About Cascade Occupational Medicine

 

Our goal is to provide you comprehensive, professional occupational healthcare that meets or exceeds your expectations. We employ a team approach and utilize our network of clinics to deliver a vast array of services within the field of occupational medicine and workplace safety.

Our physicians are led by our CEO and Medical Director Dr. John R. Braddock. Dr. Braddock is a two-time past president of Legacy Meridian Park Hospital, with over 20 years experience in Occupational Medicine and 30 years in Emergency Medicine.

 

 

What is Occupational Medicine?

 

"I am often asked this question... Occupational Medicine has two primary functions, each of equal importance."

 

Promote & Maintain Workforce Wellness – Provide a Safe Work Environment

 

For example, over the last 50 years, more than 60,000 new chemicals have been synthesized. Since only 16% or less of these substances have been studied enough so that their health effects are understood, it is apparent that toxicity testing lags behind the rate of new chemical development. Consequently, the incidence of work related illness is increasing dramatically.

 

The proliferation of occupational illness, as well as an increasing number of occupational injuries, has created a need for physicians well-versed in recognition, treatment and care of "on the job" related incidents.

 

Treatment and Rapid Return to Health of an Injured Worker

 

An equally important aspect of our profession is case management. It is the responsibility of the Occupational Medicine Physician to try to heal the injured worker and return that employee, when he or she is medically able, to a secure worksite. This may include promoting changes in the workstation to prevent further aggravation or additional injury.

 

For these kinds of reasons, the field of Occupational Medicine has developed and engaged physicians who appreciate the integral relationship between a safe, healthy workplace and healthy employees. Occupational Medicine Physicians provide the appropriate management of sometimes complex work-related cases, which usually means an overall cost savings to employers.

 

"We, at Cascade Occupational Medicine, are very proud of our group of skilled professionals and we look forward to providing you with the best medical care available."     – John R. Braddock, MD

 

 

 

History of Cascade Occupational Medicine ("COMPI")

Cascade Occupational Medicine was formed initially in 1994. It was originally set up to be a physician staffing entity for the Legacy Health System Occupational Medicine Program. It functioned in that capacity until late 1999 when Legacy decided to divest themselves of several of their outpatient programs including Occupational Medicine.

COMPI, or Cascade Occupational Medicine, then reorganized into a partnership of four with Dr. John Braddock as the majority partner. It then purchased some of the pieces of the old Legacy System and begin growing COMPI. Initially COMPI consisted of simply 3 clinics, one located on Swan Island in the old Ports-of-Call building, a clinic located within Legacy Meridian Park Hospital and one located at 122nd on Airport Way. The first order of business was to move the clinics to their current location. Once that was accomplished, COMPI then began expanding their program by the acquisition of Occupational Consultants Northwest creating a clinic near Washington Square and purchasing the old Tuality Hospital Occupational Medicine program thereby establishing a clinic in Hillsboro. Four physical therapy programs soon followed. Having our own physical therapy program within or near each clinic allows us excellent cross-facility communication.

In addition to the traditional aspects of caring for the injured worker and performing post-hire/preplacement examinations, Cascade Occupational Medicine has an active MRO service, an ergonomic program and a variety of other programs designed to enhance services that can be offered to employers.

In summer 2007, COMPI will begin developing programs outside the Portland area with its new clinic offering both Occupational Medicine and physical therapy. This new clinic will be located in Bend, Oregon, and is scheduled to begin seeing patients near the end of July.

History of Occupational Medicine

 

Workers' injuries were first identified by Ramazini in the 15th Century. Since that time there have been sporadic efforts by workers to recover the costs of illness occurring because of their employment. With the advent of mass production in factories in the early 20th century, exposure to more dangerous situations meant more people were being exposed to significant illnesses and injuries. Medical insurance was uncommon.

 

In an attempt to allow the worker to recover costs from an illness, a complicated body of law arose under the heading "master-servant" relationship. Certain legal theories were espoused by which a worker could bring lawsuit against his employer over work related injuries. This was an extremely expensive and uncertain process. People with limited resources were frequently unable to hire good lawyers and went uncompensated. Other workers with larger amounts of cash reserves and the same injuries were able to afford more adroit attorneys and often obtained large judgments. This inequity led to increasing political pressure. The courts wanted to do justice for both the injured workers and at the same time provide some protection for business. The goal was not to stop the expansion but to support increasing industrial needs.

