Guest guest Posted March 15, 2012 Report Share Posted March 15, 2012 Storm clouds, the Oregon Chiropractic Association is being proactive and pre-emptive as per troubled areas in PIP including excessive IMEs, biased IMEs, file reviews and other forms of abuse on the “over side of the fence.â€Â We do not wish to end up like Florida wherein you are reduced to having to receive a referral from a medical professional including a physician’s assistant and limits of care to $2,500….Vern Saboe PS: Have you joined the fight colleagues? Have you joined the OCA? We need your financial help and your ideas call he OCA office and join today…503-256-1601, Vern Saboe if you have specific questions call me any Time 541-231-4528 Cell From: [mailto: ] On Behalf Of ph MedlinSent: Thursday, March 15, 2012 11:07 AM Subject: IME increase The increase as of late in IME’s has been enormous in our office. We have more patients going to IME’s than not at this point. I used to NEVER have an IME requested of my patients. There is something in the water. Anyone else noticing this to a high degree as of late? I mean cases that are 8 visits in with pain levels of 5-6 of 10 and they’re getting IMEd.......uuughhh. ph Medlin D.C. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 15, 2012 Report Share Posted March 15, 2012 Definitely!!! Hell I feel like I got a target on my back here. There is absolutely something brewing. JOIN!! ph Medlin D.C. From: vsaboe Sent: Thursday, March 15, 2012 11:17 AM 'ph Medlin' ; Subject: RE: IME increase Storm clouds, the Oregon Chiropractic Association is being proactive and pre-emptive as per troubled areas in PIP including excessive IMEs, biased IMEs, file reviews and other forms of abuse on the “over side of the fence.†We do not wish to end up like Florida wherein you are reduced to having to receive a referral from a medical professional including a physician’s assistant and limits of care to $2,500….Vern Saboe PS: Have you joined the fight colleagues? Have you joined the OCA? We need your financial help and your ideas call he OCA office and join today…503-256-1601, Vern Saboe if you have specific questions call me any Time 541-231-4528 Cell From: [mailto: ] On Behalf Of ph MedlinSent: Thursday, March 15, 2012 11:07 AM Subject: IME increase The increase as of late in IME’s has been enormous in our office. We have more patients going to IME’s than not at this point. I used to NEVER have an IME requested of my patients. There is something in the water. Anyone else noticing this to a high degree as of late? I mean cases that are 8 visits in with pain levels of 5-6 of 10 and they’re getting IMEd.......uuughhh. ph Medlin D.C. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 15, 2012 Report Share Posted March 15, 2012 I'm not disputing Dr. Medlin's perception that the number of IMEs is increasing, only that there seems to be a one-sided view that continues to be expressed, namely that all chiropractors are good and IMEs are bad (with the exception of that ever-present " few " or, more recently " several " docs or " IME mills " who no one ever names). I doubt the reality can be presented in such dichotomous terms. Are any other docs on this listserv besides Dr. M experiencing this? Are there docs who have not experienced an increase? Are there docs on the listserv whose patients rarely if ever get sent for IMEs? If you believe you're experience an increase, have you looked at stats for previous years and compared them to the present to see if your perception is correct? I'm asking these questions in good faith. I think it's too easy to read someone's post, maybe see a couple of concurring posts, and assume that the problem is widespread. I really don't know, so I'm asking. I do only a few IMEs per month, and the number of IMEs I perform is much fewer than in the past, by my own choice, so I cannot judge these statements from my own experience. However, my experience tells me that there are many reasons IMEs are requested. It's not always the number of visits. If I saw a patient 8 times and the pain was still at 5-6, I would be concerned that the patient was not benefiting from my care. I might want a second opinion. Here are some reasons IMEs are requested: Causation and compensability. Sometimes the cause of the patient's injuries is in dispute. They may have had a previous problem and, whether or not it has anything to do with the current one, the insurer may have a question about it. Compensability is more of a concern in workers' compensation cases, as when the patient has degenerative disc disease and then exacerbates the problem at work (in Oregon this is called major versus material contributing cause). Medical necessity of treatment. Do the