PBMs Exposed in Workers' Comp Deception | Colleen Shields, RescueMeds

This transcript was generated automatically. Its accuracy may vary.

[00:00:15] Mike Koelzer, Host: Colleen, for those that haven't come across you online, introduce yourself and tell our listeners what we're talking about today.

[00:00:23] Colleen Shields: My name is Colleen Shields. I am the CEO of RescueMeds Pharmacy. We are exclusively a work injury pharmacy located in Annapolis, Maryland and licensed in 15 states and counting. 

[00:00:37] Mike Koelzer, Host: All right. So Colleen, a lot of sales people come in the store with a PBM connected to workers comp and.

 These guys are gal salespeople and they come in and they say, use our workers comp card, but we're going to. Take the profit because there's a certain amount that these claims have to pay.

We're going to tell you, we're going to make it really easy for you while the whole time they're taking all the profit from us. Colleen, am I close on that or am I just way off?

[00:01:17] Colleen Shields: You're a hundred percent right, a

hundred percent right. 

[00:01:22] Mike Koelzer, Host: I rarely hear that

[00:01:24] Colleen Shields: Doesn't that feel good?

[00:01:25] Mike Koelzer, Host: My employees say you're right, Mike, but they do that. Cause I pay them. They never come out and say you're a hundred percent right. But I got that from you,

 So Colleen, are listeners. They're mainly pharmacies. So they're. We know the whole vertical integration of the pharmacies. And we know that there's spread pricing and things like that. these sales people that come in , they haven't opened up their own pharmacies saying that they're workers comp pharmacies, are they?

[00:01:55] Colleen Shields: No, but what they do is they provide the patients these quote unquote pharmacy cards and they use deceptive language and we believe in fair trade practices to try to trick the patient into thinking they must use this pharmacy card.

[00:02:10] Mike Koelzer, Host: For the workers comp.

That's exactly what it is. Cause we know all the. baloney that the PBMs do. And this is worse because it's trickery. It's worse than just having a card that somebody is incentivized for and all that baloney, but it's even worse when you're injured and someone says, here's how you do it.

[00:02:30] Colleen Shields: And I should caveat that every state is different, workers compensation. you kind of have to go back to the beginning, and I'm sure your pharmacists are well aware, but I always like to remind people, workers compensation was created, 1904, back when there was no insurance. There was no health insurance.

If you were rich, you had health care. If you were poor and you chopped your arm off, it was a nice day. You went home and died. That's it. During the industrial revolution, obviously there was a lot of push to try to make, for example, a five day work week even and all these things.

Workers Comp was created called the Grand Bargain and in, in its simplistic form, it's two things, it's very simple. It's lost wages and medical care. That's it. And it's Almost the same as it was. Although there is some federal oversight very narrowly, narrowly relevant. This is decided state by state. And so subsequently, every state's laws are a little different. Obviously some can be the same, but in some states they can direct that care. Just so you're, we're clear, in some states they have the right, I would argue that anybody listening to this that's involved in any kind of PAC or any kind of legislative action make as rigorous a plan as possible to prevent any state legislatures from enacting that language

[00:03:57] Mike Koelzer, Host: When you say they can, that means it's legal for them to say, use this, but people still can go elsewhere. Or are you saying they mandate a certain way to do it?

[00:04:08] Colleen Shields: they mandate in some states,

[00:04:10] Mike Koelzer, Host: Gotcha.

[00:04:11] Colleen Shields: The federal government, in fact. Federal Workers Comp mandates the use of Optum.

they mandate it. I have a lot of potential business down at the border. But we can't take it because we're not, we don't participate with Optum .

[00:04:26] Mike Koelzer, Host: It's not just that it's mandated if you're going to use the card. In other words, could somebody get out of that if they say, I'm going to pay and get reimbursed and the pharmacy is willing to do the paperwork and all that? Or is OptumPBM the only way that it can be built?

[00:04:47] Colleen Shields: Optum PBM is my understanding. From my research, the way that this happened, it was written into their contract 

[00:04:56] Mike Koelzer, Host: I wouldn't doubt 

[00:04:57] Colleen Shields: somebody did a very good sales

job, I would question the legality of that.

I'm a little bit surprised that there's not been a suit filed

on behalf of, National Association of Independent Pharmacists or I don't know .

[00:05:10] Mike Koelzer, Host: So in some states they mandate the whole thing. You must use optum.

[00:05:15] Colleen Shields: In some states, very rare, but it's the biggest threat to any, anyone who's trying to take care of injured workers and 

any, 

and injured workers in general because then what happens? Okay. Everyone's healed. No one needs medications. It's just not good.

[00:05:35] Mike Koelzer, Host: Because they're gonna say you don't need it anymore. You've got to be healed. So much time has passed and obviously they don't want to pay, they don't want to pay more for it. So if they say you're healed, you're healed. 

[00:05:46] Colleen Shields: That's right. And there's no alternative and there's no competition.

But in, in the vast majority of states, they do in fact have a choice, despite the trickery and despite the these notices, which really are designed to deceive.

[00:06:03] Mike Koelzer, Host: Yeah. All so it's across the board, Colleen, because we've got even a local parish in our area. All of the people from this parish, the priest and the teachers at the school and so on, all get a letter that says, if you don't mail an order, your Kopey may quadruple this or that.

The hinge word is may that's not part of it. They just sent this out to scare people and they say it may happen. So they're going to use any trick. And so in this case, they're giving people the paperwork and they say, you got hurt. Here's who we use. It's got a picture of a person with a broken leg out in a wheelchair and all that kind of stuff.

