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Navigating the QME SeasCCWC Annual ConferenceJuly 18, 2014, DisneylandPanel Members:Rupali Das, MD, MPH, DWC Executive Medical DirectorRichard Newman, DWC Chief JudgeAnne Searcy, MD, Chief Medical Officer, Zenith Insurance Co.
Total QME Initial Panel 40,00020,000-201020112012Data through June 30 201420132014
QME Initial Panel Requests2010-201490,000Unrep panels80,000Rep 0102011201220132014Data through June 30 2014
QME PanelRegulatory TimeframesRegulatory timeframe45Current processing date4035302520151050Initial alData through June 30 2014
QME Specialties: MD/DO MMG Internal Medicine MOG Obstetrics and Gynecology MMH Internal Medicine-Hematology MPO Occupational Medicine MMI Internal Med-Infectious Disease MMO Oncology- Internal Medicine MMN Internal Medicine-Nephrology MOP Ophthalmology MMP Internal Medicine-Pulmonary MOS Orthopaedic Surgery (notSpine/Hand) MMR Internal Medicine-Rheumatology MTO Otolaryngology MNB Spine MHA Pathology MPN Neurology MTT Toxicology MNS Neurological Surgery (not Spine) MUU Urology
QME Specialties: Non MD/DO ACA Acupuncture DCH Chiropractic DEN Dentistry OPT Optometry POD Podiatry PSY Psychology PSN Psychology (Clinical Neuropsychology)
Small Drop in QMEs 2010-20144700460045007% Decrease4400430042004100400020102011201220132014
Top 10 QME Specialties:Chiropractic #1, Orthopaedic Surgery #24%3%Orthopaedic Surgery17%4%PsychiatrySpine14%7%HandPain MedicineChiropracticPsychology15%Internal MedicinePhysical Medicine & Rehab22%3%10%Neurology
QME Trend:Chiropractic Drops; Psychiatry 2011201220132014
Top 10 QME Specialties Requested4%3%Orthopaedic Surgery17%4%PsychiatrySpine14%7%HandPain MedicineChiropracticPsychology15%Internal MedicinePhysical Medicine & Rehab22%10%3%Neurology
Specialty Distribution Does Not ReflectPanels RequestedQME Specialties4%Specialty Panels Requested3%4%17%4%4%6%37%Ortho6%14%7%6% Chiro15%22%7% Pain8%3%10%11%11%Psych
QME Specialty PanelsAt-A-GlanceCredit: Roz Chast in The New Yorker, Jan 6, 2014
WCJ FeedbackLC 139.2 (d) (2): to be reappointed, a QME shallnot have had more than 5 evaluations rejectedby a WCJ within the previous two year period forfailure to meet minimum standards for reportsestablished by the AD or appeals board.
QME Evaluation and Report Quality LC 4628 contains mandatory requirements for medicallegal evaluations.– Failure to comply renders report inadmissible. [subdv. (e)]– Knowing failure to comply subjects physician to civilpenalty and possible termination of QME status orprobation. [subdv. (f) and (g)] AD Rules 49-49.9 [Article 4.5] establish minimum timeguidelines for neuromusculoskeletal, cardiovascular,pulmonary, psychiatric and other evlauations. Board Rule 10606 establishes elements that should beincluded in medical reports.– Failure to comply will not render reports inadmissible, butwill affect weighing of evidence.
Online QME Panel ProcessQME Online Request FormQME Panel RequestorQME Represented Panel Process FlowPROCESS STARTQME PanelRequestorcompletesonline form &uploads requiredattachmentsUser error messagerequiring formattingcorrectionsAre allrequiredfieldscomplete?YESSTOP PROCESSUser messageformineligible forQME panelNONOSTOP PROCESSUser message duplicateQME request.Display existing panel(s):*Issuance date,*Injured name,*Panel doctorsYESQME Panelcreated anddisplayed onscreenIs therequesteligible?NOYESIs therequest aduplicate?STOP PROCESSUser messagewith print and saveready QME panellist, form data& blank POSProof ofservice(POS)confirmation
Navigating the QME Seas CCWC Annual Conference July 18, 2014, Disneyland . Panel Members: Rupali Das, MD, MPH, DWC Executive Medical Director . Richard Newman, DWC Chief Judge