doctor's chart notes document medical necessity? Sometimes doctors put the cart before the horse, that is, rather than determining IF the patient would benefit from care and, if so, WHAT KIND of treatment is best for this patient, we try to build a case for treating the patient with " positive " findings. But there is no critical mass of positive findings beyond which treatment is necessarily justified. There has to be consistency between the history, mechanism of injury, exam findings, and the diagnosis. Usually a clinically meaningful cluster of findings leads to a diagnosis. Disability and impairment. Often there is a question about temporary disability - was it necessary for the patient to miss work because of the injuries? If so, for how long? Other times the question concerns permanent disability and impairment - to what degree, if any, will the patient be limited or unable to perform normal activities for the remainder of his or her life? Apportionment. Is the patient being treated for more than one condition? If so, to what extent does each condition contribute to the need for treatment? I think most chiropractors were never taught in school how to determine apportionment. I know I didn't learn it there. I see records - and have seen this method recommended on this listserv - where the doc stops treatment for one injury when the patient sustains a second injury, saying they will go back to treating the first injury when the second one resolves. In terms of tissue damage and the healing process, this makes no sense, but it's easier than trying to apportion the percentage of treatment between the two injuries. Location and nature of injury. If your patient goes to the ER shortly after an accident complaining of neck pain and later comes to you with neck pain and low back pain, the carrier might question whether the LBP resulted from the compensable injury. Also, I've seen many cases where the treating doctor gives a diagnosis for an area which wasn't injured and is not symptomatic, usually because " subluxations, " segmental dysfunction, and increased muscle tone are found on exam. The nature of the injury can be questionable as well. If you diagnose a moderate to severe cervical sprain/strain, for instance, and then proceed to adjust the patient's neck, it might appear that your treatment is injuring the patient further. After all, you are saying they have a serious ligament injury (think of a " moderate to severe sprain " of the knee or ankle). In my opinion, all of these reasons boil down to two major ones: DOCUMENTATION and COMMUNICATION. Most of these problems can be prevented by keeping accurate, legible, and complete chart records. I once heard a doctor complain that she didn't get paid enough to write good chart notes. I would say that if you don't keep good chart notes, you won't get paid. So I'll step down off my soap box for now (sorry, no pun intended). I really would like to know from other readers how much of an IME problem you perceive in your own practices. J. Burke, D.C. > > Storm clouds, the Oregon Chiropractic Association is being proactive and pre-emptive as per troubled areas in PIP including excessive IMEs, biased IMEs, file reviews and other forms of abuse on the “over side of the fence.†We do not wish to end up like Florida wherein you are reduced to having to receive a referral from a medical professional including a physician’s assistant and limits of care to $2,500….Vern Saboe PS: Have you joined the fight colleagues? Have you joined the OCA? We need your financial help and your ideas call he OCA office and join today…503-256-1601, Vern Saboe if you have specific questions call me any Time 541-231-4528 Cell > > > > From: [mailto: ] On Behalf Of ph Medlin > Sent: Thursday, March 15, 2012 11:07 AM > > Subject: IME increase > > > > > > The increase as of late in IME’s has been enormous in our office. We have more patients going to IME’s than not at this point. I used to NEVER have an IME requested of my patients. There is something in the water. Anyone else noticing this to a high degree as of late? > > > > I mean cases that are 8 visits in with pain levels of 5-6 of 10 and they’re getting IMEd.......uuughhh. > > > > ph Medlin D.C. > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 15, 2012 Report Share Posted March 15, 2012 We have MVC patients frequently and can’t remember when the last IME was ordered.Have a WC case that was sent for an IME and the patient asked the doctor “ are you going to do all the test Dr Pfeiffer did�The doctor did not answer. Have seen his report and he failed to address the chief complaint . Hearing scheduled Mar 28.Should be fun!!!!!!!!! We do an occasional IME and the usual reason