 

By the time World War I occurred, the problem of work related injuries was recognized nationally. After various considerations were made in how to deal with the increasingly complicated and inconsistent care given, the concept of "workers' compensation" insurance was adopted. Oregon initiated its own workers' compensation system in 1915.

 

Workers' Compensation is a no-fault insurance program. It was founded not only to protect the injured worker from loss of wages and cost of medical care but to prevent excessive awards and financial hardship for businesses. Initially the Workers' Compensation program was primarily used to cover the high risk businesses. Over the course of time, this program of insurance was extended to cover all workers.

 

By 1987, Oregon had the sixth highest cost in the nation spent on Workers' Compensation. Because medical costs were approaching 40% of every dollar spent on Workers' Compensation, major reforms were instituted by the Oregon Department of Insurance and Finance. These included education of the care providers of the Workers' Compensation Division of the Workers' Compensation system. In 1990 additional legislation was established to allow Managed Care Organizations (MCO) to "manage" the cost of Workers' Compensation. It was felt that this would provide better overall management of patient care and, at the same time, eliminate costs. This was further clarified in 1995 under Senate Bill 369, which inaccurately defined the Workers' Compensation system in Oregon.

 

 

 

 

State Requirements

In the State of Oregon, everyone must be covered by some sort of workers' compensation insurance with very few exceptions. The coverage can be one of three types:

1. State Accident Insurance Fund (SAIF) covers most of the small employers in the state. It is also available for the new or high risk employers who may not be able to obtain coverage through the other two mechanisms.
   
   
2. Self-Insurance is usually used by the states largest employers who have chosen to "self-insure". The ability to self-insure must be granted by the Department of Insurance and Finance in Oregon (DIF). They most post a bond large enough to ensure sufficient funds are available for any claims. Self-insured's may either hire their employees to process the claims or may hire a third party administrator.
   
   
3. Private Insurance companies are allowed to write Workers' Compensation Insurance for employers in Oregon. This is usually used by most mid-sized employers.

Any one of three "insurance programs" must be available for the worker should the worker by insured. These programs must provide:

1. Payment for time loss, whether that time loss be temporary or permanent.
   
   
2. Medical care for that injury
   
   
3. Payment for any disability resulting from that injury
   
   
4. Vocational rehabilitation if the worker is available for this

These benefits are to be kept available at all times for all workers regardless of the risk and are established by law. To trigger this mechanism, only an authentic, verifiable, occupational injury must be identified.

 

 

 

 

Reporting Guidelines

 

When an injury occurs at the work site it is the workers responsibility to initiate a Workers' Compensation claim, this is done by filing an 801 form report indicating that work related injury and/or illness resulting in medical treatment and/or time loss has occurred. This must be filed within thirty (30) days of the date of the accident or diagnosis of that particular injury or illness. This may be extended up to one year if the worker can establish at a hearing reasonable cause for failure to report within the thirty (30) day time frame.

 

The employer then completes a 801 form and is required to file it within five (5) days with the insurance carrier. Failure to do so is accompanied by severe penalties ranging from $2,000 per occurrence to up to $10,000 for any three month period. Additional fines can be assessed for improper or incomplete record keeping.

 

When the worker is initially seen in a medical facility, the provider completes an 827 form. This is the first medical report. The completed form is then mailed to the insurer no later than 72 hours after the initial visit. This form, signed by the worker, constitutes the official filing of a claim and authorizes the medical provider to release any and all information relevant to this claim. It is during this initial visit that the attending physician is responsible for clearly stating the workers' limitations relative to the injury. If the injured is considered to be "totally disabled" and the condition precludes return to regular or modified duty, time loss may be given.

 

Follow-up visits are reported to the insurance carrier via an 828 form. This form must be filed on a fourteen (14) day basis. Should the worker fail to seek treatment during any fourteen (14) day basis, the claim may be considered "closed" and further payments denied unless an aggravation or re-injury occurs to the injured worker.