And people think I can't go anywhere else. I can't go to my own pharmacy and I can't do anything else because this must be where I have to go. But that's not the case.

[00:06:54] Colleen Shields: Yes. And it's interesting to me being as, I'm not a pharmacist, I'm a pharmacy owner. And I've been involved in a lot of different types of businesses and things. And, normally pharmacists you all go get a tremendous amount of school with a large student debt and you're, that's what you do for the whole time.

I have a little bit of a different perspective, I think, because I'm a pharmacist. I've done other things too. And I can tell you that I would be putting these things on social media as an independent pharmacy organization. That is supposed to be paying dues to all those things.

Because it's deceptive. It's not right.

[00:07:39] Mike Koelzer, Host: I think a lot of pharmacists, we can see ourselves getting screwed by the PBMs. I'm glad for this episode because I think a lot of pharmacists the average pharmacist doesn't see a lot of workers comp and A lot of pharmacies just say no, because they had to do it on a paper claim 15 years ago, and they got screwed out of the 300 because the insurance didn't pay it, something like this.

Then these sales guys come in and they say, we've got these cards and we can help the sales guys, the brokers might go to the companies and even the pharmacies, they say, we're the local Workers comp thing, not telling you about the big spread pricing there. So I think pharmacists, personally, I'm talking at least we've stepped back from it because it's a pain in the ass.

We don't even want to think about doing it. And we don't want to think about the problems behind it.

[00:08:30] Colleen Shields: That's where I come in,

[00:08:32] Mike Koelzer, Host: What do you do, Colleen? How do you come in?

[00:08:36] Colleen Shields: So what we do is I'm a location, mhm, and we deliver and ship meds to all the states that were licensed in, and so when that prescription comes into us, we ship it. We fill it, provided it, passes CRSP and all that other pharmacy stuff, but clean, good, we're good to go.

It goes out. We're not looking for a pre authorization. We're not looking for a guarantee. We're not collecting a credit card number. We might not even have a claim number. 

That medication goes out. Could be 500, could be 1, 000. That medication's going out.

We hold that receivable and we know how to collect it.

[00:09:16] Mike Koelzer, Host: Colleen, I imagine then, the average pharmacy doesn't want to do that, number one. Number two, they don't want to get stung at the end by not getting paid. So I imagine there's gotta be... A little bit more profit in these claims than you're seeing in the average retail store for this.

[00:09:38] Colleen Shields: Yeah, because the reasoning is we don't participate in contracts.

So, because we are not reliant on our Medicare and Medicaid business or, we don't take good Rx cards and we don't, we just, we don't do any of that.

[00:09:59] Mike Koelzer, Host: yes.

[00:10:00] Colleen Shields: So we are not beholden to that contract.

[00:10:03] Mike Koelzer, Host: And outside of that, Colleen, aren't there certain laws that say that the workers comp claims have to be reimbursed at a certain level? 

There's laws on that. Oh, they're all different. They're all different, 

[00:10:19] Colleen Shields: And some states, it's mostly based on AWP, but in some states it's AWP plus 20 percent. In some states it's AWP plus 40 percent. Some states it's AWP minus 20 percent. That's not a very good state to do business in. And in some states the problem that I see is that They create reimbursements that are so out of whack, like NADAC or something, that you can't operate.

It's really, it's the elimination of competition. You might as well just be creating a situation where only the PBMs can survive.

[00:11:00] Mike Koelzer, Host: See, on our side of the business, Colleen, everybody who's listening to this is basically having to pay the PBMs for the honor of... Doing business for their patients. And it's why I get to be on here every week because we get to bitch and complain about it and all that kind of stuff, and hopefully find some solutions.

 Every pharmacist who heard those kinds of numbers from you is angry right now. Not at you. They're PBM for what they've done to us, I've got to think, all right, Colleen's making a lot on this. But she has niched herself for marketing and also for professional reasons into an area that you can't take every claim. And so you've got a lot of work to do to funnel that business to you.

And if you've done that correctly, and when you do that correctly, you get paid for it, 

[00:12:09] Colleen Shields: there's that. There's this huge risk.

I mean, I have cases where 30, 000 outstanding receivable.

I mean, But that's what I built my whole business on. And sometimes the cases are lost, and then also we can have a compensable case. I have one guy, a PTSD case.

And it was deemed compensable. And I think they paid $8.

[00:12:33] Mike Koelzer, Host: Compensable means that it's...

[00:12:35] Colleen Shields: He won his case.

And We've gotten 8 and I think he's got like 16, 000 outstanding. Now we gotta hire lawyers. Now we gotta go after that. There's a tremendous amount of work. This is not for

[00:12:49] Mike Koelzer, Host: The feign of

[00:12:49] Colleen Shields: the faint of 

heart.

It's not. 

[00:12:51] Mike Koelzer, Host: That's another question then, Colleen. Some of these you take up your own legal proceedings, I imagine, 

[00:12:56] Colleen Shields: Oh, yeah, I have full time lawyer on 

staff. 

[00:12:59] Mike Koelzer, Host: Is he really on staff you pay this person a ton of money 

[00:13:03] Colleen Shields: what would equate to, in many people's mind, a salary?

 And then I have a whole nother team that does loss mitigation on these cases.

[00:13:11] Mike Koelzer, Host: What does that mean?

[00:13:13] Colleen Shields: You have to analyze your risk, and you have to examine the case, and you have to understand. What that case looks like, and you have to have a legal hat, and then I have a clinical team, that's really understanding the nuts and bolts, and what kind of evidence do we need we understand that medication is related to the claim, but The insurance carrier doesn't, so what kind of documentation do we need to get to show that it is?

