Re: IME Testimony during the House Health Committee Hearing.

March 1, 2012

ph,

I don't believe I quoted any of your posts. Nonetheless, I would welcome a

personal visit from you. Perhaps we could sit down over a couple of beers and

discuss the matter. Please contact me off list if you would like to do so.

Burke

> >

> > I agree whole heartedly!!! We need to settle disputed within ourselves not

run to someone else outside our profession to " fix " our problems. I fear that

this has un done a lot of progress that has happened for us in Salem. This has

the appearance of our " in fighting " which most legislators shy ed away from

until we united. IMHO it makes us look weak and childish!!!! Now we have to

watch out that the legislature does not sees us as such and try to disband our

board and have us regulated by the medical board. How fun would that be!!!!

> >

> > Dr. A Caughlin DC CAC155 NW 1st Ave

> > Day, Or. 97845

> > office 541-575-1063

> > fax 541-575-5554

> >

> > rongrice@; mailto:%40

> > From: bluepearl2001@

> > Date: Fri, 24 Feb 2012 01:46:26 +0000

> > Subject: Re: IME Testimony during the House Health

Committee Hearing.

> >

> > This is very disappointing and upsetting to me. Everyone needs to take stock

and remember how precious our profession in, regardless of 'what side of the

isle' one might be on. Very, very disappointed to hear this.

> > Ann DC

> >

> > From: " G " <rongrice@>

> > mailto:%40

> > Sent: Thursday, February 23, 2012 3:33:14 PM

> > Subject: IME Testimony during the House Health Committee

Hearing.

> >

> > Dear Listmates.

> >

> > Yesterday at the House Health Committee hearing regarding how the OBCE deals

with complaints, specifically in regards to IMEs, three DCs testified in front

of the committee. Their testimony can be listened to at

http://www.leg.state.or.us/listn/.

> >

> > During that testimony, direct quotes from this DC List serve were entered

into the record of the House Health Committee hearing. I find this blatant

violation of List serve rules to be appalling. It is my opinion that the doctors

of record who were testifying at this committee, who violated these rules should

be expelled from having the privilege of membership on this list.

> >

> > Many forums on the net are anonymous. The reason we have signature

requirements on this list is that we are expected to respect everyone's opinion

here, realizing that this will ensure professional dialogue. When someone

violates that tenant, then the list will die and we will lose this wonderful

tool. It also speaks volumes to the integrity of the persons violating this

rule. If they are so willing to throw their colleagues under the bus in front of

the Oregon Legislature, especially when there are non-professional audience

members in the gallery, and when one of those in attendance was a medical

physician testifying on another matter, we look very unprofessional and it

appears to the audience that we need to have greater control put on us by the

Oregon Legislature.

> >

> > I would like to remind all of us, be careful what we say on this list, at

least as long as particular people have no concern about keeping our comments

private.

> >

> > Sincerely, and with tremendous respect for the integrity of this list.

> >

> > Grice, DC

> >

> > Albany, OR

> >

>

March 1, 2012

If we establish an "independent review" system in Oregon (diverse board--opinion reports only--no regulatory authority), that insurance companies, patients, and other doctors could refer cases to in order to get a TRUE independent opinion (and maybe even mediation/arbitration) the NEED for IME's from insurance companies would drop drastically.

It would be only those case that really fall "outside the norm" that would force the insurance company to utilize an IME...(so, here's hopin' we can find a solution to the IME dilemma in Oregon!). (:-)

RR

Re: IME Testimony during the House Health Committee Hearing.

