Video Is About to Become the Way We All Visit the Doctor

THE COUNTRY’S LARGEST health insurer is putting telemedicine on par with a regular trip to the doctor’s office, effectively saying a video visit is as good as brick-and-mortar medicine.

illustration of doctor video chatting
Man at Desk Working on Laptop Computer

UnitedHealthcare today is announcing a partnership with three telemedicine companies to cover video-based doctor visits just as it covers in-person visits.

The tech set has for decades predicted that we would one day get our medical care via video chat, but it wasn’t until recently that forward-thinking physicians started taking the promise of telemedicine seriously. The decision by so influential a player in the healthcare industry to telemedicine is the strongest sign yet that the technology is entering the mainstream.

United says it will cover virtual doctor visits offered through NowClinicDoctor on Demand, and American Well. These platforms connect patients with thousands of doctors—albeit not the patient’s usual doctor—via video chat. These consultations typically cost $40 to $50 a pop, but now that United is covering these visits, members will only have to pay their usual co-pay, making virtual medicine much more affordable for more people. For now, these virtual visits will be available only to UnitedHealth’s self-funded customers, but the feature will expand to most members by next year.

According to Peter Mueller, a healthcare industry analyst at Forrester, United’s embrace of doctor visits by video is a major step for the healthcare industry. “There are a lot of pros to telemedicine,” he says.
“Convenience is one. Access is another. Then there’s the immediacy of it, too.” Continue reading Video Is About to Become the Way We All Visit the Doctor

Lark Puts Food-Logging On Your Wrist With New Apple Watch App

Caitlin McGarry | @Caitlin_McGarry
Staff Writer, Macworld
Apr 28, 2015 10:12 AM

Apple Watch with Lark nutrition, activity appIf Siri sent you encouraging messages about your activity and sleep patterns, she would look a lot like Lark, a conversational wellness coaching app for iOS. Now the app is tackling food-tracking with Tuesday’s update for iOS and its launch on Apple Watch.

Lark is taking a decidedly different approach to food than its meal-tracking competitors with a focus on wellness instead of guilt. Record your meals, snacks, and drinks using voice dictation on the Watch or iPhone and Lark will parse trends from your daily food log, not specific calorie counts.

“We don’t want people to obsess about every calorie,” Lark founder and CEO Julia Hu told Macworld during a demo at our New York offices.

Lark’s mission is to help you change your habits, and Hu doesn’t believe knowing how many calories you have left to eat will help you do that. Instead, the app uses natural language processing to parse what kinds of foods you should incorporate into your meals and which you should ditch.

The app uses your iPhone’s M7 sensor on the iPhone 5s and the M8 sensor on the iPhone 6 and 6 Plus to track your activity and sleep, and it uses all of that data to give you personalized nutrition tips. For instance, if you only slept for a few hours the night before, your body will crave sugary and fatty foods to keep it going. Lark will advise you to satisfy those cravings with healthy fats like nuts.

If you have no desire to log your food, just change your goal in Lark under Settings > Edit Profile. Choosing “weight loss” will put nutrition front and center in the app, while “getting fitter” and “staying healthy and happy” will prompt fewer questions about food intake.


ADA Reasonable Accommodation And Workers Comp Questions Answered


Americans With Disabilities Act graphicWe had very successful webinar recently on the New ADA Return to Work Interpretations.  There were many questions from the audience.  Find below the responses to the questions related to Reasonable Accommodation given by Aaron Konopasky, Senior Attorney Advisor, Equal Employment Opportunity Commission, and Jennifer Christen, MD, President, Webility Corporation.

Is a reasonable accommodation having someone else do part of the worker’s job?  For example, all of the lifting? 

If lifting is an essential function of the job (central to what the person was hired to do), then, generally, no.  Reasonable accommodations enable the person to do the essential functions of the job, not eliminate them.

A few clarifications, though:

It’s possible that someone in a certain position is sometimes expected to lift something, but it’s not really what they were hired to do.  We call that a “marginal” function.  For example, an accountant might occasionally have to lift a heavy box of records above shoulder height to put it on a high shelf in a storage room.  Because she’s an accountant, her job really isn’t lifting.

In a case like that, having someone else help with the lifting could be a reasonable accommodation, especially if it’s for the short term.   But sometimes it’s possible to accomplish the same job tasks without needing anyone else’s help — and that might be even better.  For example, if the person could use a hand truck/trolley to move the records, and they could be stored on a lower shelf, the employer may need to make that reasonable accommodation.