appears to be NO PROGRESS of symptom reduction. Either wrong diagnosis and/orwrong treatment W. Pfeiffer, D.C., D.A.B.C.O.Lee Pfeiffer, R.N., B.S.46 N.E. Mt. Hebron Dr. (no USPS mail)P.O. Box 606 Pendleton, OR 97801drbob@...leernbs@...541-276-2550 All people smile in the same language From: [mailto: ] On Behalf Of mjqpdcSent: Thursday, March 15, 2012 7:24 PM Subject: Re: IME increase I'm not disputing Dr. Medlin's perception that the number of IMEs is increasing, only that there seems to be a one-sided view that continues to be expressed, namely that all chiropractors are good and IMEs are bad (with the exception of that ever-present " few " or, more recently " several " docs or " IME mills " who no one ever names). I doubt the reality can be presented in such dichotomous terms. Are any other docs on this listserv besides Dr. M experiencing this? Are there docs who have not experienced an increase? Are there docs on the listserv whose patients rarely if ever get sent for IMEs? If you believe you're experience an increase, have you looked at stats for previous years and compared them to the present to see if your perception is correct?I'm asking these questions in good faith. I think it's too easy to read someone's post, maybe see a couple of concurring posts, and assume that the problem is widespread. I really don't know, so I'm asking. I do only a few IMEs per month, and the number of IMEs I perform is much fewer than in the past, by my own choice, so I cannot judge these statements from my own experience. However, my experience tells me that there are many reasons IMEs are requested. It's not always the number of visits. If I saw a patient 8 times and the pain was still at 5-6, I would be concerned that the patient was not benefiting from my care. I might want a second opinion. Here are some reasons IMEs are requested:Causation and compensability. Sometimes the cause of the patient's injuries is in dispute. They may have had a previous problem and, whether or not it has anything to do with the current one, the insurer may have a question about it. Compensability is more of a concern in workers' compensation cases, as when the patient has degenerative disc disease and then exacerbates the problem at work (in Oregon this is called major versus material contributing cause). Medical necessity of treatment. Do the doctor's chart notes document medical necessity? Sometimes doctors put the cart before the horse, that is, rather than determining IF the patient would benefit from care and, if so, WHAT KIND of treatment is best for this patient, we try to build a case for treating the patient with " positive " findings. But there is no critical mass of positive findings beyond which treatment is necessarily justified. There has to be consistency between the history, mechanism of injury, exam findings, and the diagnosis. Usually a clinically meaningful cluster of findings leads to a diagnosis. Disability and impairment. Often there is a question about temporary disability - was it necessary for the patient to miss work because of the injuries? If so, for how long? Other times the question concerns permanent disability and impairment - to what degree, if any, will the patient be limited or unable to perform normal activities for the remainder of his or her life? Apportionment. Is the patient being treated for more than one condition? If so, to what extent does each condition contribute to the need for treatment? I think most chiropractors were never taught in school how to determine apportionment. I know I didn't learn it there. I see records - and have seen this method recommended on this listserv - where the doc stops treatment for one injury when the patient sustains a second injury, saying they will go back to treating the first injury when the second one resolves. In terms of tissue damage and the healing process, this makes no sense, but it's easier than trying to apportion the percentage of treatment between the two injuries. Location and nature of injury. If your patient goes to the ER shortly after an accident complaining of neck pain and later comes to you with neck pain and low back pain, the carrier might question whether the LBP resulted from the compensable injury. Also, I've seen many cases where the treating doctor gives a diagnosis for an area which wasn't injured and is not symptomatic, usually because " subluxations, " segmental dysfunction, and increased muscle tone are found on exam. The nature of the injury can be questionable as well. If you diagnose a moderate to severe cervical sprain/strain, for instance, and then proceed to adjust the patient's neck, it might appear that your treatment is injuring the patient further. After all, you are