Dr. Sears, Every IME report I have ever read is very careful to establish in writing that the visit is about evaluation, not treatment, and "a physician-patient relationship is neither sought nor created." In other words, I don't believe that the IME doc has any heightened legal responsibility.Also, I agree fully with the excerpt's author. While some small percentage of doctors are incompetent, poor documentarians, and/or loathe to re-evaluate regularly, whatever proportion that might be is absolutely dwarfed by the percentage of IMEs that result in the partial or total limitation of patient benefits. Anyone who reads these reports regularly knows how cynical, willfully ignorant or cherry-picking these reports often are, in service of their pre-ordained results. For all the straw man arguments about fraudster patients and PIP mill practices as continuing justifications for the IME industry as it presently exists, in my humble opinion, money continues to talk, and loudly. As of last week though, I'm happy to report that I have now come across a SECOND thoughtful, thorough, and well-reasoned DC IME report in my career as an attorney. Respectfully,Ben On Mar 1, 2012, at 1:07 PM, Sears wrote:> IME abuse cannot be dismissed as sour-grape opinions from a (semi-) private listserv, as witnessed in this article from The American Chiropractor mag, "IME Abuse: A Plan for an End." > > > To wit: "In a perfect world, the IME doctor renders a second opinion that allows for necessary care of covered issues of injured patients. However, in the real world, an IME doctor rarely gives an opinion that is in the best interest of the patient. In my 30 years of experience as a practicing doctor, a medical consultant, a medical-legal consultant that speaks to doctors in 46 different states and a former IME doctor, I have witnessed that the truth is usually not told by the IME doctor. The IME opinion usually sides with who writes the paycheck and, as the adage goes, it's always about the money!" See more at: http://www.theamericanchiropractor.com/articles-special-feature/5830-ime-abuse-a-plan-for-an-end.html> > Granted, we are each individuals before we are members of a particular group, so no one can be judged solely by his/her associations, My question is, does Oregon law treat IMEs as having the same doctor/patient relationship as the treating physician; or is it without such ethical protection of the patient (and the treating doc)?> > Sears, DC, IAYT> 1218 NW 21st Ave> Portland, Oregon 97209> v: 503-225-0255> f: 503-525-6902> www.docbones.com--Ben Attorney at Law1205 NW 25th AvenuePortland, OR 97210p. (503) 224-1787f. (888) 659-7963e. Ben@...------------------------------------All posts must adhere to OregonDCs rules located on homepage at: /Tell a colleague about OregonDCs! (must be licensed Oregon DC)

March 1, 2012

Thanks for your post Mr. . The February 2012 edition of The American Chiropractor has another article by Mark Studin, "Implementing a 'Code of Ethics' Can Help Prevent IME and Peer Review Abuse." It was this article that prompted me to post the "IME Abuse" article, as the current issue's not online yet. But, in the current issue, Studin offers an AMA Code of Ethics model that he believes could give some relief in this regard. I assume the latest article will be posted online eventually, and I would recommend it. Briefly, here are his comments on state code of ethics in this regard.". . . every national and state chiropractic organization has the ability to level the playing field in protecting both patients and doctors by having a code of ethics outlined and agreed upon by all of their members. This creates a standard of practice in the state and should an improper IME . . . be performed, then there are guidelines to justify recourse. Although some states have ruled that IME, IEP (industry employed physicians) and peer review doctors are not subject to state licensure disciplinary boards as a result of their interpretation of "duty of care" or the legal obligation of the doctor to the patient because they believe no doctor-patient relations exists, many states do hold the IME or IEP doctor to the same standard as the treating doctor. . . . Courts in New York, land, District of Columbia, Arizona, Michigan, West Virginia, Montana, and the US Court of Appeals, Fifth Circuit, among others, have ruled that these doctors are responsible in a doctor-patient relationship."It is from these comments that I question whether Oregon has such a code of ethics governing IMEs, IEPs and peer review doctors. Thanks again for your insights. Sears, DC, IAYT1218 NW 21st AvePortland, Oregon 97209v: 503-225-0255f: 503-525-6902www.docbones.comOn Mar 1, 2012, at 2:41, Ben wrote:Dr. Sears, Every IME report I have ever read is very careful to establish in writing that the visit is about evaluation, not treatment, and "a physician-patient relationship is neither sought nor created." In other words, I don't believe that the IME doc has any heightened legal responsibility.Also, I agree fully with the excerpt's author. While some small percentage of doctors are incompetent, poor documentarians, and/or loathe to re-evaluate regularly, whatever proportion that might be is absolutely dwarfed by the percentage of IMEs that result in the partial or total limitation of patient benefits. Anyone who reads these reports regularly knows how cynical, willfully ignorant or cherry-picking these reports often are, in service of their pre-ordained results. For all the straw man arguments about fraudster patients and PIP mill practices as continuing justifications for the IME industry as it presently exists, in my humble opinion, money continues to talk, and loudly. As of last week though, I'm happy to report that I have now come across a SECOND thoughtful, thorough, and well-reasoned DC IME report in my career as an attorney. Respectfully,Ben On Mar 1, 2012, at 1:07 PM, Sears wrote: IME abuse cannot be dismissed as sour-grape opinions from a (semi-) private listserv, as witnessed in this article from The American Chiropractor mag, "IME Abuse: A Plan for an End." To wit: "In a perfect world, the IME doctor renders a second opinion that allows for necessary care of covered issues of injured patients. However, in the real world, an IME doctor rarely gives an opinion that is in the best interest of the patient. In my 30 years of experience as a practicing doctor, a medical consultant, a medical-legal consultant that speaks to doctors in 46 different states and a former IME doctor, I have witnessed that the truth is usually not told by the IME doctor. The IME opinion usually sides with who writes the paycheck and, as the adage goes, it's always about the money!" See more at: http://www.theamericanchiropractor.com/articles-special-feature/5830-ime-abuse-a-plan-for-an-end.htmlGranted, we are each individuals before we are members of a particular group, so no one can be judged solely by his/her associations, My question is, does Oregon law treat IMEs as having the same doctor/patient relationship as the treating physician; or is it without such ethical protection of the patient (and the treating doc)? Sears, DC, IAYT1218 NW 21st AvePortland, Oregon 97209v: 503-225-0255f: 503-525-6902www.docbones.com --Ben Attorney at Law1205 NW 25th AvenuePortland, OR 97210p. (503) 224-1787f. (888) 659-7963e. Ben@...

