talking about is actually the, with the paragraph and the information, is actually ACOM's guidelines from 1998 that was put together by that task force. When you go to AAA AHC, they provide a little bit of information on top, but not as much, so our organization can take credit for that. But by the time those guidelines came about, leadership had sort of moved in a different direction. There wasn't the interest, so they adopted it, but nothing happened to it whatsoever. They weren't updated until now, and this is very, very exciting. And then what about on the AAA AHC side? Well, they were able to send a board member to AAA AHC, because that's what happens if you pay to be a member of the organization. I got to be that board member as well. And some, but not very many, member orgs went through the accreditation process. So ACOM decided it really wasn't worth it, and they dropped out. I did not. So when I'm not doing my occupational health practice, I'm still doing volunteer work for AAA AHC. But that's the background of it. And AAA AHCs are ACOM's heritage in their development of occupational health standards. And what happened is the standards that ACOM came up with were used to modify an occupational health chapter within AAA AHC. So with that, we're going to spend a little bit of time talking about AAA AHC and what's been happening in the past. AAA AHC is an accreditation organization that now has 6,600 different entities accredited. You might not have heard of any of them, but they're there. They represent a variety of different sort of niche organizations. There is surgical centers, so there are a lot of surgical centers that are accredited. There are some large practices. But a lot of it has to do with Indian health, community health, college health, federally funded programs, Coast Guard's in there, Department of Energy. So a lot of the Department of Energy facilities, and those are the pure occupational health, they're in there. And DOE was actually part of setting the standards way back when as well, as well as on-site clinics. And that's why I got, why I must have gotten involved is through the on-site clinics. It's just sort of happened that way. But the standards then are, they've got groups that constantly review the standards, update them annually. They've also got an extensive group of surveyors, because any AAHC accreditation will involve a survey going on-site and confirming that what the organization said they do, they truly do do. A lot, it's a large group of surveyors, but that's because many of them, like myself, are practicing in one way, shape, or form, and so don't have a lot of time, go do several a year, but that's about it. So one of the groups that has latched onto this process are ones that provide on-site clinics. And here's a partial listing of those. There's also a group called Pivot On-Site Innovations, which is pretty exclusively an occupational medicine provider, based on what I see on the website. All of these other ones may have gotten involved initially because of primary care, because that's largely what they do, but they've also accredited their occupational health clinics as well, or the occupational health that's going through the primary care clinic and blended clinics. Of them, Premise is the one that's probably most known. They also have a display booth in the vendor area. So if you want to find out a little bit about the process, and they've moved a number of their occupational health clinics into accreditation as well, if you want to find more about what it's like, what they do, and why, by all means, talk to them. So a little bit about the standards, because the standards, any time you're talking about some sort of a process, like what ACOM is, again, considering, or this, it all starts off with what are the standards? Are they worth working towards? The way Triple HC does their standards is they have a group of universal chapters. So a chapter is a whole bunch of standards related to one topic. There you see the different topics. And you can tell why they're universal. They're applied to every single organization that's accredited by Triple HC. Rights, governance, administration, big on quality management and improvement. There's a lot of requirements in that one. Infection control, facilities, environment. That then becomes the foundation on which you put your additional standards. And here are the additional standards, and they're called selective chapters. If you do lacerations, anesthesia and care services, and surgical and related services apply. If you do CLIA wave testing, pathology applies, and so on and so forth for each one of those. But if you don't, they don't. One of them, number 21, is the occupational health services. So occupational health services, there are a number of substandards underneath that one. This is some of the information they address. First off, you've got to be honest about what you're saying and what you do and what an organization, what a company will get if they use you. You've got to make sure that the folks that are at the organization are appropriately trained, certified, supported in what they're doing. You've got to be able to tell everybody who comes in for company sponsored whatever what information is going to come from that, where is it going to go, and whether or not they need follow up. Each one of these relates, you can see how they relate to the occupational medicine. So then there are a number of other standards that are only applied if the organization you're seeing provides those services. Work placement exams, work comp injuries, all the rest of those things. And finally, there's one on emergency preparedness, which is a little more relevant to implant medical departments in places like DOE. Their process, just for your information, you send in an application, they scope it, they decide based on how many services you provide, based on how large an organization you are, they will come back and say, we will need this many surveyors for this many days or this time frame. And from that generates how much it's going to be to get through the process. The accreditation preparation, you get the standards, you cross-reference what you're doing against the standards, gap analysis. And to tell you the truth, if you do this well, you will learn far more from this, the self-study, than you ever will for when the surveyor comes in and provides advice about what to do and assesses things. So that's