saying they have a serious ligament injury (think of a " moderate to severe sprain " of the knee or ankle). In my opinion, all of these reasons boil down to two major ones: DOCUMENTATION and COMMUNICATION. Most of these problems can be prevented by keeping accurate, legible, and complete chart records. I once heard a doctor complain that she didn't get paid enough to write good chart notes. I would say that if you don't keep good chart notes, you won't get paid.So I'll step down off my soap box for now (sorry, no pun intended). I really would like to know from other readers how much of an IME problem you perceive in your own practices. J. Burke, D.C. >> Storm clouds, the Oregon Chiropractic Association is being proactive and pre-emptive as per troubled areas in PIP including excessive IMEs, biased IMEs, file reviews and other forms of abuse on the “over side of the fence.†We do not wish to end up like Florida wherein you are reduced to having to receive a referral from a medical professional including a physician’s assistant and limits of care to $2,500….Vern Saboe PS: Have you joined the fight colleagues? Have you joined the OCA? We need your financial help and your ideas call he OCA office and join today…503-256-1601, Vern Saboe if you have specific questions call me any Time 541-231-4528 Cell > > > > From: [mailto: ] On Behalf Of ph Medlin> Sent: Thursday, March 15, 2012 11:07 AM> > Subject: IME increase> > > > > > The increase as of late in IME’s has been enormous in our office. We have more patients going to IME’s than not at this point. I used to NEVER have an IME requested of my patients. There is something in the water. Anyone else noticing this to a high degree as of late?> > > > I mean cases that are 8 visits in with pain levels of 5-6 of 10 and they’re getting IMEd.......uuughhh.> > > > ph Medlin D.C.> Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 15, 2012 Report Share Posted March 15, 2012 Very good concise response . Thanks. I have not had an increase in IMEs within the last 2 or 3 years. I have had a couple that I disagreed with but in those cases there were grounds for professional disagreement. I do feel that the treating physician knows much more about the myriad clinical aspects of their patient's condition than any IME. So, because many IME opinions are so definite and result in such a dramatic effect on a patient's well being, it seems unfair that one opinion from only 1 day in a patient's life carries so much weight. Not withstanding this, if the treating doc does not document the complications, altered treatment approaches, refine the dx codes and appear to be managing their patient's care thoughtfully, it is a given that someone will get wind of this and start doing IMEs. Do all the treatment codes stay the same visit by visit, are all the charges the same and at the top of the allowable limits for every visit? This IS a "mill" even if it for just 2 or 3 MVA patients! Does every PI patient PIP out with only chiropractic care or is there consultation and referral patterns that show clinical decision making? Does everyone get massage or fascial release every visit? Does their family primary care provider get a note and a request for past medicals? I was in court last week on a PIP trial and the defense asked if I knew about this patients past LBP history.......I did not, despite the fact that it was her MD that referred her to me for the MVA injuries after 4 mo of PT hadn't helped! I hadn't asked either. It won't make much difference because the primary injuries were cervical and thoracic. Nevertheless I had a wake up call again! In short we will always have problems, but the more real doctoring we do the less there is to question. On 3/15/2012 7:23 PM, mjqpdc wrote: I'm not disputing Dr. Medlin's perception that the number of IMEs is increasing, only that there seems to be a one-sided view that continues to be expressed, namely that all chiropractors are good and IMEs are bad (with the exception of that ever-present "few" or, more recently "several" docs or "IME mills" who no one ever names). I doubt the reality can be presented in such dichotomous terms. Are any other docs on this listserv besides Dr. M experiencing this? Are there docs who have not experienced an increase? Are there docs on the listserv whose patients rarely if ever get sent for IMEs? If you believe you're experience an increase, have you looked at stats for previous years and compared them to the present to see if your perception is correct? I'm asking these questions in good faith. I think it's too easy to read someone's post, maybe see a couple of concurring posts, and assume that the problem is widespread. I really don't know, so I'm asking. I do