March 1, 2012

For anyone to connote that IME and file review bias doesn't exist or that

there are no chiropractic and medical clinics (namely pain

management/percutaneous interventions) which treat excessively is simply not

reality. The Oregon Chiropractic Association our only state association that

is looking out for you is discussing this and other issues relative to abuse

in auto PIP and are going to address these issues head-on. The OCA is going

to be proactive and preemptive. We have a wonderful auto PIP law hear in the

great state of Oregon and we do not wish to lose it, we do not wish to go

through what Florida is going through which is due to fraud and abuse by a

few that state is about to lose its auto PIP....

Vern Saboe

Oregon Chiropractic Association

Re: IME Testimony during the House Health

Committee Hearing.

Dr. Sears,

Every IME report I have ever read is very careful to establish in writing

that the visit is about evaluation, not treatment, and " a physician-patient

relationship is neither sought nor created. " In other words, I don't

believe that the IME doc has any heightened legal responsibility.

Also, I agree fully with the excerpt's author. While some small percentage

of doctors are incompetent, poor documentarians, and/or loathe to

re-evaluate regularly, whatever proportion that might be is absolutely

dwarfed by the percentage of IMEs that result in the partial or total

limitation of patient benefits. Anyone who reads these reports regularly

knows how cynical, willfully ignorant or cherry-picking these reports often

are, in service of their pre-ordained results. For all the straw man

arguments about fraudster patients and PIP mill practices as continuing

justifications for the IME industry as it presently exists, in my humble

opinion, money continues to talk, and loudly.

As of last week though, I'm happy to report that I have now come across a

SECOND thoughtful, thorough, and well-reasoned DC IME report in my career as

an attorney.

Respectfully,

Ben

On Mar 1, 2012, at 1:07 PM, Sears wrote:

> IME abuse cannot be dismissed as sour-grape opinions from a (semi-)

private listserv, as witnessed in this article from The American

Chiropractor mag, " IME Abuse: A Plan for an End. "

>

> To wit: " In a perfect world, the IME doctor renders a second opinion that

allows for necessary care of covered issues of injured patients. However, in

the real world, an IME doctor rarely gives an opinion that is in the best

interest of the patient. In my 30 years of experience as a practicing

doctor, a medical consultant, a medical-legal consultant that speaks to

doctors in 46 different states and a former IME doctor, I have witnessed

that the truth is usually not told by the IME doctor. The IME opinion

usually sides with who writes the paycheck and, as the adage goes, it's

always about the money! " See more at:

http://www.theamericanchiropractor.com/articles-special-feature/5830-ime-abu

se-a-plan-for-an-end.html

>

> Granted, we are each individuals before we are members of a particular

group, so no one can be judged solely by his/her associations, My question

is, does Oregon law treat IMEs as having the same doctor/patient

relationship as the treating physician; or is it without such ethical

protection of the patient (and the treating doc)?

