Now in its 15th year, Central Medical Services of Westrock, PC provides occupational and environmental medicine services to patients, unions and businesses throughout New York, specializing in the nuances and complexities of workers’ compensation.
A primary care provider has one last appointment before 5 p.m. In 20 minutes, she’ll be out the door to pick up her children from day care, she thinks. All she has to do is ascertain that her last patient, a bus driver, is managing his diabetes well. A careful man, this patient typically has his glucose under tight control.
After discussing his diabetes, he tells the physician about the back injury he sustained at work. When the power steering failed, he had to turn the bus manually — and he felt something in his back tear. A week later, his back hurts worse than ever. He hopes his physician can resolve his back pain — and demystify his workers’ compensation paperwork.
An hour later, the physician looks up from the last of the complex forms. She hopes she completed them correctly. She wants her patient to get the care he needs — and she wants to get out to her family.
A Complex Care Situation
Michael Hearns, MD, MSc, CEO and President of Central Medical Services of Westrock, discusses diagnostic results during a follow-up visit and refers the patient for further care and treatment available at CMSW.
Patients seeking workers’ compensation benefits have special needs and require attentive treatment. In addition to requiring sound medical care by physicians accustomed to treating traumatic and repetitive strain injuries and environmentally based illnesses, these patients present challenges unique to their economic and legal situations. Their physicians must serve not only as healers but also as advocates in an adversarial legal system, making their jobs doubly complex. Matthew A.T. Clarke, MD, MBA, Medical Director of Central Medical Services of Westrock and Associate Professor at New York Medical College, has navigated this complexity for many years.
One fact he shares readily: A typical primary care physician (PCP) patient encounter takes 20 minutes. Each encounter with a workers’ compensation patient entails 45–60 extra minutes of paperwork — or up to a 200 percent increase.
And, workers’ compensation patients involve more than just extra work.
To start, they must rely on a different insurer from their usual payer, and that insurer looks to an independent medical examiner — rather than the patient’s own physician — to approve or deny treatments.
“This can result in delays in care,” Dr. Clarke says. “Physician-recommended treatments must be approved by the workers’ compensation insurance carrier, which is in turn guided by the opinion of the independent medical examiner. This physician has no doctor-patient relationship with your patient and has been contracted to save the insurance carrier money. So he or she may be more likely to deem a treatment unnecessary or declare the patient’s condition to be resolved or less serious than the treating physician has observed.”
Matthew A.T. Clarke, MD, MBA, Medical Director of Central Medical Services of Westrock and Associate Professor at New York Medical College
To obtain treatment, patients must often go to court and ask for a judgment approving treatment requested by their treating physician. When the independent medical examiner is at odds with their treating physician, the time frame for approval may turn into months, as opposed to hours or days for a typical patient. Delayed treatment may result in minor conditions becoming more severe, and the physician then has to deal with an irate patient who feels he or she has received substandard care, Dr. Clarke says.
Additionally, many patients lose employment, some portion of their income and their normal health insurance while awaiting a decision. These factors may lead to economic distress, depression and the worsening of non-work-related health conditions.
“Many jobs have a time limit for which you can be out of work and still receive job-related benefits,” Dr. Clarke says. “Whether 12 weeks under the Family Medical Leave Act or 12 months under some union contracts, at the end of that time, patients may lose their major medical health insurance. Other conditions will no longer be treated, and family members may lose coverage as well. This adds to the emotional distress surrounding injury due to work-related conditions.”
These factors can create confusion and frustration for PCPs as well. The solution: a practice dealing with a high volume of workers’ compensation cases of all kinds. In New York, that practice is Central Medical Services of Westrock.
“We are skilled at navigating the system, and with our training in occupational medicine, a subspecialty of preventive medicine, we know how to address those issues so that your patient with a work-related condition can improve,” Dr. Clarke says.
Central Medical Services of Westrock simplifies the workers’ compensation system for patients and their doctors.
Strong Capabilities in Occupational, Environmental Medicine
A multispecialty practice, Central Medical Services of Westrock has broad expertise, including:
- Chiropractic care
- Counseling services
- Environmental medicine
- Functional evaluation testing
- General occupational medicine
- Orthopedic medicine
- Pain management
- Physical therapy
The physicians associated with the practice are board-certified, and the non-physician practitioners are highly trained specialists who focus their practice on patients who have experienced injury or illness on the job. Together, this group of practitioners cares for a variety of work-related conditions. They most frequently see blunt force traumatic injuries, musculoskeletal disorders associated with repetitive strain, respiratory and dermatological disorders related to work-related exposures, and psychiatric conditions due to workplace trauma. Counselors also treat psychological issues that are sequelae of injury and unemployment.
Dr. Clarke examines a patient with a work-related, repetitive-strain wrist injury.
“The cases we see can be divided into two categories — traumatic injuries and occupational disease,” says Michael Hearns, MD, MSc, CEO and President of Central Medical Services of Westrock. “Traumatic injuries most often include musculoskeletal conditions, such as broken bones, joint problems and soft-tissue damage, chronic strain injuries, such as epicondylitis, and entrapment syndromes, such as carpal tunnel syndrome. Occupational disease refers to illnesses resulting from on the job exposures. Common exposures include chemicals such as solvents, cleaners, paints, oil, dust, asbestos and multiple other sources. Additionally, our in-house psychologists treat psychological injuries incurred on the job.”
“If patients are out of work due to a work-related injury, they are entitled to compensation and free medical care. Often, they do not receive any of these. Administratively, because they are unfamiliar with the necessary paperwork, and medically, because they are uncertain how to obtain authorization for their patients, primary care physicians find themselves stymied. So when patients come to us, they are at their wits’ end. Because we know the system very well and have deep expertise in occupational medicine, we get their situations turned around right away. They receive compensation, they are again able to meet obligations such as paying their rent, and they get the correct diagnosis and treatments so their health can improve and they can return to work. As a testimony, many of our referrals come from family members. Our work speaks for itself, and our patients speak for us.”