only a few IMEs per month, and the number of IMEs I perform is much fewer than in the past, by my own choice, so I cannot judge these statements from my own experience. However, my experience tells me that there are many reasons IMEs are requested. It's not always the number of visits. If I saw a patient 8 times and the pain was still at 5-6, I would be concerned that the patient was not benefiting from my care. I might want a second opinion. Here are some reasons IMEs are requested: Causation and compensability. Sometimes the cause of the patient's injuries is in dispute. They may have had a previous problem and, whether or not it has anything to do with the current one, the insurer may have a question about it. Compensability is more of a concern in workers' compensation cases, as when the patient has degenerative disc disease and then exacerbates the problem at work (in Oregon this is called major versus material contributing cause). Medical necessity of treatment. Do the doctor's chart notes document medical necessity? Sometimes doctors put the cart before the horse, that is, rather than determining IF the patient would benefit from care and, if so, WHAT KIND of treatment is best for this patient, we try to build a case for treating the patient with "positive" findings. But there is no critical mass of positive findings beyond which treatment is necessarily justified. There has to be consistency between the history, mechanism of injury, exam findings, and the diagnosis. Usually a clinically meaningful cluster of findings leads to a diagnosis. Disability and impairment. Often there is a question about temporary disability - was it necessary for the patient to miss work because of the injuries? If so, for how long? Other times the question concerns permanent disability and impairment - to what degree, if any, will the patient be limited or unable to perform normal activities for the remainder of his or her life? Apportionment. Is the patient being treated for more than one condition? If so, to what extent does each condition contribute to the need for treatment? I think most chiropractors were never taught in school how to determine apportionment. I know I didn't learn it there. I see records - and have seen this method recommended on this listserv - where the doc stops treatment for one injury when the patient sustains a second injury, saying they will go back to treating the first injury when the second one resolves. In terms of tissue damage and the healing process, this makes no sense, but it's easier than trying to apportion the percentage of treatment between the two injuries. Location and nature of injury. If your patient goes to the ER shortly after an accident complaining of neck pain and later comes to you with neck pain and low back pain, the carrier might question whether the LBP resulted from the compensable injury. Also, I've seen many cases where the treating doctor gives a diagnosis for an area which wasn't injured and is not symptomatic, usually because "subluxations," segmental dysfunction, and increased muscle tone are found on exam. The nature of the injury can be questionable as well. If you diagnose a moderate to severe cervical sprain/strain, for instance, and then proceed to adjust the patient's neck, it might appear that your treatment is injuring the patient further. After all, you are saying they have a serious ligament injury (think of a "moderate to severe sprain" of the knee or ankle). In my opinion, all of these reasons boil down to two major ones: DOCUMENTATION and COMMUNICATION. Most of these problems can be prevented by keeping accurate, legible, and complete chart records. I once heard a doctor complain that she didn't get paid enough to write good chart notes. I would say that if you don't keep good chart notes, you won't get paid. So I'll step down off my soap box for now (sorry, no pun intended). I really would like to know from other readers how much of an IME problem you perceive in your own practices. J. Burke, D.C. > > Storm clouds, the Oregon Chiropractic Association is being proactive and pre-emptive as per troubled areas in PIP including excessive IMEs, biased IMEs, file reviews and other forms of abuse on the “over side of the fence.