>

> Sears, DC, IAYT

> 1218 NW 21st Ave

> Portland, Oregon 97209

> v: 503-225-0255

> f: 503-525-6902

> www.docbones.com

--

Ben

Attorney at Law

1205 NW 25th Avenue

Portland, OR 97210

p. (503) 224-1787

f. (888) 659-7963

e. Ben@...

------------------------------------

All posts must adhere to OregonDCs rules located on homepage at:

/

Tell a colleague about OregonDCs! (must be licensed Oregon DC)

Links

March 1, 2012

Absolutely.

To fantasize that this is strictly about doctors note taking is to be naïve to the greatest order. There is no standard to the process. Rebuttals? When the Documentation has been rock solid and has determined a clear method of injury and justification for care, it proves there is something wrong with the system when a Rebuttal is necessary. It PROVES the IME was not performed correctly.

Somewhere in this thread someone mentioned that the legislature was minimizing the detriment of a poor IME to the patient. Allow me to give you the freshest example out of practice today March 1st 2012:

Patient was driving mother’s vehicle. They were at a stop and struck at 50-60mph. Seat backs broke (most of my cases don’t break the seatback). Patient and mother were sent to ER via ambulance. Patient suffered severe strains of Neck and Upper Back. She mentioned in the ER that her Ear hurt. They passed it off as the cervical collar pinching it.

Patient appeared 3 days after accident with extensive Whiplash/Strains and a compression fracture of T2. Treated for 8 visits and did a Re-exam. Pain levels dropped from 8 of 10 to 6-7. Wrote Report sent off called adjuster. Treated another 8 visits gradually instituting more motion and light strength. Did Re-eval. On this visit patient noted that she was having a “bad day” and the pain levels were the same if not exacerbated. She also noted that the ear pain had been getting severe and making her neck worse. She also has emotional problems and is medicated for depression and anxiety and she felt that emotional health was also the reason for the exacerbation....

All of this was noted. I mentioned in the report that she made mention of ear pain on ER visit initially and that I was sending her for a TMJ referral (she has obvious dysfunction). Sent report to adjuster with follow up call.

Today, 5 days after the last visit which was her last re-eval, she stated that the adjuster called her to inform her that she is being IME’d and all bills would not be paid pending exam. She’s freaking out, can’t keep the TMJ appt. due to fear of inability to pay, crying on the table as I was treating her, already a psychological wreck.......

Her mother is still being treated by a chiro, had less extensive injuries, has been seen at the same frequency and has not been ordered to see IME. However, the mother is the policy holder.

This is a case where it’s not even a Poor IME, but simply the order of one that has been detrimental to the patient and has no basis from what I can see. The adjuster told her he wants to make sure she’s receiving the proper treatment.

I’m pretty confident it was the order of the TMJ referral that caused the IME order, but at this point who knows. Our documentation is solid. She’s been seen 16 times. Today even mentioned that the pain levels have gone down, but that her ear is “killing” her.

Can’t wait to see the IME report on this one.

ph Medlin D.C.

From: M. s, D.C.

Sent: Thursday, March 01, 2012 6:20 PM

Cc: Oregon Chiropractors

Subject: Re: IME Testimony during the House Health Committee Hearing.

If we establish an "independent review" system in Oregon (diverse board--opinion reports only--no regulatory authority), that insurance companies, patients, and other doctors could refer cases to in order to get a TRUE independent opinion (and maybe even mediation/arbitration) the NEED for IME's from insurance companies would drop drastically.

It would be only those case that really fall "outside the norm" that would force the insurance company to utilize an IME...(so, here's hopin' we can find a solution to the IME dilemma in Oregon!). (:-)

RR

Re: IME Testimony during the House Health Committee Hearing.