[00:13:37] Mike Koelzer, Host: So do some of these you reject before you fill them? Are there some that you say we can't do because this isn't clear enough that it's all the reasons you mentioned?

[00:13:47] Colleen Shields: The first script goes out, by and large. Unless it doesn't, pass CRSP or something. But that, actually, I can't even think of a time that's ever happened. I think the only thing that's ever come up is, yeah, it's early. We're gonna be sorry. You're gonna have to wait two more days for that.

so that first one goes out. And that's our value prop, we're going to take care of it. If your people refer me to somebody that they can't take care of, they wanna take care of, we don't solicit their commercial insurance.

We're not trying to get those other meds with it.

We just stick to it, we stay in our lane.

We stay in our lane strictly, we fill those meds, we get them out, then we do a full unpack of that case. And we're looking for loss mitigation strategies to understand our risk and how bad it is.

[00:14:34] Mike Koelzer, Host: So by giving the first one then that gives you like a 30 day buffer To decide on the next one or maybe 15 days or something, 

[00:14:44] Colleen Shields: usually 30.

[00:14:45] Mike Koelzer, Host: Colleen? How long have you been doing this? How long has your pharmacy been open?

[00:14:50] Colleen Shields: Rescue meds since 2021.

[00:14:53] Mike Koelzer, Host: 

So Colleen, what was your proof of concept with this, with the big numbers and the risk and all that? Obviously you can't just eyeball this with that kind of number. So how did you know this would work?

[00:15:07] Colleen Shields: With everything there's a silver lining, and I was in sales for a long time. I worked for a company called Injured Workers Pharmacy. known as IWP, which is the largest work injury pharmacy in the space. And really they taught me a lot. And I'm very grateful for my experience there.

And I left there and I started a company called Public Safety RX because I am particularly enthusiastic about it. public safety. So please fire EMT correctional. And my partners and I separated companies. They kept half and I took half kind of thing. And I opened in Maryland as rescue meds.

So I did the second company for three years and then did. This one. So all told it's been 13 years in space.

[00:15:58] Mike Koelzer, Host: So you already had the feel of everything

[00:16:00] Colleen Shields: Oh, I had five year projections, and I knew it. I know exactly to the day exactly how much we need to be filling, exactly what that revenue looks like, exactly the risk, everything to the letter.

 We do two big team meetings a week and everyone is accountable to their responsibility 

[00:16:25] Mike Koelzer, Host: did you pick Maryland for a reason? Oh, you live there. So it wasn't like there were certain laws that really allowed you to take off and kind of things.

[00:16:33] Colleen Shields: No. No, but this is where my my marketing network is and has been

 I'm very involved in the community here in the workers comp community. My husband's actually an optometrist, so he's. He's like a local celebrity here in Annapolis actually but not necessarily in the workers comp space although he's been seeing more because my attorneys are always looking for somebody to provide ratings on vision so he's been seeing some more and he's a very good practitioner

and it's a big huge risk but I'm a risk taker so I was okay.

[00:17:09] Mike Koelzer, Host: Colleen, when you think about things like a lawsuit going on here or a case going on here or waiting for something to happen or, waiting for a big claim to see if it's gonna come to fruition and all that kind of stuff. Is all that risk spread out in your mind, in other words?

Is that just part of doing the business? Are there any of those that rise above that level? Like Mike, whenever I have to deal with this or I'm waiting for this answer or something, do any of those get under your skin more? Or do you just get used to being in the area I hate attorneys.

I can't imagine spending more time with them than I have to, but you just get used to the top risk or is there any of that? Pop up above that level.

[00:17:56] Colleen Shields: From an emotional point of view, I think that I am very conditioned to risk tolerance.

I can't really think of a scenario that would necessarily cause me alarm that I've experienced so far.

[00:18:21] Mike Koelzer, Host: Cause it's like, what's the worst that can happen? Because none of it's going to push you out of business.

[00:18:27] Colleen Shields: But there are some changes coming. The Maryland Workers Compensation Commission is attempting to create a new fee guide. That's a concern. I think there's a lot of people involved that don't know anything about pharmacy and there's also a lot of insurance companies involved and not what we consider claimant friendly companies.

So that's a problem. That's really problematic. But like today, for example, I met with the actually several important meetings today, but one of them was with the Maryland State Economic Development Committee So I think that as long as there's like a fair fight

know what I'm saying, as long as there's a fair fight, almost nothing bothers me, but I sense that things are. Set up so that we as pharmacy providers, and we as advocates for the injured worker, don't have a fair fight against some of the biggest billion dollar companies in the world.

And the people that are there to protect us, they're elected, they're appointed by the governor, don't recognize that?

Geez, maybe this is, maybe we should listen to our constituency or, maybe we should be a little concerned about our people that put us here. That really bothers me a lot.

And that's a, that should concern everyone, I 

think. 

And I personally feel like for me, this is just a deep, I feel a deep sense of obligation to this business to my injured workers. We even started a foundation for them because, we call them, we say, hey, we just want to let you know that your prescriptions are being delivered tomorrow between 12 and 2. And they're like I don't know if I'm going to be here because my house is being foreclosed on and the sheriff is coming tomorrow. So we do have a foundation just recently set up for that, to address those urgent financial needs. Patients who are being really not treated well by the 

[00:20:24] Mike Koelzer, Host: sure. Sure. Colleen, out of your week, what is the. Hour of the week where you say, ah, I gotta do that. This is a pain in the ass this hour. Is there anything like that, that you wake up on a certain day, maybe weekly, maybe monthly, where you say this is a pain in the ass, this part of it.