If the job involves rotations or assignments that sometimes require lifting and sometimes do not, assignment to a non-lifting rotation/assignment may be a reasonable accommodation that the employer might have to provide, unless doing so would impose undue hardship.

Can you address how Collective Bargaining Agreements (CBAs) affect the interactive process for accommodation?


This is a complicated topic, and I can’t cover it all here.  But two basic points are: (1) the ADA prohibits employers from entering into CBAs that discriminate on the basis of disability, and (2) employers are required to comply with the ADA regardless of whether a CBA exists.


In the reasonable accommodation context, many times it will be possible to provide a reasonable accommodation without violating the terms of a CBA.  If an accommodation is required that would violate the terms of a CBA, the employer and union may need to negotiate a variance.  If a CBA is raising complicated ADA issues for you, you may wish to consult a private attorney.

Continue reading ADA Reasonable Accommodation And Workers Comp Questions Answered

Study Says Physical Therapy as Effective as Lumbar Surgery

Note: Luckily, Central Coast IndustrialCare has a great Physical Therapy Facility headed by Ed DonahueM.S.P.T.

illustration highlighting the lumbar region of the spineBy 04/08/2015 17:25:00

Sacramento, CA ( – Physical therapy may work as well as surgery for easing symptoms of lumbar spinal stenosis, a common cause of nerve damage and lower back pain among older people, according to a new study summarized by Reuters Health. Lumbar spinal stenosis, a compression of open spaces in the lower spinal column, can lead to pinched nerves, tingling, weakness and numbness in the back and the lower extremities. The condition becomes more common with age, and an estimated 2.4 million Americans may have it by 2021, according to the American Academy of Orthopedic Surgeons.

“Surgery is a riskier procedure, with about a 15 percent complication rate, and half of those are life-threatening,” said Dr. Anthony Delitto, chair of physical therapy at the School of Health and Rehabilitation Sciences at the University of Pittsburgh. “It isn’t a life-risking procedure to do physical therapy.” Delitto and colleagues set out to see if they could show that physical therapy, long known to be safer than surgery, could work as well as at easing symptoms. Between 2000 and 2005, they asked 481 patients who consented to surgery if they would be willing to join a study where they would be randomly chosen to proceed with the operation or receive physical therapy. Most declined, to avoid being assigned to the non surgical group, but 169 patients agreed to participate in the experiment. Ultimately, 87 patients had surgery and 82 were assigned physical therapy.

Men Have a Higher Level of Function Before and After Total Knee Replacement Surgery

Men, women have comparable implant survival rates, range of motion and level of improvement

illustration showing before and after total knee replacement LAS VEGAS – While men and women have similar levels of improvement following total knee replacement (TKR) surgery, men have higher levels of function before and after TKR, according to new research presented today at the 2015 Annual Meeting of the American Academy of Orthopaedic Surgeons (AAOS).

According to the Agency for Healthcare Research and Quality, more than 600,000 knee replacements are performed in the U.S. each year. In 2012, 393,345 women and 237,896 men underwent TKR, most often to alleviate the pain and immobility associated with late-stage arthritis. While research has looked at the anatomic differences between the knees of men and women, the higher levels of arthritis in women versus men, and the utilization of TKR among men and women, there has been little study on how gender influences the level of function before and after surgery.

In this study, researchers identified and studied 287 TKR patients at seven different institutions between 2005 and 2007. All of the patients were between the ages of 21 and 80 at the time of surgery and a body mass index <40 g/m². All of the patients except two had a diagnosis of end-stage arthritis.

Continue reading Men Have a Higher Level of Function Before and After Total Knee Replacement Surgery

Cal/OSHA Urges Employers with Outdoor Workers to Prepare for Heat Season Now

Summer heat safety patchCal/OSHA is urging employers with outdoor workers to prepare for high heat now. According to the National Climatic Data Center, 2014 was the hottest calendar year on record since 1895 in California, and the Center has already recorded similarly record-breaking temperatures over the last two months. Preparation is essential to prevent heat illness which can include headaches, fatigue, excessive sweating and muscle cramps in the early stages, and can rapidly progress to mental confusion, vomiting, fainting, seizures and death.