Dr. Sears, Every IME report I have ever read is very careful to establish in writing that the visit is about evaluation, not treatment, and "a physician-patient relationship is neither sought nor created." In other words, I don't believe that the IME doc has any heightened legal responsibility.Also, I agree fully with the excerpt's author. While some small percentage of doctors are incompetent, poor documentarians, and/or loathe to re-evaluate regularly, whatever proportion that might be is absolutely dwarfed by the percentage of IMEs that result in the partial or total limitation of patient benefits. Anyone who reads these reports regularly knows how cynical, willfully ignorant or cherry-picking these reports often are, in service of their pre-ordained results. For all the straw man arguments about fraudster patients and PIP mill practices as continuing justifications for the IME industry as it presently exists, in my humble opinion, money continues to talk, and loudly. As of last week though, I'm happy to report that I have now come across a SECOND thoughtful, thorough, and well-reasoned DC IME report in my career as an attorney. Respectfully,Ben On Mar 1, 2012, at 1:07 PM, Sears wrote:> IME abuse cannot be dismissed as sour-grape opinions from a (semi-) private listserv, as witnessed in this article from The American Chiropractor mag, "IME Abuse: A Plan for an End." > > > To wit: "In a perfect world, the IME doctor renders a second opinion that allows for necessary care of covered issues of injured patients. However, in the real world, an IME doctor rarely gives an opinion that is in the best interest of the patient. In my 30 years of experience as a practicing doctor, a medical consultant, a medical-legal consultant that speaks to doctors in 46 different states and a former IME doctor, I have witnessed that the truth is usually not told by the IME doctor. The IME opinion usually sides with who writes the paycheck and, as the adage goes, it's always about the money!" See more at: http://www.theamericanchiropractor.com/articles-special-feature/5830-ime-abuse-a-plan-for-an-end.html> > Granted, we are each individuals before we are members of a particular group, so no one can be judged solely by his/her associations, My question is, does Oregon law treat IMEs as having the same doctor/patient relationship as the treating physician; or is it without such ethical protection of the patient (and the treating doc)?> > Sears, DC, IAYT> 1218 NW 21st Ave> Portland, Oregon 97209> v: 503-225-0255> f: 503-525-6902> www.docbones.com--Ben Attorney at Law1205 NW 25th AvenuePortland, OR 97210p. (503) 224-1787f. (888) 659-7963e. Ben@...------------------------------------All posts must adhere to OregonDCs rules located on homepage at: /Tell a colleague about OregonDCs! (must be licensed Oregon DC)