— Michael Hearns, MD, MSc, CEO and President, Central Medical Services of Westrock
Patients find Central Medical Services of Westrock through many outlets. Emergency providers, internists and family care physicians refer patients with work-related conditions. Others self-refer due to the practice’s excellent reputation. Still others come because unions and employers choose Central Medical Services of Westrock as their workers’ compensation point of reference.
Over the years, the physicians of Central Medical Services of Westrock have developed sturdy institutional relationships, giving them access to uniformly high-quality care for patients. Initial diagnosis and most treatment take place at Central Medical Services of Westrock, while physicians perform minor surgeries at local community hospitals and freestanding surgical centers. Physicians are on staff at North Shore-LIJ University Hospital at Forest Hills, and the most complex patient cases are cared for at tertiary research facilities.
For as long as they suffer outcomes of their work-related injury, patients stay with Central Medical Services of Westrock, receiving regular care aimed toward healing, improving quality of life, regaining employment and, when necessary, obtaining long-term disability benefits. Many develop lifelong relationships with their providers.
Aggressive Pursuit of Patients’ Well-being
In addition to high-quality patient care, Central Medical Services of Westrock provides another important service: obtaining authorization and payment for the correct care for their patients, a process that involves navigating a system of Byzantine complexity.
Karen Hearns, RN, Executive President, and Dr. Hearns collaborate on the administrative and clinical operations for each of the Central Medical Services of Westrock’s seven locations.
“Because 90 percent of our cases involve workers’ compensation, we are skilled at filing the relevant paperwork and highly experienced at testifying in court,” Dr. Clarke says. “We deliver sound testimony and have wonderful success rates in obtaining authorization for treatments for patients, as well as making sure they have compensation decisions that accurately reflect their degree of disability.”
Due to the intricacy of the workers’ compensation system, a single clerical mistake by a provider may cost patients valuable treatment options or necessary benefits, Dr. Clarke says. At Central Medical Services of Westrock, the administrative staff knows exactly how to complete the paperwork and take the correct steps to ensure patients receive the care they need.
“The system is adversarial and complex — it’s not designed to make things simple for the injured worker,” Dr. Hearns says. “The process is labor-intensive, creating what I call a ‘hassle-factor’ for treating physicians and patients, so that at the end of the day the injured worker cannot obtain what he or she needs.”
Central Medical Services of Westrock does not accept that status quo. A care coordinator helps each patient negotiate the system’s complexities, guiding the patient through paperwork filings, providing administrative support, and assisting with union and employer documentation.
“Our staff keeps up with calls to claims examiners, files papers and provides patients with their own documentation for court,” Dr. Clarke says. “The system requires medical evidence of injury and disability. The workers’ compensation insurer is looking to reduce its liability. We fight aggressively to ensure our patients receive the treatments they need.”
In Your Patients’ Corner
“Referring physicians need to understand that workers’ compensation is an adversarial system. Providers must be ready to fight for their patients — because they will have to. On one side, the employer, the workers’ compensation insurance company and the independent medical examiner will work to limit liability. On the other side, the patient and his or her physician, union and attorney are working to make sure he or she gets the right treatment. The workers’ compensation system — the New York State Workers’ Compensation Board and the judges — stands in the middle as referee. We want referring physicians to understand this process should not be taken lightly. Workers’ compensation patients require a lot of treatment, even while the physician fights an uphill battle to secure insurance approval. As specialists with years of experience, we make it our business to fight for your patients.”
— Matthew A.T. Clarke, MD, MBA, Medical Director, Central Medical Services of Westrock; Associate Professor, New York Medical College
Creating Healthy Environments
Central Medical Services of Westrock is active in environmental medicine as well. The physicians are expert at treating illnesses acquired from the environment in multiple ways, whether through mold from damp housing or chemical exposures from old landfills.
Physical therapy is offered at several of the Central Medical Services of Westrock locations.
“Not everyone develops problems at work,” Dr. Hearns says. “People can be at home, at a friend’s house or at a shopping mall and be exposed to mold, chemicals or other environmental factors.”
Trained in both occupational and preventive medicine, Dr. Clarke and Dr. Hearns work with patients, employers and the general public to prevent injury and illness.
“Prevention means a lot to us,” Dr. Hearns says. “We give lectures for employees and in public forums about recognizing high-risk environments and mitigating risk factors that can lead to occupational or environmental injuries. We are very much involved in teaching — educating the public about health risks and screening them so we can detect environmentally related diseases at an early stage, before they progress.”
Co-Partners in Care
Although Central Medical Services of Westrock often develops long-term patient relationships, at no time do its physicians seek to replace or fill the roles of PCPs. Restricting their services to occupational and environmental medicine, they work hand-in-hand with providers in a synergistic relationship Dr. Hearns refers to as “co-management.”
“Patients can have chronic medical problems, such as diabetes, and work-related issues simultaneously,” he illustrates. “Often, their PCPs would prefer not to testify in court or perform other tasks related to the work-related condition. We take that burden off their shoulders, so they can do what they do best, which is to treat their patients’ non-work-related issues.”
Central Medical Services of Westrock’s Management Team includes Matthew A.T. Clarke, MD, Medical Director; Karen Hearns, RN, Executive President; Michael Hearns, MD CEO; Aziza Abiodun, Office Administrator; and Ronald Latta, marketing.
To refer a patient to an occupational or environmental specialist familiar with workers’ compensation cases, please visit www.cmswpc.net.