More on Independent Medical Review Pay

Monday, February 25, 2013 | 0

In two recent posts I've examined the issue of what doctors will be paid to do independent medical reviews (IMRs) under the new system that has gone into effect for post-1/1/13 cases.

Greg Jones of WorkCompCentral.com has been covering this issue. In a piece posted Feb. 13 on the website, Jones quotes from an interview with Michael Gavin, an executive with a Georgia based company called Prium Medical Cost Management Services.

Apparently Gavin is skeptical of the constitutionality of a non-appealable IMR system. That's an issue that will be sorted out by the courts.

Gavin was asked about concerns that the IMR reviewer will not sift through a voluminous amount of medical records that may be submitted to demonstrate the rationale for treatment.

Jones quotes Gavin as saying that there is no reason to burden the IMR doctor with voluminous records or any more information than was submitted with the original request. Gavin apparently argued that the data set available to the IMR reviewer should be the same as was offered to the utlization reviewer.

There's a problem with that, though.

First, the rules on what a carrier must provide to the UR reviewer are very lax. Any workers' comp attorney could tell you that carriers often send very little information to the UR reviewer. Important test results are sometimes omitted. Records documenting what treatments worked and what treatments did not work are often not submitted.

The UR reviewer often has very scant contextual medical documentation. UR reviews are often done on a "top sheeting" basis.

The recently adopted IMR rules require the adjuster to send more information to the IMR reviewer.

That's as it should be.

If Gavin is advocating for a form of IMR that is really a second-level UR, that's not what seems to be contemplated by the IMR rules.

So it is not mere quibbling to have concerns over whether doctors will be paid adequately to do a thorough job in doing an IMR which is essentially non-appealable.

But David DePaolo, publisher of workcompcentral.com has an interesting take on the issue.

Readers should check out DePaolo's argument on his DePaolo's Work Comp World blog with his piece titled "It's Not What IMR Costs, But the Costs of IMR".


<i>Julius Young is an applicants' attorney for the Boxer & Gerson law firm in Oakland, Calif. This column was reprinted with his permission from his Workers' Comp Zone blog.</i>