[00:20:47] Colleen Shields: Oh gosh, this happens so often.

 I'm not a math or science person, but I am. Knee deep in spreadsheets all the time and knee deep in, in account with accountants and bookkeeping and data integration and we use Prime from merchant, micro merchants.

 And we use Salesforce. Trying to integrate these three systems together is challenging.

[00:20:51] Mike Koelzer, Host: But it sounds like that. It sounds like you'd have to do a lot of that, but that's a pain. What balance is that with your joy of that?

[00:21:00] Colleen Shields: Success.

[00:21:02] Mike Koelzer, Host: moving forward with the plans.

[00:21:05] Colleen Shields: Yeah, I set out a five year plan. And I knew exactly what I wanted, and I knew what I wanted to do, and how I wanted to do it, and we had a down, we've, we had a down month in July but other than that, we've been on track. As long as we're on track,

[00:21:23] Mike Koelzer, Host: How many people are in the company? How many full time employees?

[00:21:27] Colleen Shields: Nineteen.

[00:21:29] Mike Koelzer, Host: 19. I had a clue. I saw it on LinkedIn. There were like 12 people on LinkedIn in your company, so I knew it was somewhere in there.

Break that down, Colleen, the 19 roughly. What do you get? A couple of this, a few of this. How 

[00:21:40] Colleen Shields: We got five billing people. We've got marketing, Let's see, me... We have four. We have one technician, three pharmacists. We have two admin staff. Float implementers. And then I have off off payroll, but provide services, bookkeeping and accounting and legal and 

all that 

stuff.

[00:22:16] Mike Koelzer, Host: And Colleen, what percent right now Of your customers are in the area that you can use your own courier or they come in the store versus things that you're actually using the mail 

[00:22:31] Colleen Shields: and 

[00:22:31] Mike Koelzer, Host: to send out further

[00:22:34] Colleen Shields: probably 80 percent

[00:22:37] Mike Koelzer, Host: is in the area. 

[00:22:39] Colleen Shields: I don't know if I'm necessarily delivering that, we have a couple routes that 60 mile radius, but we deliver all over Maryland, we dispense to patients all over Maryland, but so I don't know what percentage of them are actually through the delivery drivers.

We've three delivery drivers.

[00:23:01] Mike Koelzer, Host: What percent are actually coming into the store? Any or some?

[00:23:05] Colleen Shields: Less 

than a half.

If somebody is nearby, like they work, like we have one fellow who worked across the street,

 It was funny because he didn't use us because he worked across the street. He used us because he was recommended to use us and then we're like, oh you're right across the street.

I did do COVID testing. during the height of that. And so people would come in then.

And they can come in. We offer that sometimes. But mostly it's delivered.

[00:23:36] Mike Koelzer, Host: Colleen, I imagine, I know I saw on your website there's some of the states where you do and some you hope to do and so on. Is that your growth where you would have one pharmacy and everything would come out of there?

And you would do it as far as you could go?

[00:23:55] Colleen Shields: Yes. Look, it's the most cost effective approach.

I'm always open to other ideas and things like that. But look, there's a lot of business to be had in a lot of different places. Imagine if you opened up something outside of an Amazon

warehouse. I don't know, or something with a significant amount of injuries.

That might make sense, but I... Then you have to relicense a whole nother facility. It's Reinspect and it's just oh 

[00:24:29] Mike Koelzer, Host: a pharmacy like yours your game plan, you have to funnel, you have to funnel it into you because you're specialized.

[00:24:37] Colleen Shields: yes. Yes, it's we're not like Oh foot traffic 

[00:24:42] Mike Koelzer, Host: Colleen, how close, Let's say that you had to only pull from a certain area. Where do you think, I'm just going to say like a breakeven point kind of thing. Where do you think you could remain in business with at least some profit if you had to.

Pull back. In other words, you couldn't survive as a business. If you're only able to pull customers from your block, and you probably can't do it within 10 miles. Not that you want to, but how close could you be to make it work

[00:25:17] Colleen Shields: I don't know about me. Maybe 80 miles or something, but you'd have to for your listener. They'd have to understand How much workers comp business is in that? How many injuries do you have in that area? And these are available; you can find this data on workers comp websites of each state.

They are required to publish data. 

[00:25:40] Mike Koelzer, Host: So yours might be 80 miles, but if you're in the middle of Wyoming, it might be 

[00:25:43] Colleen Shields: Exactly. 

[00:25:43] Mike Koelzer, Host: city, it's going to be 

[00:25:45] Colleen Shields: exactly. And then not only that, you, you have to have favorable laws in the state that actually care about the injured worker but I would say in terms of just The semantics of it Philadelphia probably could survive with Philadelphia,

Because it's heavily populated. It's got a significant amount of construction work and other work of that nature that's very dangerous.

Look at September 11th. 

Something like, what was it? 20, 2653 people I think died.

in the World Trade Center, but, over 26, 000 workers, have significant illness and 

injury from the pile,

from the recovery effort of that.

Just think about that. 

[00:26:28] Mike Koelzer, Host: So Colleen, if I came to you years ago and I said, Colleen, in your area, you can only do this radius. Are you still going to open your business? Would that be like an 80 mile radius? This is just fictitious. I'm not going to do it if I can't go out 80 miles and get that business.

[00:26:47] Colleen Shields: It's just too difficult and hypothetical to answer. I don't think that I would do anything that unless I knew exactly what that return looked like,

I think that would be a mistake. For example, like there are some areas where filing a claim 

there's a certain shame attached to it.