a critical element. Then the scheduling, and I want to point out that when you go out, when a surveyor goes out, first off, it's announced, so you know exactly when it is, you call ahead of time to make sure it's as convenient a time as you can have for the organization, because you know they practice and you practice as well, and anybody who comes in has been through the process, they've sat on the other side of the table, and they've had to explain what the heck they're doing and why, and why there might be little gaps here and there that they didn't identify or did identify and couldn't figure out in time to correct when they got there. And if it weren't that kind of collegial, peer-based process, I would have gotten out of it years ago, as well as many others. But you do assess the standards in the process. So what are some challenges? Well, I think challenges now are similar to the challenges that we had 25 years ago, and that's really knowing what membership wants or what value they'll get out of it, other than the intrinsic value of going through the survey process. You know, when we take a look at Triple HC, it's an accreditation organization. There are some things that must be in place, just because they always are, which includes an onsite and includes evaluation of all those universal standards. Those universal standards are important for safe clinic operations, but they do not address what you as a provider end up doing with your patient and how that's implemented. So there's a whole bunch of tiers of things you do before you get to that direct relationship, and an organization has to be aware, ACOM has to be aware of that, and what limits will occur because you have a lot of different things. It's a very compulsive, complete evaluation process. But it's very exciting to see what's going on with this task force. There are some things that can be done quickly with Triple HC, such as using the information that comes out as a reference material. Triple HC has a lot of references that they add into their document. That's one of them. The second level of activities is taking the information from this and modifying the standards, updating the standards and modifying the standards themselves. That would normally not be a great deal of challenge either. Triple HC does standard revisions all the time. Beyond that, you can start talking about taking the information and having a special program of some sort. Health recognition. At least recognition that you've achieved the occupational health chapter, because right now you'll get a certificate without that wording on it. But were one to become involved and really push this a little bit, it would be real valuable to have that listed as well. They haven't done that a lot, but they might be encouraged to do that if there was interest by ACOM for having that done. And lastly, a program of center of excellence. They've done this for orthopedic, different orthopedic procedures. It could be done for occupational health. It's involved, as you might guess. It usually involves a cadre of surveyors that are trained a little bit more than the average. And there are a lot more hoops to jump through. But if there was an interest, that might be a possibility too. It would take some arm leverage. So that's a little background of where ACOM has been in the past with accreditation. And I think there are a lot of options there, as long as there's a sense of what's needed. And at a minimum, the updates are extremely valuable. So I'm very excited to see what's going on. And I'll be available for questions afterwards as well. Thank you. There. Thanks, Chris. Sure. So we send out a survey that I'd like to just pause here and see if there are any questions, because we only have about five minutes. If not, I can go over the survey so you can see what other people said about it. But we have 20 minutes. We have 20 minutes? Yeah. We have an hour total. Oh, then I'll talk longer. All right. Go ahead, David. So I have a question about, when we get to the point where we start accrediting, are there going to be things that you say, ooh, you do that, you're out, like overtreatment? Everybody walks in, gets an x-ray. Everybody walks in, gets a PT, because we have x-ray and PT on site. Or the clinic is doing things that are contrary to practice guidance. Everybody gets sent to the pain guy who does shots, because we have hired the anesthesiologist in our clinic who does the shots. Are there going to be things like that that make you instantly not qualified? Do you want to, David, do you want to say? Danny, I'll tell you that things, no, the things that you mentioned are poor medical practice. I don't know, me personally, I don't know that the guidelines are going to be written that way, that if you do something, you're out, but I'll tell you, employers are unhappy about it, payers are unhappy about it, and as a TPA, I'm unhappy about it. So David? Yeah, I can speak to the work when we focused on the workers' compensation subgroup, and a lot of it really came down to how you're documenting what you're doing for your patient, and is that appropriate. So to the degree that's audible is the question, taking a broader approach, I apply concepts of value-based healthcare where employers should have choice in where to direct care, and this is a model that's routinely seen in commercial health plans with open enrollment and STAR systems in that world. I think applying that to workers' compensation where we're not there, that's a gap, is employers do not, currently they do not have choice. That came out of our discussions with the employers, where they didn't know what is a good clinic from this person to the next, and as I see this program, if we were to go along with it, whether it be a certification versus an accreditation, it allows those clinics of ACOM members to market themselves to those employers to help drive choice to that entity. I know that doesn't necessarily answer the question about if you're out or not, I think that just is that, it's hard to say, especially when we'd be looking more for the workers' compensation-based process measures rather than outcome measures. I think ideally, if you could do value over cost, that would be ideal, where you could assign a cost for a certain medical condition stratified based on level of risk and comorbidity, then you can have appointment cadence and what you'd want to do to take someone from date of injury to the end, but