Reprinted from the California Worker’s Comp Review. Reprinted exactly as published..
Vol. 9, No. 8 April 28, 1999 Other articles may be downloaded from their site at: www.cawcadvisor.com for a small fee.
Updated QME Regulations Undergo Public Review
Nearly 100 pages of Industrial Medical Council regulations are undergoing a host of changes, including several that will impact literally every one of the state’s nearly 4,000 Qualified Medical Evaluators.
The new QME regulations will give the council authority to lower by 50 percent the annual fees assessed QME’s, simplify many of the forms evaluators and injured workers use and make it easier for disabled physicians to join the evaluator ranks.
Also included in the draft regulations are a more detailed definition of face-to-face time and a 60-day deadline for submitting supplemental reports.
The updated regulations will be reviewed when the IMC meets May 20 in South San Francisco. After that, the regulations undergo a 45-day public comment period, followed by a public hearing.
"A lot of things will change based on the input of the public," said David Kizer, the IMC attorney overseeing the regulation changes. "Every time we’ve done this we’ve gotten some really good suggestions from the public."
Doctors who do more than 25 medical-legal exams a year will see QME fees drop from $500 to $250 a year. Those who do from 11 to 24 evaluations a year will pay $125 annually and QME’s who do 10 or less medical-legal reports a year will pay $110.
The dramatic cut in QME fees was approved last December by the IMC. Kizer said it takes a regulation change to put the fee reduction in effect. Since the fee cut is being processed as part of the update of all QME regulations, evaluators will see their fees drop when the full set of new regulations take effect later this year, he said. Most QME’s won’t begin paying the reduced fees until 2000, Kizer said.
The IMC reduced fees because it has a $4 million surplus – an amount that exceeds its annual budget.
Another feature of the regulation changes is a new section that sets 60 days as the deadline for submitting supplemental reports in unrepresented cases. The current regulations are silent on how promptly such reports should be submitted.
The proposed regulations amplify the current definition of face-to-face time by saying this standard is met when the evaluation is "in direct face-to-face physical contact with an injured worker." The word "physical" was added in the new regulation. Likewise, the regulation says face to face time can’t be considered as "time spent by the injured working in a waiting room or area." Kizer said he expects the face-to-face wording to be further refined after public input is received.
Face-to-face time became an issue last year when an Orange County doctor was hit with 67 felony charges because he counted the time patients spent in the waiting room as face-to-face time. A judge threw out the case, which was based on an alleged violation of a Labor Code Section, not the IMC’s regulations.
"We’ve had complaints that some physicians don’t get supplemental
reports to parties in a timely manner."
---David Kizer, IMC attorney
The regulation update includes a section that allows physicians who are retired due to a disability to qualify as a QME under special ""retired physician""status by having 10 years experience in worker’s compensation medicine. The standard is higher for other retired doctors.
Kizer said several forms used by doctors and injured workers have been updated, "We tried to give them more information, and at the same time we tried to simplify the forms."