 I don't know if you're gonna get

[00:27:11] Mike Koelzer, Host: Workers are supposed to be tough 

[00:27:14] Colleen Shields: there's, look, there's shame, there's bullying, there's there's a sense that malinger there's a really big fallacy out there that, injured workers are faking or

something,

and, not to say there's nobody that takes advantage of the system, but really, I saw that 11 percent of all fraud is among insurance carriers.

And less than two are patients, injured workers. so it's just very difficult. 

[00:27:38] Mike Koelzer, Host: But 

how far could your business go out right now and, do

[00:27:41] Colleen Shields: still surviving? 

[00:27:43] Mike Koelzer, Host: Yeah, still surviving.

[00:27:45] Colleen Shields: I guess 90 miles.

[00:27:47] Mike Koelzer, Host: Ninety, hundred miles. Something like that.

[00:27:49] Colleen Shields: It'd be a significantly different business, 

[00:27:51] Mike Koelzer, Host: many percent are you going past 90 miles right now?

[00:27:56] Colleen Shields: maybe 20.

But, a lot of that has to do with the age of my company. You start here and you go and you go, and like, you know, my rep and myself, we can only get to so many events over a period of time. And as we continue to grow and continue to go to these, then your, your circle expands and you keep going like that.

[00:28:18] Mike Koelzer, Host: What's your dream, Colleen, when you started this? I know it's making some dough, and I know it's helping the injured and so on, but as far as what were some of the things that you thought about that you'd say, I never really pictured much more than this.

[00:28:35] Colleen Shields: It's so interesting because I am not really the type of person that can answer that. I think, every goal I have is set to the first, the immediate.

So like, today when I'm finished with you, I'll get on my computer and see how many scripts we did. The end of the week, I'll analyze how many scripts we did.

The end of the month, and I look at it like a really small bite size and then the end of the quarter and then the end of the year and then the phase, there's different phases and plans and then did I get to that phase, did I get to, so everyone I get really excited about. Oh, I got my first hundred patients.

Now I got it. My first thousand patients, so if you ask me what is the end? What does the last month of the five year plan look like? I wouldn't know the answer if I had to look it up. I just know what this month looks like. I know we got to get to you know what I mean?

And

 You don't want to grow too fast, you want to have excellent service, you want to have the most premium service available. if you screw it up, you're really in trouble, 

You want to have a great brand, performance.

I do have some ideas for other companies, adjunct companies and things. I try to not go too far off of my lane on that, but other sort of health care oriented companies within the comp space that I'm looking at we're also looking at cannabis and expanding there as cannabis is becoming more and more relevant 

in the workers comp space.

I'm really only interested in it as far as the workers comp space in the medical field, 

[00:30:09] Mike Koelzer, Host: Without giving away your secrets, when you talk about other companies in the comp space, you mean something in this, but not necessarily the pharmacy, some other ways to help these people. Share as much as you can on that.

[00:30:22] Colleen Shields: there's a lot of opportunity out there. There's a lot of things. I mean, think about it. Anything a person needs, , okay, that is normally through a baloney like contract of like commercial or government contract 

you can provide in comp without that contract by state mandate in all but let's say a handful of states

[00:30:48] Mike Koelzer, Host: Give me an example of that, what you just said 

[00:30:50] Colleen Shields: Okay, so what about transportation?

[00:30:55] Mike Koelzer, Host: Yeah, cause we covered so far the lost work and the medical, but these are some other things

[00:31:00] Colleen Shields: These are relevant, important things in comp. If you can't drive, what about transportation? What about DME

[00:31:09] Mike Koelzer, Host: And what does that mean though, that it's not in the contract, but it's in the comp? What does that mean?

[00:31:14] Colleen Shields: It means that the carrier is obligated to pay for it.

[00:31:18] Mike Koelzer, Host: Oh, it can't be like an optional thing. They have to when they sign up for this.

[00:31:22] Colleen Shields: as a provider, as an insurance carrier in space, you are required to provide that transportation so that your injured worker can get medical treatment.

[00:31:35] Mike Koelzer, Host: that's a legal mandate versus just something that's optional in these contracts.

[00:31:40] Colleen Shields: And they're also required to provide DME products.

[00:31:44] Mike Koelzer, Host: So you could set up some kind of a go bus thing. You could do DME with this instead of the other one, that kind of thing.

[00:31:52] Colleen Shields: They're also required to provide dental stuff. They're required to provide vision aids. Prosthetics. And then you have other things. You have imaging.

Then you've got surgery. You've got medical office visits. Then you've got depositions.

You've got IMEs. Independent medical evaluations. You've got ratings, so they rate your case. Interesting story, I'll tell you, actually. The Spanish pirates created this originally. Workers Comp. Funny story. If you lost a ring finger versus losing a thumb, they pay you X number of shillings, 

whatever it was, pieces of gold.

 If you lost your hand from here

down, you get Y number of pieces of gold. if you lost from here down.

So this is the original system of ratings.

We're gonna rate. How bad is the level of loss? Somebody has to perform those ratings, a physician, presumably, in some cases, you can put up a psychologist or a psychiatrist. These are all opportunities.

[00:33:06] Colleen Shields: I think it would be really fun to do too. I don't know if you've watched what's going on in England with regard to pharmacists, but pharmacists can prescribe their own meds.

Why is that? Because they're doctors of pharmacy. 

Duh!

You know what I mean? They know more about pharmacology than a

Physician,

you know what I'm saying? So it would be really fun to be on top of that wave too, somehow. And I think that there could be, we'll see what, we'll see what happens in the healthcare space and how many, how desperate we get for providers and things like that.