†We do not wish to end up like Florida wherein you are reduced to having to receive a referral from a medical professional including a physician’s assistant and limits of care to $2,500….Vern Saboe PS: Have you joined the fight colleagues? Have you joined the OCA? We need your financial help and your ideas call he OCA office and join today…503-256-1601, Vern Saboe if you have specific questions call me any Time 541-231-4528 Cell > > > > From: [mailto: ] On Behalf Of ph Medlin > Sent: Thursday, March 15, 2012 11:07 AM > > Subject: IME increase > > > > > > The increase as of late in IME’s has been enormous in our office. We have more patients going to IME’s than not at this point. I used to NEVER have an IME requested of my patients. There is something in the water. Anyone else noticing this to a high degree as of late? > > > > I mean cases that are 8 visits in with pain levels of 5-6 of 10 and they’re getting IMEd.......uuughhh. > > > > ph Medlin D.C. > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 15, 2012 Report Share Posted March 15, 2012 I think that should go to the head of the class for working “Not withstanding” into his message. (I think it’s supposed to be one word but, c’mon: brilliant!) -- E. Abrahamson, D.C. Chiropractic physician Lake Oswego Chiropractic Clinic 315 Second Street Lake Oswego, OR 97034 503-635-6246 Website: http://www.lakeoswegochiro.com From: Colwell <johncc48@...> Date: Thu, 15 Mar 2012 21:42:51 -0700 mjqpdc <mjqpdc@...> Cc: < > Subject: Re: IME increase Very good concise response . Thanks. I have not had an increase in IMEs within the last 2 or 3 years. I have had a couple that I disagreed with but in those cases there were grounds for professional disagreement. I do feel that the treating physician knows much more about the myriad clinical aspects of their patient's condition than any IME. So, because many IME opinions are so definite and result in such a dramatic effect on a patient's well being, it seems unfair that one opinion from only 1 day in a patient's life carries so much weight. Not withstanding this, if the treating doc does not document the complications, altered treatment approaches, refine the dx codes and appear to be managing their patient's care thoughtfully, it is a given that someone will get wind of this and start doing IMEs. Do all the treatment codes stay the same visit by visit, are all the charges the same and at the top of the allowable limits for every visit? This IS a " mill " even if it for just 2 or 3 MVA patients! Does every PI patient PIP out with only chiropractic care or is there consultation and referral patterns that show clinical decision making? Does everyone get massage or fascial release every visit? Does their family primary care provider get a note and a request for past medicals? I was in court last week on a PIP trial and the defense asked if I knew about this patients past LBP history.......I did not, despite the fact that it was her MD that referred her to me for the MVA injuries after 4 mo of PT hadn't helped! I hadn't asked either. It won't make much difference because the primary injuries were cervical and thoracic. Nevertheless I had a wake up call again! In short we will always have problems, but the more real doctoring we do the less there is to question. On 3/15/2012 7:23 PM, mjqpdc wrote: I'm not disputing Dr. Medlin's perception that the number of IMEs is increasing, only that there seems to be a one-sided view that continues to be expressed, namely that all chiropractors are good and IMEs are bad (with the exception of that ever-present " few " or, more recently " several " docs or " IME mills " who no one ever names). I doubt the reality can be presented in such dichotomous terms. Are any other docs on this listserv besides Dr. M experiencing this? Are there docs who have not experienced an increase? Are there docs on the listserv whose patients rarely if ever get sent for IMEs? If you believe you're experience an increase, have you looked at stats for previous years and compared them to the present to see if your perception is correct? I'm asking these questions in good faith. I think it's too easy to read someone's post, maybe see a couple of concurring posts, and assume that the problem is widespread. I really don't know, so I'm asking. I do only a few IMEs per month, and the number of IMEs I perform is much fewer than in the past, by my own choice, so I cannot judge these statements from my own experience. However, my experience tells me that there are many reasons IMEs are requested. It's not always the number of visits. If I saw a patient 8 times and the pain was still at 5-6, I would be concerned that the patient was not benefiting from my care. I might want a second opinion. Here are some reasons IMEs are requested: Causation and compensability. Sometimes the cause of the patient's injuries is in dispute. They may have had a previous problem and, whether or not it has anything to do with the current one, the insurer may have a question about it. Compensability is more of a concern in workers' compensation cases, as when the patient has degenerative disc disease and then exacerbates the problem at work (in Oregon this is