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Tuesday, March 5, 2019

Lawmaker Wants Auditor to Investigate QME Issues

  • By Greg Jones
  • State: California
  • Topic: Top
  • - Popular with: Legal
  • -  6 shares
A California lawmaker is requesting an audit of the qualified medical evaluator program to explore r…

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5 Comments (4 Replies)

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Lori McCoy Mar 5, 2019 a 2:03 pm PST

QME's are getting around this by scheduling multiple exams on a straight forward case. Maybe she should be looking into that instead!

Mar 5, 2019 a 4:03 pm PST

[deleted]

Shane Hutton Mar 5, 2019 a 4:03 pm PST

Absurd - cart before the horse argument. The system is doing a fine job in weeding out crooked and poor QME's - which leaves the good ones - not vice a versa

Mar 5, 2019 a 4:17 pm PST

The QME process is badly broken. Rarely is an initial evaluation scheduled within 60 days. Many, many low-quality reports. That is what happens when the remaining physician is the result of strikes from a random panel. While I understand that we will not be going back to party-selected, dueling QMEs, then maybe allow each party to request their own panel and select from the panel? That will do away with 100% of the QME games that are played under the existing system and will require the parties to utilize quality doctors.

Mar 5, 2019 a 4:03 pm PST

[deleted]

Shane Hutton Mar 5, 2019 a 4:03 pm PST

Absurd - cart before the horse argument. The system is doing a fine job in weeding out crooked and poor QME's - which leaves the good ones - not vice a versa

David Hall Mar 5, 2019 a 7:03 pm PST

As a QME, I see many cases that could be resolved immediately. However they are sent out for tx, or testing, and invited back for another bite at the $$apple$$

Ron Perelman Mar 6, 2019 a 5:03 am PST

I look at a QME exam as my chance to resolve a case. To do this I need as much information as possible. I am obligated to see the patient within a legally prescribes period. The records need to be in my office well before the visit, so they can be reviewed, and I know what has gone on before me. Unfortunately, there are no regs for this and so I am getting many records the day before or on the day of the visit. Yes, there are times when I need a consult or testing and need a second visit. I would rather just see the patient once, but it doesn't always work out that way.
Another problem is that I have needed various consults, and they are being denied by the adjuster. This shouldn't be allowed.
I believe those of us who are left doing these evals truly want to do a good job. Most doctors would rather just practice medicine.

Peggy Sugarman Mar 6, 2019 a 5:03 pm PST

Certainly, doctors would rather just practice medicine without having to request permission for every little thing. In our claims operations, I have instituted a preauthorization program with our MPN Clinics to fast-track a multitude of services for the first 6 months of the claim to try to achieve this. However, we must remember that treating physicians did have the "presumption of correctness" given to them in 1993 for the purposes of expediting care. What happened were huge increases in spinal surgeries that would be considered unnecessary according to today's guidelines, daily chiropractic care, and lots of abuses. We also have an opioid crisis. The challenge is to somehow provide a balance between ensuring that physicians have the space to do their work for the best interests of their injured or ill patients while limiting abuses.

Steven Chandler Mar 6, 2019 a 5:03 pm PST

When QME's and AME's bill such egregious amounts for multiple visits, it leaves one wondering where their loyalty remains - to the money or to the power. In one case, I sent an IW for a QME evaluation which resulted in an $18,000 bill. In another case, the QME examined an IW and drafted a report. AA subsequently drafted two separate interrogatories with one question each. The combined billing for this one exam and answering two questions equated to $27,000!! How does one exam and answering two questions equate to the equivalent cost of a mid-size sedan? QMEs are leaving in droves because the District Attorneys are catching on to their games of reporting 18+ hours of recycled research already used on multiple other IWs. The solution here is by no means to give more money. There needs to be an overhaul to the QME system so that unscrupulous and greedy QME's are no longer exploiting it for personal gain off the backs of the IW.

Ron Perelman Mar 6, 2019 a 7:03 pm PST

We all agree the ML billing system needs revision. It needs less complexity and more transparency. A flat rate for the evaluation and charges for records by the inch or hour basically is what is being considered. Anyone should be able to calculate the fee

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