Job Changing, Again, for California AMEs
Saturday, December 3, 2005 | 0
by Bill Zachry
In the past, new legislation and regulations forced Agreed Medical Evaluators (AMEs) to acquire new knowledge, skills and responsibilities. With the passage of SB 899, which instituted the use of evidence-based medicine, objective standards for measuring permanent impairment and new apportionment rules, interested California physicians now require additional training to develop the skills needed to become an effective AME.
The AME role in the California workers compensation system is important because it helps the parties resolve complex medical and legal issues. Good AMEs result in faster benefit provision to injured workers and facilitate prompt resolution to complex litigated claims. With the advent of the new legislation, there are currently not enough AMEs in the system that have the appropriate skills and training.
Prior to the mid -1990s, the primary role of the AME was to provide an independent, quality medical-legal evaluation of the injured worker. Generally, the best AMEs had excellent medical credentials. They reviewed the medical records and comprehensive medical evaluations, obtained all necessary medical tests, and provided a thorough review and analysis of the existing records. Additionally, they provided a reasoned analysis of the current status of the injured worker with regard to permanent disability (PD) and the prospective need for future medical care.
AMEs occasionally opined on causation for more complex medical issues. Comments on apportionment were typically focused on dividing the PD cause between defendant employers.
During the 1990s, changes in the law changed the role of AMEs. The implementation of the Primary Treating Physician (PTP) presumption resulted in a carnage in the role of the AMEs. The increased use of work preclusions to determine the extent of permanent disability also supplanted the need for the prior, highly developed clinical skills of the AME.
The implementation of the work preclusions also led to large discrepancies between applicant and defense medical reports. Because the evaluations were based on subjective complaints, many AMEs became mediators of discrepancies in subjective opinions (rather than providing independent objective medical evaluations).
SB 899 was a complete overhaul of the workers compensation system that will require new skills of AMEs.
A new PD system (based on the 5th edition of the AMAs Guides to the Evaluation of Permanent Impairment) has been put in place. Unfortunately, few workers compensation physicians in California are well versed in the new PD rating system. Software programs have come onto the market and many training programs are available for training in this specific area.
New apportionment rules will require that AMEs be highly skilled in determining the apportionment between the different systems, and between industrial and non-industrial factors, particularly in cumulative trauma claims.
Based on ACOEM Guidelines, all medical treatment is now subject to objective treatment standards and evidence-based medicine. The AME must now have a working knowledge of the guidelines and follow its diagnostic and therapeutic recommendations.
Though much of the old Vocational Rehabilitation system has been abolished, the AME remains responsible for describing and characterizing the physical capacity of the injured workers, and their capacity/limitations for return to work. This is important because employer accommodations committees must know what the employee can and cannot do regardless of causation.
It is clear that both old and new AMEs will once again be required to learn new skills. Participation in ongoing multifaceted educational efforts will be required for individual AMEs to acquire the knowledge and skills needed to perform at a world-class level. Increased expectations of AMEs must also be matched with just compensation, and the new medical legal fee schedule proposed by the DWC (supported by the employer community) will significantly increase fees for the first time since 1995.
The DWC, medical community and claims payer community should work together to create the necessary training programs and ensure that AMEs get the training they need and compensation they deserve.
Article by Bill Zachry,
VP Corporate Workers Compensation,
Safeway Inc.
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The views and opinions expressed by the author are not necessarily those of workcompcentral.com, its editors or management.
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