March 1, 2012

Trouble is how do you define an “improper IME?” Where is that definition found? What constitutes an improper exam? There be the rub…I wrote the original draft language to the “Evidence-based Outcomes Management” OBCE Admin Rule language with the strategy of using evidence based outcome assessment tools as the evidence based measuring stick by which to determine if treatment being review (IME/file review) was clinically justified. A double edge sword that was designed to swing both directions if the outcome assessments on re-exam failed to show a progression of care/improvement then curative care should end (MMI). Alternatively if the IME doc or file reviewer disregarded the outcomes that clearly showed a progression of care they would be in hot water. But here is the other “rub” doctors must perform the outcome assessments they must generate adequate chart notes and many is the time our colleagues are not….trust me I know I review many files as an independent expert. Yes, in my opinion there are biased examiners who work exclusively for the auto PIP insurers but there are also examiners who work for the insurers that are attempting to perform straight up exams. The “rub” is this, it is very difficult to support ongoing curative care when the treating doctor(s) has/have not performed timely re-exams implementing outcome assessments nor have adequate chart notes that one can actually read….leaving the examiner very little ability to support ongoing curative care….in short we could and must do a better job of documenting…..all of which is part of the equation when viewing the IME/file review issue….. Vern Saboe From: [mailto: ] On Behalf Of SearsSent: Thursday, March 01, 2012 6:36 PMBen Cc: Oregon ChiropractorsSubject: Re: IME Testimony during the House Health Committee Hearing. Thanks for your post Mr. . The February 2012 edition of The American Chiropractor has another article by Mark Studin, " Implementing a 'Code of Ethics' Can Help Prevent IME and Peer Review Abuse. " It was this article that prompted me to post the " IME Abuse " article, as the current issue's not online yet. But, in the current issue, Studin offers an AMA Code of Ethics model that he believes could give some relief in this regard. I assume the latest article will be posted online eventually, and I would recommend it. Briefly, here are his comments on state code of ethics in this regard. " . . . every national and state chiropractic organization has the ability to level the playing field in protecting both patients and doctors by having a code of ethics outlined and agreed upon by all of their members. This creates a standard of practice in the state and should an improper IME . . . be performed, then there are guidelines to justify recourse. Although some states have ruled that IME, IEP (industry employed physicians) and peer review doctors are not subject to state licensure disciplinary boards as a result of their interpretation of " duty of care " or the legal obligation of the doctor to the patient because they believe no doctor-patient relations exists, many states do hold the IME or IEP doctor to the same standard as the treating doctor. . . . Courts in New York, land, District of Columbia, Arizona, Michigan, West Virginia, Montana, and the US Court of Appeals, Fifth Circuit, among others, have ruled that these doctors are responsible in a doctor-patient relationship. " It is from these comments that I question whether Oregon has such a code of ethics governing IMEs, IEPs and peer review doctors. Thanks again for your insights. Sears, DC, IAYT1218 NW 21st AvePortland, Oregon 97209v: 503-225-0255f: 503-525-6902www.docbones.com On Mar 1, 2012, at 2:41, Ben wrote:Dr. Sears, Every IME report I have ever read is very careful to establish in writing that the visit is about evaluation, not treatment, and " a physician-patient relationship is neither sought nor created. " In other words, I don't believe that the IME doc has any heightened legal responsibility. Also, I agree fully with the excerpt's author. While some small percentage of doctors are incompetent, poor documentarians, and/or loathe to re-evaluate regularly, whatever proportion that might be is absolutely dwarfed by the percentage of IMEs that result in the partial or total limitation of patient benefits. Anyone who reads these reports regularly knows how cynical, willfully ignorant or cherry-picking these reports often are, in service of their pre-ordained results. For all the straw man arguments about fraudster patients and PIP mill practices as continuing justifications for the IME industry as it presently exists, in my humble opinion, money continues to talk, and loudly. As of last week though, I'm happy to report that I have now come across a SECOND thoughtful, thorough, and well-reasoned DC IME report in my career as an attorney. Respectfully, Ben On Mar 1, 2012, at 1:07 PM, Sears wrote: IME abuse cannot be dismissed as sour-grape opinions from a (semi-) private listserv, as witnessed in this article from The American Chiropractor mag, " IME Abuse: A Plan for an End. " To wit: " In a perfect world, the IME doctor renders a second opinion that allows for necessary care of covered issues of injured patients. However, in the real world, an IME doctor rarely gives an opinion that is in the best interest of the patient. In my 30 years of experience as a practicing doctor, a medical consultant, a medical-legal consultant that speaks to doctors in 46 different states and a former IME doctor, I have witnessed that the truth is usually not told by the IME doctor. The IME opinion usually sides with who writes the paycheck and, as the adage goes, it's always about the money! " See more at: http://www.theamericanchiropractor.com/articles-special-feature/5830-ime-abuse-a-plan-for-an-end.html Granted, we are each individuals before we are members of a particular group, so no one can be judged solely by his/her associations, My question is, does Oregon law treat IMEs as having the same doctor/patient relationship as the treating physician; or is it without such ethical protection of the patient (and the treating doc)? Sears, DC, IAYT1218 NW 21st AvePortland, Oregon 97209v: 503-225-0255f: 503-525-6902www.docbones.com --Ben Attorney at Law 1205 NW 25th AvenuePortland, OR 97210 p. (503) 224-1787f. (888) 659-7963e. Ben@...

March 1, 2012

The lack of a doctor/patient relationship allows the IME and/or file

review doctor to shred what paperwork he or she has been provided in

response to preparing for the exam, or generates during the evaluation

itself. When the IME/File reviewer destroys any and all paperwork, it

relieves them of having to defend the work they reviewed, or the

entirety of their exam. Whether their was a complete exam, or the exam

was auto created by their report software.

I truly believe the OBCE should change this situation. They should at

the very least require a doctor/patient relationship to be developed by

chiropractic IME and/or File reviewers. That way, the IME/file reviewer

would have to keep any and all paperwork for the requisite legal time.

This would eliminate any appearance that file reviewers sell their

signature to insurance companies or auditing firms for the sole purpose

of rubber stamping the denial of further treatment. A very simple fix

to this problem, at least in our profession.

Grice, DC

Albany, OR

On 3/1/2012 2:41 PM, Ben wrote:

> Dr. Sears,

>

> Every IME report I have ever read is very careful to establish in writing that

the visit is about evaluation, not treatment, and " a physician-patient

relationship is neither sought nor created. " In other words, I don't believe

that the IME doc has any heightened legal responsibility.

>

> Also, I agree fully with the excerpt's author. While some small percentage of

doctors are incompetent, poor documentarians, and/or loathe to re-evaluate

regularly, whatever proportion that might be is absolutely dwarfed by the

percentage of IMEs that result in the partial or total limitation of patient

benefits. Anyone who reads these reports regularly knows how cynical, willfully

ignorant or cherry-picking these reports often are, in service of their

pre-ordained results. For all the straw man arguments about fraudster patients

and PIP mill practices as continuing justifications for the IME industry as it

presently exists, in my humble opinion, money continues to talk, and loudly.

