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Monday, July 15, 2019

Legislation Would Give QMEs a Big Boost in Pay

  • By Elaine Goodman
  • State: California
  • Topic: Top
  • - Popular with: Legal
  • -  11 shares
A bill that would give a pay raise of at least 50% to physicians performing workers’ comp medi…

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James Witkop Jul 15, 2019 a 3:34 pm PDT

Long overdue. No one should go 13 years without a raise. We need additional regulations too. In represented cases THE PARTIES should be able to agree that the initial medical report can go out later than 30 days. Current rules only allow the Medical Unit to grant an extension. In complex cases with thousands of pages of medical records, it is not reasonable to demand a quality med-legal report within 30 days and the parties should have more control over the process than they currently do, which is almost zero. This will reduce the need for multiple supplemental reports due to an initial report that was rushed due to time constraints.

James Witkop Jul 16, 2019 a 2:51 pm PDT

A fair rate has nothing to do with overbilling. The goal of a fair rate is to keep good physicians in the system and attract more of them. A low rate results in a limited number of low-quality QMEs and encourages the very things about which you complain. I know too many good QMEs who have given up their QME status simply because they are not fairly compensated by the system.

Jonathan Ng Jul 16, 2019 a 7:23 pm PDT

If there were such egregious abusive billing cases you could simply turn it into DWC and they will drum the QME out in no time.What we see in the QME trenches is being nickled and dimed to death at a payment rate that is half of a new Law school grad.

Steven Chandler Jul 15, 2019 a 3:07 pm PDT

Inadequate reimbursement? I see invoices regularly padded with so much fluff and regurgitated 'research' that it makes me sick. Multiple exams just to get an opinion and only after a certain billing quota has been met. I've regularly seen invoices that are $k, $10k, and even $18k - for ONE EXAM! And, you want to increase this? How about collecting data on how much QMEs bill. They need only to attest under penalty of perjury that they spent x amount of hours for this and that. I had one who billed an hour just to review his signature. Another (once) prominent QME/AME billed over $27k for one exam and 2 subsequent reports which each asked one question - is weight gain a result of the industrial injury? Seriously - the value of an average mid-size car is being billed and paid and this needs to be increased? Heck no! I haven't seen a report under $1k in years. Even when the cover letter is written so specifically to only address one issue, the boilerplate reports come back addressing multiple items with no specificity causing even further dispute. The issue here is not about money - it's about enforcing the rules and getting rid of those who milk it for everything its got.

Dr Jul 17, 2019 a 9:07 pm PDT

See also Workcompcentral column, 2019-07-12, re "Bad Faith Changes to Regulations Have Good Chance of Passage," changes potentially harmful to injured workers and the proper use of QME evaluations. -- robert L. weinmann, MD, San Jose

Dr Jul 17, 2019 a 9:07 pm PDT

Parties interested in how regulators may want to change rules and regs re QMEs should also look at Greg Jones' News item in Workcompcentral News dated 2019-07-10 -- entitled "Med-Legal Providers Say Changes to WCAB Rules will Delay Payment." This piece quotes Suzanne Honor-Vengerov, owner of Honor System consulting, Assemblywoman Blanca Rubio, State Auditor Elaine Howie, and the undersigned. -- Robert L. Weinmann, MD, San Jose

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