“Employers must ensure they take the steps necessary to protect outdoor workers, especially during times of high heat,” said Christine Baker, Director of the Department of Industrial Relations. Cal/OSHA is a division within DIR.

Employers are required to take the following minimum, basic steps:

• Train all employees and supervisors about heat illness prevention.

• Provide employees with enough cool, fresh water to drink at least 1 quart per hour, and encourage them to do so.

• Provide access to shaded areas, and encourage employees to take rest breaks of at least 5 minutes – before they feel any sickness.

• Develop and implement written procedures – in English and other languages as necessary – for complying with Cal/OSHA’s Heat Illness Prevention Standard.

“California has the most extensive heat illness prevention requirements in the country,” said Cal/OSHA Chief Juliann Sum. “The goal is to ensure that outdoor workers are not risking their health.

” Employers must also take special protective measures when temperatures reach 95 degrees or above. Supervisors must:


Drones: The Risk from Above

At the 2015 Advisen Casualty Insights Conference, the topic of drones and risk management concerns related to them was discussed by Justin Green, Aviation Attorney at Kreindler & Kreindler and Thomas Klaus, Vice President at Willis Aerospace.
Drones currently have widespread application in a variety of industries:

FAA Approves Drones for Real Estate photoLaw enforcement uses them for surveillance and search.
The insurance industry uses them to look at unstable roofs.
Journalists are using them for photography in war zones.
The oil and gas industry uses them to inspect pipelines.
The motion picture and television industry is now using drones for most overhead shots instead of helicopters.

The use of drones is very well established in government contracting, military, insurance, oil and gas, and the boarder patrol. Drone usage is rapidly expanding in other industries because there are many benefits to using them. In many ways, drones can be much safer than the use of helicopters in instances such as searching a forest fire zone.  A drone can eliminate putting people at risk in dangerous situations while also providing the necessary information.

Currently there are no FAA regulations around the use of drones and the FAA is trying to catch up with this quickly-growing potential exposure.  The FAA has indicated that no commercial use of drones is allowed without special permission. Amazon was just approved to start testing drones for commercial use after several months of trying to secure this authorization. What is yet to be determined is, once FAA has regulations in place, how will these regulations be enforced?  There is also significant concern around potential terrorism risk using drones.  While the FAA can regulate commercial use of drones, the private use is very difficult to regulate. For example, the person who crashed a drone on the White House lawn was not charged because the individual did not violate any laws.

Secret Service is looking into developing laws to prevent this from happening in the future.
Insurance exposure for drones is similar to aircraft exposure, which focuses on damage caused to people and property on the ground.

But there can also be privacy exposures like paparazzi using drones to get pictures and videos. Coverage for the risks associated with drones is usually placed in a general liability policy with an endorsement, but the aviation insurance industry is also in the process of customizing policies to include drones.


Why Telemedicine’s Time Has Finally Come

Partner, Asset Management Ventures

illustration with smartphone for telehealth, tele healthTelemedicine may just be the biggest trend in digital health in 2015. As a partner focused on digital health investments at venture capital firm AMV, I spend a lot of time crisscrossing the country chatting with leading healthcare providers and insurers about their technology needs. By far the area they are most interested in is telemedicine. For hospitals, expanding telemedicine is a way to cut costs while providing consumers with the convenience they crave. But the idea has been around for a while so why now?

For one, the technology around virtual consultations has finally matured to the point where doctors can offer a good experience. As Andrew Watson, Chief Medical Director of Telemedicine at University of Pittsburgh Medical Center, puts it “Telemedicine is moving like lightning. We’re able to do so much more than before.” Faster Internet connections and better software facilitate far smoother video chatting than in days past. With ubiquitous mobile devices, people can now access consultations from anywhere. And the advent of electronic health records has certainly increased the ease of going digital.

Additionally, telemedicine has expanded to include asynchronous messaging, which patients are increasingly more comfortable using and which truly allows doctors to better utilize their time. A single doctor can now advise many patients on routine issues, freeing up more time to focus in-person on trickier cases.

Most importantly, there is demand to harness the capabilities of these technological innovations. In the last few years, more and more patients have increasingly looked to retail pharmacies in their neighborhoods for routine healthcare services because it’s more convenient than visiting their doctor. The logical next step is that they won’t have to leave their homes at all. Continue reading Why Telemedicine’s Time Has Finally Come