>

> As of last week though, I'm happy to report that I have now come across a

SECOND thoughtful, thorough, and well-reasoned DC IME report in my career as an

attorney.

>

> Respectfully,

>

> Ben

>

> On Mar 1, 2012, at 1:07 PM, Sears wrote:

>

>> IME abuse cannot be dismissed as sour-grape opinions from a (semi-) private

listserv, as witnessed in this article from The American Chiropractor mag, " IME

Abuse: A Plan for an End. "

>>

>> To wit: " In a perfect world, the IME doctor renders a second opinion that

allows for necessary care of covered issues of injured patients. However, in the

real world, an IME doctor rarely gives an opinion that is in the best interest

of the patient. In my 30 years of experience as a practicing doctor, a medical

consultant, a medical-legal consultant that speaks to doctors in 46 different

states and a former IME doctor, I have witnessed that the truth is usually not

told by the IME doctor. The IME opinion usually sides with who writes the

paycheck and, as the adage goes, it's always about the money! " See more at:

http://www.theamericanchiropractor.com/articles-special-feature/5830-ime-abuse-a\

-plan-for-an-end.html

>>

>> Granted, we are each individuals before we are members of a particular group,

so no one can be judged solely by his/her associations, My question is, does

Oregon law treat IMEs as having the same doctor/patient relationship as the

treating physician; or is it without such ethical protection of the patient (and

the treating doc)?

>>

>> Sears, DC, IAYT

>> 1218 NW 21st Ave

>> Portland, Oregon 97209

>> v: 503-225-0255

>> f: 503-525-6902

>> www.docbones.com

> --

> Ben

> Attorney at Law

>

> 1205 NW 25th Avenue

> Portland, OR 97210

>

> p. (503) 224-1787

> f. (888) 659-7963

> e. Ben@...

>

> ------------------------------------

>

> All posts must adhere to OregonDCs rules located on homepage at:

/

> Tell a colleague about OregonDCs! (must be licensed Oregon DC)

Links

>

March 1, 2012

Dr. Burke. I think we can put a quick and simple end to this

discussion, at least as it relates to the testimony you provided, if

you would simply state to this list, and your colleagues, what

percentage of IMEs you perform are done at the request of the

Defense, and what percentage of IMEs you do at the request of the

Plaintiff.

Along with this information, could you put into percentages, even to

the closest 10%, the reports you write where your opinion is that

the care provided to the patient needed to be continued, and what

percentage, again to the nearest 10% where you stated the care was

unnecessary, and should be stopped.

I think this entire list would be greatly appreciative of you if you

would simply put this information out there for us all to read and

digest.

Thank you in advance for your response.

Grice, DC

Albany, OR

On 3/1/2012 3:44 PM, mjqpdc wrote:

,

I quoted some of these same sentences from the American

Chiropractor article in my testimony to the House

Healthcare Committee last week. My point was that opinions

like these, which paint all IMEs with the same brush, have

prejudiced many in the profession, including members of

the OBCE, against chiropractors who do IMEs to the extent

that we can no longer get a fair hearing from the Board.

(Of course, Dave McTeague and Dr. Coté denied that in

their testimony.) Articles like this are divisive. They do

not increase anyone's understanding of what an IME is, how

it's done, or what the IME doctor considers in the

evaluation. It only fosters the erroneous idea that a

"good" IME supports the treating chiropractor's opinion

and a "bad" IME cuts off care. That is an extreme

oversimplification, but most people seem to be satisfied

with it.

There are chiropractors whose patients are almost never

sent for IMEs, and in those rare instances the IME

doctor's opinion usually supports the treating doc. This

happens because the treating DC does a proper intake

history and physical examination, makes a reasonable

diagnosis based on the available data, provides reasonable

and medically necessary care, and documents everything in

a manner that makes sense and is easily understood by

others reading the chart. Furthermore, in those cases

where the independent examiner provides an unreasonable

opinion not based on the available data, the treating

doctor is then in a position to rebut the IME effectively.

In our profession, IMEs are a highly contentious issue,

far more so than in some other healthcare disciplines. The

article in the American Chiropractor only serves to add

fuel to the fire. There is a lot more going on than can be

understood by assuming an "us versus them" attitude.