 

 

Definitions

(skip directly to: A, C, I, L, M, O, or P )

 

Aggravation Care – An aggravation is an objective and measurable worsening of an original compensable workers' compensation injury which causes the worker to be less able to work.

 

Elements of an aggravation claim:

1. Worsening: an aggravation claim is not compensable unless the worker establishes an actual worsening or "change" in his or her original compensable condition.
   
   
2. Objective findings: as with the original claim, the worsening must be established through medical evidence supported by objective findings.
   
   
3. External causes: an aggravation claim is not compensable if the major contributing cause of the worsening was an off-the-job injury. Original injury must be major contributing cause.
   
   
4. Waxing and waning (good days, bad days): If a worker has received an award of compensation for permanent disability for the original claim, the worker will have to show the asserted worsening is more than the anticipated "waxing and waning" that was expected and compensated in the original claim.

Arising Out of Employment – An injury arises out of employment when it results from a risk that is reasonably linked to the worker's employment duties or relationship.

 

Attending Physician – The attending physician is a doctor or physician who is primarily responsible for the treatment of a worker's compensable injury and who is a medical doctor or doctor of osteopathy licensed by the Board of Medical Examiners or a board certified oral surgeon licensed by the Board of Dentistry; or for a period of 30 days/12 visits from date of first visit on the claim, whichever comes first. Chiropractic physicians may serve as "attending physicians" only for a period of 30 days or 12 visits, whichever comes first, and only during the initial open period of a claim.

 

Attending physicians retain exclusive authority to authorize time loss, approve modified job offers, prescribe treatment, prescribe medication, or refer for ancillary services. They must declare the worker medically stationary and rate impairment for computing partial disability awards, and is the "gatekeeper" who provides all crucial information governing the nature and extent of the benefits a worker will receive on a claim.

 

Workers are entitled to only one attending physician at a time. This is activated by signing a Form 827 that the doctor submits with his first treatment. A worker may change attending physicians twice (for a total of 3) during the "life" of a claim. A Form 829 must be signed by the worker to change attending physicians and must notify the insurer. The rules require such a notice by submitted within 5 days of changing physicians.

 

Claim – A written request for compensation from a subject worker or someone on the workers' behalf, or any compensable injury of which a subject employer has notice or knowledge.

 

Combined Condition – If an otherwise compensable injury combines at any time with a pre-existing condition to cause or prolong disability or a need for treatment, the resultant combined condition is compensable if, so long as and to the extent that the otherwise compensable injury is and remains the major contributing cause of the disability of the combined condition or the major contributing case of the need for treatment of the combined condition.

 

Compensable Injury – An accidental injury, or accidental injury to prosthetic appliances, arising out of and in the course of employment requiring medical services or resulting in disability or death; an injury is accidental if the result is an accident, whether or not due to accidental means, if it is established by medical evidence support by objective findings.

 

No injury or disease is compensable as a consequence of a compensable injury unless the compensable injury is the major contributing cause of the consequential condition.

 

If a compensable injury combines with a pre-existing disease or condition to cause or prolong disability or a need for treatment, the resultant condition is compensable only to the extent the compensable injury is and remains the major contributing cause of the disability or need for treatment.

 

Consequential Condition – Sometimes workers develop medical conditions as an indirect consequence of a compensable injury. No injury or disease is compensable as a consequence of a compensable injury unless the compensable injury is the major contributing cause of the consequential condition.

 

Consulting Physician – The consulting physician is a doctor or physician who examines a worker or the workers' medical record to advice the attending physician regarding treatment of a workers compensable injury. The attending physician limitation does not apply to consulting physicians, emergency services, or referrals made by the attending physician. Attending physicians may request that other physicians examine and offer opinions as to a workers status without regard to the 3-physician rule.

 

Curative Care – Medical care intended to stabilize a temporary and acute waxing and waning of symptoms of the workers condition. Curative care does not require pre-approval by the insurer. Claims subject to a managed care organization, however, do have MCO (Managed Care Organization) pre-certification requirements for some treatments such as surgical procedures and hospital admissions.

