A Doctor Tells Us How To Make Workers Compensation IMEs More Useful

A Look at Today and a Quick View to Tomorrow

Today
Most of us are aware at the macro level an Independent Medical Exam (IME) is a medical exam meant to deliver an independent medical opinion for the purpose of determining, if possible, root causation of a given condition and the necessity along with appropriate level of any further treatment. The IME should be performed by a physician with credentials and training necessary to deliver the opinion and with no connection to the current patient treatment. The independent physician will first review the case medical file with all associated films and medical history, then, if not just simply doing a Record Review, see the patient for an exam. The physician will dictate notes from the exam and a final report will be delivered back to the IME requestor.

Several factors play into a well delivered IME.

1. First and foremost, a qualified physician must be found to execute the exam. Qualifications vary by state in terms of Workers’ Compensation certification, but in all cases an IME is best executed by a State Board Certified physician. In a very close second, validation must be made that the physician has never had a loss of license to practice, never had a loss of drug license and is currently seeing patients with no more than 20% of patient load being devoted to IME work. If a physician has been reported to a medical review board, records should be fully reviewed to determine if the incident could have any negative impact down the road should the physician need to go to deposition or take the stand. The above precautions on physician selection all play a part to lowering workers’ compensation costs by making sure only well-qualified physicians are handling these cases. IMEs performed by physicians not meeting the above conditions will most likely be thrown out under cross in court and new IME’s will have to be ordered.

2. The requester’s part in this process should be to deliver to the physician a set of questions outlining exactly what needs to be answered by the exam. The number of questions is generally less than 10 but in some very complicated cases can be as many as 15 – 20. By committing every time to taking this step, the requester draws a firm line around what should be discussed by the physician. This is the one step where the requester can take a forward leadership role versus having tangents or introducing elements that were of no concern. This in no way means that there is influence over the unbiased nature of the opinion, but it does mean the requester offers guidelines to what needs to be discussed.

3. Once a competent physician is found, the goal is to deliver an IME report that answers the requester’s questions in an unbiased, medically sound manner based on current accepted literature within a given medical specialty. Preferably, the IME report will give a brief synopsis of medical history and how it relates to the current condition followed by answers to the questions, and â€˜only’ the questions, in order, using language similar to that posed by the requester. This method of reporting provides clarity while following the requester’s direction.

The following items of concern are controlled differently in almost every state and include the allowance of videotaping during an IME, attendance by court reporters, and audio only recording. These concerns will not be elaborated on here as this is a whole discussion in and of itself. Next, fees for executing an IME may also be predefined under a given state’s laws or may have no boundaries at all. The key here is to be well versed in the laws of each state where one must request an IME as they directly affect process, level of effort and cost.

IME Companies
Digging a bit deeper, as most are aware, the process around delivering an IME has many more moving parts and several of which are highly time consuming, hence costly. IME companies began with the idea to not only connect physicians with requesters, but also to take over many of the time-consuming processes to offer requesters savings in personnel, level of effort and of course financials. Most IME companies have a panel of physicians they offer their clients. IME company physician panels vary greatly in number of physicians, geographic scope and specialties covered. Some IME companies will offer to search out physicians for a requester for a fee or for free. A good IME company’s physician panel should already be prescreened for the physician conditions noted earlier.

Additional services offered by IME companies can include some or all of the following: collecting medical records, scanning paper records into electronic format, using medically trained personnel to thin and organize medical records, setting up patient appointments, offering dictation and transcription services for physicians, and offering requesters standard report formatting. Some IME companies offer medical/legal review by nurse paralegals who make sure the medical opinions fulfill all of a requester’s questions and do so in a legally meaningful way. This quality control check acts as a large cost saver by reducing the need for addendums and reducing the number of additional IMEs.

In addition to offering the full range of services, there are several other key points to factor in when searching for a good IME company:

1. Make sure the company follows the three main areas of a well delivered IME from above.

2. A requester should have a list of physicians to select from within one (1) business day if no physician search is required. If a search is required, a list should be delivered within five (5) business days of a request.

3. Creating an appointment should happen within 24 hours of selecting a physician with most within a few hours. Specialty does not matter to make an appointment.

4. The actual appointment, pending on specialty, should be set generally within two weeks (10 business days) of selecting the physician. One note, it is not uncommon for â€˜highly specialized’ physicians to take up to 25 business days to work in an appointment.

5. The best fee structures are typically “all-in” fees. This means whatever has to occur to get the report delivered for the IME is covered. Just think the spaghetti sauce motto – “it’s in there.” A la carte pricing may look good on the face, but time has generally proven this scenario ends up costing more to the requester in the long run.

6. Web access in a HIPAA compliant environment to review case files and check status has begun to be a bigger part of the process. This can be a plus and, in larger customers, may be a requirement.

Tomorrow

As we move toward the current administration’s healthcare reform, the amount of oversight and influence of laws being set up by the federal government will play in this field is still unclear. The one thing that is certain is more influence is surely coming.

Almost as a preemptive move, the trend at the top end of IME delivery is rapidly moving to consolidation of IME companies into larger national IME provider networks. The insurance industry at the very top end has also started to pick up on this trend by eliminating regional IME companies and building central processes to utilize only a handful of national IME provider networks. The move is stated by the carriers as a cost saving effort. In their defense, the point of safety in numbers because of uncertainty must be considered. The concern in this move for the carriers and IME providers will be in taking greater effort with quality control and patient care.

More workers re-entering or moving to litigation because of a lack of proper care in the system does not save anyone. Unfortunately, in the short-term, most of the level of effort of quality control and problem solving will be placed on the shoulders of already stretched front line claims adjusters. Ultimately this trend toward consolidation will need to be watched to see if it is truly in the best interest of the patients and actually supports the purported cost savings.

In the middle portion of the market and for the foreseeable future, regional IME companies are still strong and viable choices for assisting with this type of work and many times offer similar or more services for similar costs. These regional companies are motivated to earn a requester’s business and should be more responsive to a requester’s needs in order to secure longer term relationships. The service relationships should bare additional cost savings for requesters coupled with an ease on the constraints of requester’s own work force. (workersxzcompxzkit)

At all levels, the industry will be keeping a watchful eye as to the final direction of the federal government and its reform efforts. This legislation will surely make changes for all of us. Until then, smarter IME companies will find a way to continue to improve and put themselves into the best position possible to take necessary advantage of whatever the administration finally delivers and use that for the continued service of requesters.

Author: Dr. Jared Salinsky, D.O. We welcome as a guest writer, Dr. Jared Salinsky, DO, Chief Medical Officer with InMedEx. Contact him at email: JSalinsky@inmedex.net; www.InMedEx.com or by phone: 727-514-2259.

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Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker about workers’ comp issues.