that's my blue sky aspirational goal. A couple of thoughts. Go ahead. If you're going to have any kind of recognition program, there's got to be criteria, and if you don't meet the criteria, then you don't get the recognition. I haven't heard about, well, we're not far enough down the road to even think about what that might look like, but it's also an open book test. I mean, in my experience in primary care and occupational clinics, yeah, there are going to be little glitches, but they know what it is, they know how to do it, and you don't go bring somebody in if you're really up the, you see that in surgical centers that have to have that certification to keep practicing, but you just don't. But yeah, I would think that if there are some that don't meet the requirements when it's rated out, they're not going to get the recognition. Now, in AAAC, if you see something that you consider to be a direct threat to patient safety, that's a different level up. You've got to tell somebody about something, but that's few and far between, quite honestly. I just want to emphasize a point Dennis made earlier, too, that this is really, at this stage, a helpful reference. So we want clinics that, if they're looking at having, for instance, on-site imaging or laboratory studies, there's a tool here, and there's a resource that they can look at to self-audit and self-promote that service within their own clinic. Hi. Rick Armone, CMO and founder of Zella International, but actually, what I'd like to mention now is I'm the vice president of the faculty in the UK, and I'm hoping you've heard of Seaquash. Anyway, I bring you bad news and good news. The bad news is we started the exact journey you're on now back in 2008. Took us 10 years to get to an accreditation system, but in the UK, we now have a occupational health clinic accreditation system. So my good news is, don't reinvent the wheel. We're in discussions with Australia. Australia are looking at using it. We have spoken to several of the board here at AECOM. So now in the UK, it's a situation that if you don't have the Seaquash accreditation, which is safe, effective, quality occupational health services, there's eight modules similar to yourself that you have to go through. You can't bid for, to your point, companies will now insist as part of the tendering process, we will only accept companies who are Seaquash accredited. So it's not mandated by government, but actually you can't operate in the UK if you haven't got your OH accreditation. The UK faculty and AECOM, we collaborate on many, many things. And this is certainly something that we and I would very, very happy to collaborate on because it's a lot of work. We fine tuned it. We've just revamped it this year. And part of the last module is actually to make it more valid internationally with different legal jurisdictions. So don't reinvent the wheel. We're very happy to share. So if I can answer, where have you been all my life? No. I was sitting here thinking, I said to the lady here, I said, have they mentioned Seaquash yet? And they went, no. Well, it was in there. Was it? Beg your pardon. No. I was in late. I'm sorry. Actually, there was a link to the webpage. But Richard Hearn sat in on one of the listening sessions, but hang out afterwards and let's exchange cards. Yeah. We're delighted to collaborate. Great. That's really appreciated. Marilyn. Well, this sounds really exciting. I'm noticing that healthcare has a very large carbon footprint and the Office of Climate Change and Health Equity has put out some very extensive resources that actually very clearly describe what healthcare institutions in the United States should be doing to decrease their waste, increase their sustainability, decrease their carbon footprint. I was wondering if you could go into more detail about what that one bulleted point of environment and safety was and what criteria were being contemplated being used to see how far a particular clinic might have met those kinds of sustainability goals. Dennis, was that something in ... Do you remember, Marilyn, which presenter it was? I think it was this gentleman on the end. That environment care is not that kind of ... What that is is basic safety, electrical safety, making sure that you don't have too much of the hand sanitizer next to an electrical source if you are doing ... So that environment, that's what that's about. The Triple HC standards do not get into climate, they have not done that. There was some discussion, but that's not something they've done. Well, I'm suggesting that as an organization, that should be our input, that they do that and that we provide that input and not let it go forward unless we have that. Because we're kind of behind the times already if we're not thinking in that way. We didn't think of that at all, but the good news is that we're in the same time zone, so let's talk about it. No, seriously. I mean, so the point in my mind for having this session is to take some of the mystery off out of what we've been doing for the last two years. We did include a lot of people. I see plenty of people here. I think that's why there's so many people in the audience, because everybody who came was part of this endeavor. Everybody else is with Natalie, damn her. I want people who have an interest, and I see everybody leaning off the front of their seat in anticipation. I never realized that accreditation could be that sexy, but we want your help. We want your input. This isn't a finished product. There are definitely things we want to improve on, and so that's a perfect example. Maybe. Thanks. Yes. Happy to help. The way you make an impact on accreditation organizations is to have a professional body like this adopt something and say it's important, because then you can say, well, here's peer-based. It's right here. And once it's out there as a recommended standard, it propagates and has a life of its own, and this is the way we would make a systemic change in the country. And another thought, rather than using the triple aim, using the quadruple aim, which is how well we as physicians or providers feel about the whole situation. Again, I don't know what Kenji's going to decide to do, ultimately, because it's the presidential task force, but if people are really interested, if this piques your interest, we'd love to get you involved as well. Okay. Thanks. And I think we're paying like $1,000 an hour, so I had my fingers crossed like this. So