But,

[00:33:46] Mike Koelzer, Host: right now the AMA or whoever they don't want to bend until they have to probably do that stuff.

[00:33:53] Colleen Shields: That's what... Lots of other countries do it.

[00:33:56] Mike Koelzer, Host: Colleen, who are the bad players in this industry? And would be tempting just to say, oh, people faking it, we already talked about that. But who are the bad players? There's obviously some people, maybe some companies, some insurances we talked about.

Who's abusing this system?

[00:34:11] Colleen Shields: I did hear a report about some things that were going on in California that were really disturbing.

Like people, I heard a story once about the, and I don't know, it was an NPR or something, but these like family members would go work for the same employer and then suddenly quote, everyone would get injured, but

I don't think it's good to propagate that.

I've only personally come across that experience once ever where I've thought, and I think the problem is when people do that, it does leave a bad taste in the provider's mouth, and so that, that's mainly it, but I would say that I think that the PBMs are the worst ones, because what they do is they cloak themselves in this concept that we're saving money for the taxpayer, and it's all for the taxpayer. Totally absolute nonsense. I mean they literally have five streams of income

On a single patient.

And no transparency, and I'm sure you guys talk about it all the time, and it's just nutty, 

[00:35:13] Mike Koelzer, Host: Colleen, you wake up tomorrow and you're not allowed to be in the medical space, let's say, but you've got these skills and talents. And somebody says you've got to start a business. What space are you going to outside of medicine? Outside of comp, also.

[00:35:37] Colleen Shields: It's a very good question. 

Gosh, the first thing that comes to my mind is to go back to acting, but I was an actress originally.

[00:35:46] Mike Koelzer, Host: were. 

[00:35:47] Colleen Shields: mhm.

[00:35:48] Mike Koelzer, Host: What stuff did you like?

[00:35:51] Colleen Shields: Shakespeare.

[00:35:53] Mike Koelzer, Host: Oh, a thespian. Wow.

[00:35:58] Colleen Shields: I know. Gosh, that's such a good question.

Real estate investing, probably.

[00:36:04] Mike Koelzer, Host: Real estate investing.

[00:36:06] Colleen Shields: Real estate investing. I love business building. I love working with people to get them in their light and,

 Get them to see themselves as talent and skill set and moving them along and 

[00:36:22] Mike Koelzer, Host: how long have you been in the top leadership role with your earlier companies you were with, were you in a CEO role at all? Because it seems to fit your personality. And it seems like if you weren't in this role, it wouldn't quite fit. 

So when did,

[00:36:42] Colleen Shields: a smart, smart guy. 

[00:36:43] Mike Koelzer, Host: when did you finally get into this? 

[00:36:46] Colleen Shields: when I was at IWP, I have to say that I became very disenchanted because I felt that I was using one tenth of my talent and skill set. And it was really very frustrating for me.

And so my last role before starting Rescue Meds with Public Safety Rx, I was CEO.

Then I had investors step in and I was co president.

It was challenging. Had his challenges, but and, you know, thus I'm here. you can let your imagination run wild with that, but it was the best thing and I'm extremely grateful that there were a few people there that really taught me quite a bit in terms of numbers and and planning and implementing and leading and I, it was a nice learning 

transition for me

because I shared the risk, like even to my chagrin,

Okay, I shared that risk. So what a perfect learning time

To share the risk.

Now

We absolutely. killed it. We were incredibly successful and the plan that I had originally put in place worked. And so that was my learning ground and now it's all my risk, 

 I just took exactly what I learned and. From the last, prior to that, what, 10 years or whatever, and I implemented it and it's, we're much faster, much more efficient, have lower days outstanding, higher, all the metrics that you need to know, the cost of goods, and all that, and the write off margin, everything is just so much better, and I get to do it my way, 

and, 

[00:38:27] Mike Koelzer, Host: It's funny. You mentioned that Colleen, because I was just going to tell you, this is me. I think you're also stubborn. Are you pretty stubborn? In a good way.

[00:38:41] Colleen Shields: I am, but I'm actually oddly flexible on a lot of things.

[00:38:45] Mike Koelzer, Host: What are you flexible in and what are you stubborn in?

[00:38:48] Colleen Shields: If somebody has a new idea or a better idea or they want to improve an idea that I have, I'll listen to them. But once I say no, it means no.

[00:38:57] Mike Koelzer, Host: How many kids do you 

have? How old are they?

[00:39:01] Colleen Shields: Twenty three, twenty one, nineteen, and seventeen.

[00:39:05] Mike Koelzer, Host: And is that true with them too? When you said no, you meant no?

[00:39:10] Colleen Shields: No, not as much.

[00:39:12] Mike Koelzer, Host: I didn't think so. But in the business, you get to play that way at least.

[00:39:17] Colleen Shields: At least somebody listens to

[00:39:19] Mike Koelzer, Host: That's right.

[00:39:20] Colleen Shields: Ha, ha, Ha.

[00:39:21] Mike Koelzer, Host: It's like earlier when you said I was 100 percent correct. I don't get that with my employees. But at least they have to say you're correct and at least they have to listen to you.

[00:39:31] Colleen Shields: They don't have to say I'm correct all the time, too. And I tell them all the time. I'm not looking to be right here. 

I'm looking for feedback. This is the way we've done it. We'll see how it works. I also say, there's a lot of things I say for example, this is a test. This is a test. In other words, people get this thing in their mind that they have to do it this certain way, when there's so many ways to do it, you just gotta get to the end of it, 

and hopefully the outcome is where you want it. But there's a lot of ways to go about it, and you may think that this thing is going to work, and you try and try, you gotta pivot, it's not working. Gotta try this other thing, because that one didn't work. 