called major versus material contributing cause). Medical necessity of treatment. Do the doctor's chart notes document medical necessity? Sometimes doctors put the cart before the horse, that is, rather than determining IF the patient would benefit from care and, if so, WHAT KIND of treatment is best for this patient, we try to build a case for treating the patient with " positive " findings. But there is no critical mass of positive findings beyond which treatment is necessarily justified. There has to be consistency between the history, mechanism of injury, exam findings, and the diagnosis. Usually a clinically meaningful cluster of findings leads to a diagnosis. Disability and impairment. Often there is a question about temporary disability - was it necessary for the patient to miss work because of the injuries? If so, for how long? Other times the question concerns permanent disability and impairment - to what degree, if any, will the patient be limited or unable to perform normal activities for the remainder of his or her life? Apportionment. Is the patient being treated for more than one condition? If so, to what extent does each condition contribute to the need for treatment? I think most chiropractors were never taught in school how to determine apportionment. I know I didn't learn it there. I see records - and have seen this method recommended on this listserv - where the doc stops treatment for one injury when the patient sustains a second injury, saying they will go back to treating the first injury when the second one resolves. In terms of tissue damage and the healing process, this makes no sense, but it's easier than trying to apportion the percentage of treatment between the two injuries. Location and nature of injury. If your patient goes to the ER shortly after an accident complaining of neck pain and later comes to you with neck pain and low back pain, the carrier might question whether the LBP resulted from the compensable injury. Also, I've seen many cases where the treating doctor gives a diagnosis for an area which wasn't injured and is not symptomatic, usually because " subluxations, " segmental dysfunction, and increased muscle tone are found on exam. The nature of the injury can be questionable as well. If you diagnose a moderate to severe cervical sprain/strain, for instance, and then proceed to adjust the patient's neck, it might appear that your treatment is injuring the patient further. After all, you are saying they have a serious ligament injury (think of a " moderate to severe sprain " of the knee or ankle). In my opinion, all of these reasons boil down to two major ones: DOCUMENTATION and COMMUNICATION. Most of these problems can be prevented by keeping accurate, legible, and complete chart records. I once heard a doctor complain that she didn't get paid enough to write good chart notes. I would say that if you don't keep good chart notes, you won't get paid. So I'll step down off my soap box for now (sorry, no pun intended). I really would like to know from other readers how much of an IME problem you perceive in your own practices. J. Burke, D.C. > > Storm clouds, the Oregon Chiropractic Association is being proactive and pre-emptive as per troubled areas in PIP including excessive IMEs, biased IMEs, file reviews and other forms of abuse on the “over side of the fence.‡ We do not wish to end up like Florida wherein you are reduced to having to receive a referral from a medical professional including a physician’s assistant and limits of care to $2,500â€&brkbar;.Vern Saboe PS: Have you joined the fight colleagues? Have you joined the OCA? We need your financial help and your ideas call he OCA office and join todayâ€&brkbar;503-256-1601, Vern Saboe if you have specific questions call me any Time 541-231-4528 Cell > > > > From: <mailto:%40> [mailto: <mailto:%40> ] On Behalf Of ph Medlin > Sent: Thursday, March 15, 2012 11:07 AM > <mailto:%40> > Subject: IME increase > > > > > > The increase as of late in IME’s has been enormous in our office. We have more patients going to IME’s than not at this point. I used to NEVER have an IME requested of my patients. There is something in the water. Anyone else noticing this to a high degree as of late? > > > > I mean cases that are 8 visits in with pain levels of 5-6 of 10 and they’re getting IMEd.......uuughhh. > > > > ph Medlin D.C. > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 15, 2012 Report Share Posted March 15, 2012 CUTE! I was stuck with my spellchecker...it made me doubt myself and I caved in to it's insistence! On 3/15/2012 9:54 PM, Abrahamson wrote:  I think that should go to the head of the class for working “Not withstanding†into his message. (I think it’s supposed to be one word but, c’mon: brilliant!) -- E. Abrahamson, D.C. Chiropractic physician Lake Oswego Chiropractic Clinic 315 Second Street Lake Oswego, OR 97034 503-635-6246 Website: http://www.lakeoswegochiro.com From: Colwell <johncc48@...