I work for a hospital, and in our hospital, we have a trauma unit, we have a burn unit, we have a hyperbaric unit. All these different areas now have their own accreditation in addition to JACO, and in our institution, at least I'm told that if you are accredited by one of these other areas, let's say the burn unit, which in our hospital recently got accredited, then you pretty much fly through a JACO survey when it comes around. But I think if this doesn't happen, it should, because everybody else is doing their own accreditation, and from the hyperbaric perspective, the members of the underseen hyperbaric medical society participate as surveyors. There's a nurse, a tech, and a medical doctor on each survey that looks at this, and you could certainly have the same model for occupational health clinics. Thank you. And thank you, Dr. Allman, that's a great point. When developing our strategy, we wanted to try to encompass as many practice settings as possible. So to your point about imaging and labs, that doesn't necessarily happen in a hospital-based practice, maybe labs, but imaging certainly is always a referral out to a different department. In those settings, I think the measure of quality would be around workers' compensation care as kind of encompassing that. Do you have a lab as a JACO accredited, et cetera? But then there are those clinics that have on-site imaging or on-site labs, and that's why we thought it would be important to also speak to that piece as well. And Michael, before you speak, I just wanted to congratulate you on your third annual retirement. Wendy, you're going to hang around a little bit longer, right? Okay, Michael Hodgson. One of the things that people have been talking about as competition for occupational medicine are near-plant first aid stations. So increasingly, somebody is setting up systems to deliver first aid a la poultry plant, Amazon, and the like that are not in the construction site, not in the factory, but like an urgent care but not care, first aid, first aid only, meaning the OSHA first aid only rules, ice, no heat, no modified work, you know. Over-the-counters. Right. Over-the-counter. Yeah. 400 or 650, but not 400 plus 325. So all of those first aid. So I wonder whether this group could articulate what is also unacceptable, and there was this issue of what happens if you don't meet those, but I think increasingly where AECOM has not done the work it might is the public documentation of medical malpractice, of people's, you know, grandmothers practicing medicine for pay. I had hoped because I flattered you that you would give me a softball, but I don't know Dennis or David, any thoughts on that? If you have to think about it, it is a hard question. That's an excellent question, and I think it does speak to the fact that the purveyors of occupational medicine care, 50 to 60 percent of those are outside our college, and that's really where the issue of quality is. It's folks that are unknown to us or unaware of us that are practicing, that provide occupational medicine as part of their practice, where the variability of quality exists, but from an employer standpoint, as you mentioned, the competitive marketplace, they don't know necessarily who to direct to, and to your point, I think this could be an opportunity for AECOM to market its members a bit more as the purveyors of quality in the occupational medicine injury care space. Just to follow up, the problem is that these first aid stations are staffed by EMTs, LPNs, athletic trainers, who are not working even within the scope of their license, because all of them have defined requirements for working under the supervision of an independently licensed provider or in collaborative practice with a physician, so AECOM is losing business, to put it that way, it seems to me. It is tough. It's a tough situation. I know I staff a clinic, implant medical department, where all I do is first aid, believe it or not. So the way they set it up, and we've got an athletic trainer that works there as well and does first aid kind of things, tissue immobilization, so you always have to be cautious, but I've also received patients from Amazon whose first aid management seemed very, very appropriate. The scope of practice is an issue, and it varies state to state, but it's a very interesting quagmire to try to get in when you're saying this, but not that, and how do you focus on the ones you know you want to focus on? But it would be an interesting challenge for this group to take up. Why not? Yeah, you should. We've got workers being seen for weeks or months for first aid and not being referred, sending them back to their regular job, which is causing worse. So there is medical mismanagement going on in these places. Oh, no doubt. Without any supervision, these guys are being supervised by their safety director. They're not working, they're not really, they're now filing their state, and a big warehousing company that shall be named, in my opinion, is the largest employer of EMTs in the world. So this is a helpful discussion because it really raises for the organization an issue of locus of control. What is it that AECOM can have an impact on versus what can't we necessarily have an impact on? And some questions that come to mind are, who are the insurance carriers for these companies? Are they self-insured? Are they with a national company that they purchase services from? Are they with a TPA aggregator? So where would be the points of effort to try to drive quality in this model? And that's part of the discussion. Maybe for Dr. Fagan, Dr. Hodgson, or the group, where could we influence? I guess I can't help but comment on saying that, you know, if we promote this work on the accreditation process, it should be paralleled with work effort to promote it among carriers, you know, workers' comp systems, employers, and so on. But my question, and I apologize if it's, you know, nefarious in its concept, but when you mentioned at first about, you know, income generating or revenue stream, did you think, for even a second, that clinics would be accredited in this process would pay a fee to AECOM? 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ACOM Presidential Task Force

Clinical Quality and Credentialing

occupational medicine services

recommendations for improvement

brand awareness

workers' compensation landscape

accreditation bodies

telemedicine

clinics of excellence

guidelines and standards