 

In the Course of Employment – In the Course of Employment is a "time, place and circumstances" test. It generally means the injury occured at or during employment.

 

Legal Causation – Legal causation means the injury or work condition is legally related to the workers employment. The law provides that a workers injury is legally caused by work when it is shown to have "arisen out of and in the course of employment." A claimant must establish both elements: injury occurred during work and because of work.

 

Major Contributing Cause – Major contributing cause means that employment conditions or factors represent more than half (51% or more) of the cause of the condition claimed. In other words, if given two causes, it was the greater contributing cause, more than half.

 

Material Contributing Cause – Material contributing cause means that employment conditions or factors played some material role in causing the injury or disease claim. It is any degree of causation that is more then minimal, but need not be the sole or even the primary cause.

 

MCO (Managed Care Organization) – MCO's are groups of health providers who contract with insurers or self-insured employers to treat injured workers applying treatment standards or procedures and special fee arrangements.

 

Medical Causation – In addition to proving "legal causation", a worker must also establish "medical causation". First a worker must prove a medical condition actually exists, based on medical evidence supported by objective findings.

 

Medically Stationary – Medically stationary means that no further material improvement would reasonably be expected from medical treatment or the passage of time. All of the workers accepted conditions within the claim must be medically stationary before closure may proceed. Medically stationary does not exactly equal medical stable. The test is a lack of likely further improvement. If a workers medical situation has plateaued, and is then deteriorating without likely future improvement, the worker is deemed "medically stationary". If the condition does subsequently worsen, the worker may seek to reopen the claim on an aggravation basis.

 

Objective Findings – Objective findings in support of medical evidence are verifiable indications of injury or disease that may include, but are not limited to, range of motion, atrophy, muscle strength, and palpable muscle spasm and diagnostic evidence substantiated by clinical findings. Objective findings do not include physical findings or subjective responses to physical examinations that are not reproducible, measurable or observable.

 

Occupational Diseases – Occupational diseases are conditions that develop gradually and not unexpectedly in light of the work activity or conditions; arthritis, allergies and chronic overuse conditions. They are not compensable unless work activities or conditions are the major contributing cause of the disease. Unlike in injury claims, disease claims involving an asserted worsening of or "combination" with pre-existing conditions can be compensable only if work conditions or activities are the major contributing cause of a "pathological worsening or actual acceleration" of the disease process.

 

Palliative Care – Medical service rendered to reduce or moderate temporarily the intensity of an otherwise stable medical condition, but does not include those medical services rendered to diagnose, heal or permanently alleviate or eliminate a medical condition. This is usually treatment of chronic waxing and waning (i.e., flare up) of symptoms and is only compensable under specific conditions. In other words, palliative care is offered merely to treat or temporarily alleviate a workers symptoms, as opposed to curing the underlying conditions.

 

OAR: 436-10-041(3) specifies that palliative care which enables the injured worker to continue current employment may be approved by the workers compensation insurer. Medical providers need to complete Palliative Care Request and send to the appropriate insurer for pre-authorization. Insurer has 30 days to respond. If no response, attending physician may seek Department approval.

 

Palliative care treatment is compensable without the insurers prior approval for workers that have been legally defined as permanently totally disabled (PTD), need prosthetics monitored or prescription medication managed. Medical providers do not need to complete the Palliative Care Request form for cases that fall in these categories. Except in certain specified situations, palliative care is generally not compensable in Oregon once a workers condition has become medically stationary. It is compensable in just four situations:

1. Where it consists of prescription medication.
   
   
2. Where it is prescribed for a worker who has been determined to be permanently and totally disabled.
   
   
3. Where it is requested in order to repair or replace a prosthetic device.
   
   
4. Where an attending physician prescribes it as necessary to enable a worker to return to work (subject to Insurer and/or department approval).

Pre-existing Condition – Any injury, disease, congenital abnormality, personality disorder or similar condition that contributes or predisposes a worker to disability or need for treatment and that precedes the onset of an initial claim for an injury or occupational disease, or that precedes a claim for worsening.

 

 

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