Direct Care + Worker’s Compensation = An Interesting Idea

Direct Care + Worker’s Compensation = An Interesting Idea

A subscriber emailed us over the weekend asking if direct care and worker’s compensation have ever been merged. It’s an interesting concept that until now we haven’t considered. J (name changed to protect identity) writes:

I’d love to hear of Direct Care doctors who handle Work Comp & basic Occ Med for employers. My company pays cash for Occ Med procedures (UAs, DOT medical exams) and First Aid procedures. Are there any doctors who handle injuries for self-insured employers who pay cash for injuries up to a certain point (ie $10k, $25k)? 
Thank you,

Fantastic question. We don’t know of any currently but it’s a genius idea. Entrepreneurs, take note — this could be a new niche to carve out within the growing direct care movement. To get started, we imagine you would want to take on altogether ~3,000 employees, and charge each one ~$10/month for a limited Workmen’s Comp coverage, not including surgeries. There are more logistics to figure out, though. For instance, if an employee never used the insurance (and therefore created no work for the physician) would they be entitled to a refund? Also, the physician would need to provide a range of treatments in order to address legitimate work-related injuries.

Ideally, this direct care meets worker’s comp physician has access to necessary equipment (MRIs, CT-scans, etc.), can prescribe and/or dispense the right medications and has experience treating injuries commonly associated with the employer. Perhaps they would charge the monthly fee (that brings in roughly $30,000/month) and then offer unlimited appointments to the employees, addressing issues such as carpal tunnel syndrome and providing health/safety tips to eliminate/prevent/deter long-term stress factors. This would be by definition Direct Care Occupational Medicine. Yes, this would require a major time commitment (the recruitment might be the biggest hurdle) but to the tune of $360,000 year gross salary, we believe you can find time to address employee healthy-safety concerns, and treat them in the rare case of a work-related injury.

As for an event that requires surgery? This will take some creativity, negotiation, etc. Obviously, there is a pool of cash to draw from and it should be applied to treat the patient, within reason. However, we recommend a wrap around insurance plan to complement all direct care (which comes with a higher deductible, generally somewhere between $2,500 – $5,000). Come to think, a good compromise might be to pay the employee’s deductible for them, then let their insurance plan cover the the surgery and hospitalization. It’s up to you whether or not your model includes prescriptions, sells them wholesale, or if you just write prescriptions and let the patient fill them separately.

Again, these are just some thoughts to stir the pot. If you have any insight or ideas regarding direct care and worker’s comp, send us an email. We’d love to see a project like this come to fruition.