James Witkop Jul 13, 2017 06:23 AM
I think we all knew that IMR, as written, would not last. It will be interesting to see what exactly happens next year.
Rhonda Wofford Jul 13, 2017 07:31 AM
It is human nature to do what you are paid to do. UR doctors get paid more money to deny care; than, to approve that same care. If a treating physician gets paid extra money to refer a patient for care, we call it a "kickback," and we rightfully prosecute that physician. Take the financial incentive out of having a UR physician denying care; and then, we can have UR decision rendered only based on what is medically "reasonable and necessary."
John A. Don esq. Jul 13, 2017 11:14 AM
If the patient, the PTP & the AME all say that the treatment is helping - how can the IMR ghost doctor keep saying it is not?
Pete Almeida Jul 13, 2017 05:41 PM
Our repairs/reforms are always instigated by one end of the bell curve. This bill is like a street by my house. The speed limit was 50 mph. A few 18-25 year olds were killed or injured while driving 90-100 mph late at night. The city responded by reducing the limit to 40. The cars are still doing 80+ at night. Treatment should be directed by the condition not the cause of the injury. 90% of the treatment requests were approved. Immediately accessible advocacy services - we can easily incorporate that into the duties of the existing "medical access assistants" that is part of the MPN. Incentivize the treating doctor and the injured worker by offering bonuses for better than expected outcomes. Why is the cost for treating personal injury cases so much less than workers comp? Since the study revealed that the problem was the treating doctor didn't document the need for the treatment maybe require treaters that do more than 10% of their practice in wc to attend continuing ed for MTUS and report writing. Set up a CURES type program to monitor providers that have a percentage of their treatment requests denied - they are either over treating or they need further training. Eliminate the excessive interpreter bills by including a billing modifier to facilities that have bilingual staff where the applicant signs a verification that he/she required interpretation and was satisfied with the interpretation. Get rid of the chiro QMEs - this only leads to gaming the system. Investigate whether there is any scientific, evidence based etc to support the existing presumptions.
Dr. Ron Perelman Jul 13, 2017 11:08 PM
Yes, the system needs reform, as far as treatment goes. We had reforms in 1989,1990, 1993, 2003, 2005 and 2012. With each reform, treatment has gotten worse. We have MPNs. If the employer has one, he needs to accept the treatment of his doctors, or why have an MPN? Still UR may be needed, but only for things like surgery. At present the UR companies are wedded to the carriers, not visibly, but if there are no denials, why are they needed? Unconsciously, they want the carrier to be happy, so they stay employed. Why not use CMA and COA, our medical societies to form UR groups. They would be board certified instate physicians. The carriers should be mandated to use them. They would pay the society, who would pay the reviews, who are beholden to no one. Meds, MRIs, consults should not require UR. IMR is a failure and would not be needed. Don't blame providers for not enough info. The carriers are supposed to supply IMR with a complete file