Respectfully,

J. Burke, D.C.

> > >

> > > I agree whole heartedly!!! We need to

settle disputed within

> > ourselves not run to someone else outside our

profession to "fix"

> > our problems. I fear that this has un done a lot

of progress that

> > has happened for us in Salem. This has the

appearance of our "in

> > fighting" which most legislators shy ed away

from until we united.

> > IMHO it makes us look weak and childish!!!! Now

we have to watch

> > out that the legislature does not sees us as

such and try to

> > disband our board and have us regulated by the

medical board. How

> > fun would that be!!!!

> > >

> > > Dr. A Caughlin DC CAC155 NW 1st Ave

> > > Day, Or. 97845

> > > office 541-575-1063

> > > fax 541-575-5554

> > >

> > > rongrice@;

> > > From: bluepearl2001@

> > > Date: Fri, 24 Feb 2012 01:46:26 +0000

> > > Subject: Re: IME Testimony

during the House

> > Health Committee Hearing.

> > >

> > > This is very disappointing and upsetting to

me. Everyone needs to

> > take stock and remember how precious our

profession in, regardless

> > of 'what side of the isle' one might be on.

Very, very disappointed

> > to hear this.

> > > Ann DC

> > >

> > > From: "G" <rongrice@>

> > >

> > > Sent: Thursday, February 23, 2012 3:33:14

PM

> > > Subject: IME Testimony

during the House Health

> > Committee Hearing.

> > >

> > > Dear Listmates.

> > >

> > > Yesterday at the House Health Committee

hearing regarding how the

> > OBCE deals with complaints, specifically in

regards to IMEs, three

> > DCs testified in front of the committee. Their

testimony can be

> > listened to at http://www.leg.state.or.us/listn/.

> > >

> > > During that testimony, direct quotes from

this DC List serve were

> > entered into the record of the House Health

Committee hearing. I

> > find this blatant violation of List serve rules

to be appalling. It

> > is my opinion that the doctors of record who

were testifying at

> > this committee, who violated these rules should

be expelled from

> > having the privilege of membership on this list.

> > >

> > > Many forums on the net are anonymous. The

reason we have

> > signature requirements on this list is that we

are expected to

> > respect everyone's opinion here, realizing that

this will ensure

> > professional dialogue. When someone violates

that tenant, then the

> > list will die and we will lose this wonderful

tool. It also speaks

> > volumes to the integrity of the persons

violating this rule. If

> > they are so willing to throw their colleagues

under the bus in

> > front of the Oregon Legislature, especially when

there are non-

> > professional audience members in the gallery,

and when one of those

> > in attendance was a medical physician testifying

on another matter,

> > we look very unprofessional and it appears to

the audience that we

> > need to have greater control put on us by the

Oregon Legislature.

> > >

> > > I would like to remind all of us, be

careful what we say on this

> > list, at least as long as particular people have

no concern about

> > keeping our comments private.

> > >

> > > Sincerely, and with tremendous respect for

the integrity of this

> > list.

> > >

> > > Grice, DC

> > >

> > > Albany, OR

> > >

> >

>

March 2, 2012

By the way,

As my long winded post indicates: It’s the ordering of the Exam that’s the rub.

IME’s validity and objectiveness aside, it’s having an adjuster without any medical training or education deciding to personally order an IME on a case where there has been absolutely NO cause to do so. This is where it all begins. Having people without any training stick their nose into the case and potentially adversely effect it, is ridiculous.

Anyone who thinks that these are always justified or that there HAS to be something wrong with the doctors record keeping etc. to trigger an IME order, simply hasn’t seen enough PIP patients. Period. Yes, Record keeping can be improved by many doctors and this will indeed help some avoid an IME. However, we’ve seen enough to conclude that the ordering of these exams is arbitrary. Some will say there are perhaps reasons that we don’t see or know of that cause the order. Again, to that I say, sure, perhaps on a case here and there. BUT, the overwhelming majority have no “secret” reason that we are unaware of except to see if they can get the persons care shut down.

Talk to any doctor that documents well and sees a lot of PIP. They will agree. A doctor who “rarely” gets IME’d simply doesn’t see a lot of PIP. Period.

ph Medlin D.C

From: ph Medlin

Sent: Thursday, March 01, 2012 7:04 PM

M. s, D.C.