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Thursday, May 24, 2018

QME Fee Schedule Proposal Prompts Call for Reassessment of Med-Legal System

  • By Greg Jones
  • State: California
  • Topic: Top
  • - Popular with: Legal
  • -  5 shares
Rather than trying to clarify the Medical-Legal Fee Schedule, some observers are suggesting that the…

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May 24, 2018 a 2:37 pm PDT

Table 12, which is the med-legal fee schedule, hasn't been updated since 1993 or something crazy like that. If we want quality physicians in the system, they need to be paid fairly. Not many people could survive without a raise for 25 years. $312.50/hour in 1993 is probably worth half of that today.

May 24, 2018 a 10:05 pm PDT

[deleted]

Sharon Renzi May 25, 2018 a 12:05 am PDT

Defense attorney rates haven't changed in that many years either. We still are forced to accept what insurance companies pay despite our level of expertise.

May 24, 2018 a 8:20 pm PDT

Better quality doctors want nothing to do with work comp system, no changes to fee schedule would make them subject themselves to depositions and haggling over a few percentages in impairment. The system does not have enough QMEs as it is, reduce payments and there will be even fewer.

May 24, 2018 a 10:05 pm PDT

[deleted]

Sharon Renzi May 25, 2018 a 12:05 am PDT

Defense attorney rates haven't changed in that many years either. We still are forced to accept what insurance companies pay despite our level of expertise.

Gary Nelson May 24, 2018 a 2:05 pm PDT

Many of the QME doctors are a joke. A good reform would include getting rid of the ones terribly biased for either side, and then paying the remaining doctors more money for the evaluations so that better quality doctors would be interested in signing up.

Ron Perelman May 25, 2018 a 5:05 am PDT

Here is the reality. There are less QMEs every year. As our medical population ages, younger doctors go to work at Kaiser, UCLA, etc. They can't afford a private practice., and get a salary. They want to practice "real" medicine. not report writing, which is some legal and some medical. All the QMEs are older doctors, some have basically retired. At present, we have about 1300 QMEs in the state and 400 of them received nonrenewal notices. Perhaps, that has been reversed, because of the recent lawsuit. Now, the DWC wants to make the disputed underground regulations, the law, so to speak. Please understand that as our QME pool ages, there may be even fewer. Several of our esteemed colleagues have recently passed away or retired.
Now the DWC wants to make it more difficult to be able to produce a report that is substantial medical evidence and can resolve complex medical legal issues. Let me explain- a history is performed that takes 30-60 minutes. Record need to be reviewed that are then woven into the history. The records can be an inch or two or 10+ inches. The doctor the sees the patient and asks questions based on the history. Sometimes, we find a prior claim that was not disclosed. This takes time A PE is then done and in many cases, Xrays are needed. Then the doctor sits down and makes a diagnosis. The case needs explanation and analysis. Causation may or may not be an issue. I see many denied CTs that require a complex explanation. Then there is a discussion where the case is is summarized to explain the theories of what exactly is going on. Then the factors of disability are addressed. These need to be appropriate. Apportionment, may need to be explained.Next are the AMA guides. To produce a well thought out report, takes hours. It takes multiple office staff. Once prepared, it needs to be proofed for errors. If the report is good, the case can be settled. If it is bad, it is worthless. How much is that worth? I fdoctors don't feel, it is not worth their while, they will stop doing these reports. Perhaps the older docs will retire, the younger ones will just see private patients. The fee schedule as it exists is very complex but it has been working. If these underground regs become law, then ML104s will basically cease to exist . If that happens, meaningful reports will not be able to be produced.There is the law of unintended consequences I believe the pre 2006 system was best for ML104s Time based $250/hr. No complexity factors, just pay for time. Attorneys are paid for time and these reports are like attorney work product. What I would like to see is QMEs and AMEs as part of the decision making system. If we all put our heads together, a fair fee schedule is possible. Please don't force this down our throats

Vincent Gumbs May 27, 2018 a 8:05 pm PDT

I agree 100% with Ron. By the time you add all the hours spent in producing a report, you are lucky if you are being paid $60.00 per hour!

Karen Ridge May 28, 2018 a 6:05 pm PDT

There is tremendous pressure put onto Q/AME physicians to resolve common sense dilemas . This is a result of a failing WC system. The physicians need to be paid their worth and agreed they are not, as many times the entire files are sent to the doctors (4 bank boxes) and these physicians need to sort out 15 years worth of treatment because no one has up to that point. There is NO incentive to have new physicians enter this system without reform, clean up and a whole understanding that WC needs to change entirely.

Karen Ridge May 28, 2018 a 6:05 pm PDT

There is tremendous pressure put onto Q/AME physicians to resolve common sense dilemas . This is a result of a failing WC system. The physicians need to be paid their worth and agreed they are not, as many times the entire files are sent to the doctors (4 bank boxes) and these physicians need to sort out 15 years worth of treatment because no one has up to that point. There is NO incentive to have new physicians enter this system without reform, clean up and a whole understanding that WC needs to change entirely.

John Hill May 31, 2018 a 8:05 am PDT

The agenda of the DWCs’ “underground regs” has been to eliminate QMEs from the system.
The purpose of the new purposed regs is to discourage QMEs from performing evaluations.
The goal of the DWC is to eliminate the QME report.
This would leave only one option to settle the claim. That would be the PTP report for which the IC has complete control. That is where the IC will save the most money.

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