[00:40:04] Mike Koelzer, Host: When do you lose your temper? And I know we're not talking about your kids here now. In 

the workplace, where do you lose your 

[00:40:09] Colleen Shields: I won't lose it in front of people. But if somebody does not take my direction 

as explicitly stated on something that's extremely important that they know this much about, 

and I know this much about, And I'm just like, do X. 

And it's really important that you do X and they 

don't do it. George is like my husband's, why are you yelling at me? I'm not yelling at you. I'm just yelling.

[00:40:37] Mike Koelzer, Host: So you take your it gets your dander up, but you do it, you blow off the steam a little bit and then 

approach it, compose. You're supposed to let your frontal cortex catch up from your lizard brain

[00:40:52] Colleen Shields: self. Base self. Yeah.

[00:40:54] Mike Koelzer, Host: Yeah.

[00:40:55] Colleen Shields: That's a good point, it's not always easy, of course, but that's certainly, I try to keep my cool.

[00:41:00] Mike Koelzer, Host: I'm better now than I used to be. I've always Thought maybe the worst of a situation.

I'm a little bit better now.

[00:41:08] Colleen Shields: The worst.

[00:41:09] Mike Koelzer, Host: If I had a chance to think, why did someone do this? I would often think. They did it for the worst reason, 

but I wouldn't, but I wouldn't, approach it that way. I would approach it in a more thoughtful manner once my frontal cortex Caught up.

[00:41:28] Colleen Shields: up. 

[00:41:29] Mike Koelzer, Host: but I guess it prepared me for the worst situation of them being disrespectful or something I could prepare myself for.

It was inside of me if I needed it. Because of that. Thought already crossed me, but I didn't show that but what do you mean by pharmacist Colleen? Is that how pharmacists are?

[00:41:47] Colleen Shields: Everyone's a drug seeker. I'm like, okay let's just settle down and

unpack it. 

[00:41:53] Mike Koelzer, Host: I was gonna say that cuz I've got someone close to me a family member not directly but close and If it wasn't for a guy like that, where I knew his whole history of what his neck problem was from being in a certain construction business and stuff, I've been following his neck problem for 20 years since I met him.

If it wasn't for someone like that, I would think everyone was a drug addict. And if it wasn't for someone like so and I would think every workman's comp was a lazy ass this and that. And I can't help it. It's like it's on my radar.

[00:42:27] Colleen Shields: You guys are trained like that at school, I think,

[00:42:31] Mike Koelzer, Host: To look 

[00:42:31] Colleen Shields: to think everything is the worst because the board of pharmacy will think everything is the worst. First, and then, so you have to presume everything is the

worst 

Until you know it's not. It's crazy if you think about this. Think about this for a second. You have doctors self-dispensing out of their offices. Now who is doing that? 

Is a pharmacist there doing that? 

No. Is a pharmacy technician there doing that?

No. No, they're not. Do they have a high school diploma?

Are they vetted? Do, is there a background check? Have they been urine tested?

Like, why this double standard? 

It just makes me nuts. 

You said what gets me fired up? This

gets me fired up. 

[00:43:23] Mike Koelzer, Host: I think, though, with pharmacists, that physicians are trained in almost all professions where you have to. Make a decision and sometimes it's wrong, but you're making a decision. Pharmacists though, how traditionally it's been, I know these things are changing.

You don't really make the decision. It's all based on whether it's correct. It's gotta be a hundred percent correct. And you're never really putting yourself out there to make mistakes, physicians make mistakes and everybody makes mistakes, but pharmacists don't make mistakes. And so it's almost like, you're the best if you don't make the mistake, but you never even try something that can make a mistake.

[00:44:09] Colleen Shields: The way that I look at it and what I tell my people that I speak to in my world that I call on and I market to is that, we have the highest level clinical team available in the marketplace, bar none. And I can say that with total confidence for the state of Maryland as a workers comp pharmacy.

Okay. And then I say, have you called CVS lately?

How long did you wait on the phone? Did you actually get to speak to a pharmacist? I mean, People go crazy about CVS. Look, it's not you guys, it's not the pharmacists out

there, the CVS pharmacists. It's the people that are demanding your license.

 , so what I say is, to the people I call on , is that we have such an incredible clinical staff and what you don't understand is that the pharmacist and the doctor share the responsibility

that patient. They have a shared responsibility, so we do, we look very closely at our prescriptions and we collaborate and coordinate care in a way that is.

It's just simply not seen in the marketplace, and it's not because pharmacists don't care, it's

because they're overworked.

And they just simply don't have the time to sit there and scrutinize and say, why are there three NSAIDs on this?

and we do. 

[00:45:25] Mike Koelzer, Host: I'm the first one to say for years, We don't want to do mail order and this and that and it's better to talk to a pharmacist. Like, Yeah, it is. If you're comparing it to standard mail order or standard this or that. But once you get into things that are...

Specialized and deeper. Does it matter if I'm standing next to you or I'm on a screen with you across the United States? That's the form, but the function, what's happening, that is important.

[00:45:55] Colleen Shields: The financial investment into the expertise of pharmacists. I think it has been underrated and it should no longer be. This is a doctor of pharmacy. I say that. I put it on all the stuff that my pharmacists wear. The name tags and stuff. I make sure that it's there for them And here she shall be respected that way.

And trust me, they know a lot more about pharmacology than this physician right here. But, they're going to collaborate with them. Okay, and you're going to listen to my pharmacist. You know what I mean? I wish that more pharmacy organizations would push that kind of thing.

Because I think that community pharmacies are, Sometimes the only link people have, and I think that the question is like, how do you utilize your expertise, your education and your knowledge in a way that maximizes your benefit to the world? You can do that on the phone. You can do that on, zoom.

You can do that in person, but how, I 

[00:46:56] Mike Koelzer, Host: My thought is that we've got some pharmacists that are way over trained and some that are properly trained But I think most are way over trained and I think the industry the profession it was Sometimes a fast when they pulled on people, it pulled on students. It's like we don't Think that this profession does enough so we're gonna train you more instead of Using what you know and trying to get paid for that.

It was more like, we're gonna try to make you more attractive to the community, but you're already attractive with even a smaller degree.

[00:47:37] Colleen Shields: would 100 percent agree with you because I think that they put the cart before the horse.

[00:47:46] Mike Koelzer, Host: exactly. 

[00:47:47] Colleen Shields: I love the knowledge, but then they should be able to write. They should be able to have more say. Maybe, I think it's a risk averse, if we pulled a pharmacist, put them on a Myers Briggs scale or Clinton survey scale. I think that most pharmacists are pretty risk averse, very exacting, very diesel oriented, so maybe they wouldn't even want to be pharmacists anymore, 

[00:48:11] Mike Koelzer, Host: Do you think that's a combination of nature and nurture kind of thing? Like Some of those people went into it, but then it also trained them more to do that, and people that were maybe not as risk averse maybe never even went into it.

[00:48:23] Colleen Shields: yeah. I think that I'll give you an example. When they did our inspection. The Board of Pharmacy did our inspection. God love you, love y'all, my Maryland Board of Pharmacy people,

you're so great. But, just tell you one inane thing. They told me what to expect, but when they were like, everybody gets tripped up on the security system.

No problem. Just so they tripped it on purpose of course, to, to test it. And then they wanted to see a printout from... The security company that's monitoring it sent it to us in real time to show that it was tripped. 

Okay. So we did that. For 45 minutes. She just couldn't, she just couldn't, she didn't like the way it looked.

She said it looked different than

the inspector. The inspector, it appeared different. than other security companies print out looks. My point is that it is a top down thing. I'm sure that this girl didn't initially, like somebody has been browbeat somewhere to, to actually be caught up on this.

[00:49:31] Mike Koelzer, Host: Yeah! 

[00:49:32] Colleen Shields: Do you know what I mean? like... 

what kind of beatings took place to get 

someone to be like that?

[00:49:38] Mike Koelzer, Host: Exactly. Colleen. My wife and I went to a store. I wanted a big TV for our fireplace at our cottage, and we went to a store. I won't say the name, but we go to Walmart and. I said, how do we get this TV off of the thing and get it up front?

She said I have a cart. I'll bring it over. So she's like 17 or 18. So she brings this cart over and there's six boxes on the cart, empty boxes. Okay. She takes the first box up, slice, fold, flatten, and put it in a file in the box on the floor. Pick up the next box. Slice. She's like breaking down these boxes as we're waiting for this TV.

And I joked to my wife, I said, it's not her. It's whoever chewed her out last time for leaving boxes in that area. So it's always that. It's got chewed out by whom?

[00:50:42] Colleen Shields: Who's doing the beatings?

So I just 

think there should be some logic 

And there should be room for logic in this space.

[00:50:52] Mike Koelzer, Host: isn't it ironic that they're bringing their Honesty into the discussion when the whole thing is to catch thieves that are breaking into a pharmacy. It's like they're looking at the wrong end

[00:51:05] Colleen Shields: Yeah it's super bizarre.

 It's just shocking to me that this is accepted at all that this kind of thing, like I'm coming in as an outsider in, that's how I see it, and I see this stuff and I see where pharmacists lose their mind on a particular thing. I'm

Like, this isn't logical.

You understand? This is not logic. Like it's gonna be okay. 

[00:51:27] Mike Koelzer, Host: And here's the problem too is when I was out of the pharmacy for a while, I was out a few years before COVID. And so I put one of my pharmacists as a pharmacist in charge and the problem, putting her in charge without really having a financial background. Association, because she was really in charge of the professional rules and things like that, she didn't have money in her mind or efficiency really in her mind.

So we would have people waiting for an ungodly long amount of time to get the control drugs so they could count them this many times and then put this in a column and then subtract this and then do all that. And. I really didn't blame her. If I was in her position and if there was no connection to finance and I was going to get my ass chewed out or my licenses on the line for not doing this correctly, I'm going to double and triple check because there's no association.

There's no association of efficiency.

[00:52:25] Colleen Shields: It's bureaucracy at its finest.

[00:52:29] Mike Koelzer, Host: Golly, Colleen, thanks for joining us. And you're a sitting duck for me because I always try to put our guests in a good light, and I thought you were on the side of the. Pharmacy versus one of these creepy guys that comes in and tries to sell these comp plans to everybody.

And I'm glad you're on the light side instead of the dark side, but it was really interesting getting into the middle of that 

[00:52:56] Colleen Shields: It's been fun, and I appreciate you having me and I really want the best for everyone out there. I want the best for your listeners and yourself and I think there's a lot of ways that we can do this and I think it's great that you're helping other pharmacies and pharmacists get there.

That's really generous of you. Colleen,

[00:53:15] Mike Koelzer, Host: Colleen, how did they find you online?

[00:53:17] Colleen Shields: Rescuemeds. com

[00:53:19] Mike Koelzer, Host: Alright Colleen, keep it going. Thanks again.

[00:53:21] Colleen Shields: Thank you so much.