> Date: Thu, 15 Mar 2012 21:42:51 -0700 mjqpdc <mjqpdc@...> Cc: < > Subject: Re: IME increase          Very good concise response . Thanks.   I have not had an increase in IMEs within the last 2 or 3 years. I have had a couple that I disagreed with but in those cases there were grounds for professional disagreement.   I do feel that the treating physician knows much more about the myriad clinical aspects of their patient's condition than any IME. So, because many IME opinions are so definite and result in such a dramatic effect on a patient's well being, it seems unfair that one opinion from only 1 day in a patient's life carries so much weight.   Not withstanding this, if the treating doc does not document the complications, altered treatment approaches, refine the dx codes and appear to be managing their patient's care thoughtfully, it is a given that someone will get wind of this and start doing IMEs. Do all the treatment codes stay the same visit by visit, are all the charges the same and at the top of the allowable limits for every visit? This IS a "mill" even if it for just 2 or 3 MVA patients!    Does every PI patient PIP out with only chiropractic care or is there consultation and referral patterns that show clinical decision making? Does everyone get massage or fascial release every visit? Does their family primary care provider get a note and a request for past medicals?   I was in court last week on a PIP trial and the defense asked if I knew about this patients past LBP history.......I did not, despite the fact that it was her MD that referred her to me for the MVA injuries after 4 mo of PT hadn't helped!  I hadn't asked either. It won't make much difference because the primary injuries were cervical and thoracic. Nevertheless I had a wake up call again!   In short we will always have problems, but the more real doctoring we do the less there is to question.      On 3/15/2012 7:23 PM, mjqpdc wrote:     I'm not disputing Dr. Medlin's perception that the number of IMEs is increasing, only that there seems to be a one-sided view that continues to be expressed, namely that all chiropractors are good and IMEs are bad (with the exception of that ever-present "few" or, more recently "several" docs or "IME mills" who no one ever names). I doubt the reality can be presented in such dichotomous terms.   Are any other docs on this listserv besides Dr. M experiencing this? Are there docs who have not experienced an increase? Are there docs on the listserv whose patients rarely if ever get sent for IMEs? If you believe you're experience an increase, have you looked at stats for previous years and compared them to the present to see if your perception is correct?   I'm asking these questions in good faith. I think it's too easy to read someone's post, maybe see a couple of concurring posts, and assume that the problem is widespread. I really don't know, so I'm asking. I do only a few IMEs per month, and the number of IMEs I perform is much fewer than in the past, by my own choice, so I cannot judge these statements from my own experience.   However, my experience tells me that there are many reasons IMEs are requested. It's not always the number of visits. If I saw a patient 8 times and the pain was still at 5-6, I would be concerned that the patient was not benefiting from my care. I might want a second opinion.   Here are some reasons IMEs are requested:   Causation and compensability. Sometimes the cause of the patient's injuries is in dispute. They may have had a previous problem and, whether or not it has anything to do with the current one, the insurer may have a question about it. Compensability is more of a concern in workers' compensation cases, as when the patient has degenerative disc disease and then exacerbates the problem at work (in Oregon this is called major versus material contributing cause).   Medical necessity of treatment. Do the doctor's chart notes document medical necessity? Sometimes doctors put the cart before the horse, that is, rather than determining IF the patient would benefit from care and, if so, WHAT KIND of treatment is best for this patient, we try to build a case for treating the patient with "positive" findings. But there is no critical mass of positive findings beyond which treatment is necessarily justified. There has to be consistency between the history, mechanism of injury, exam findings, and the diagnosis. Usually a clinically meaningful cluster of findings leads to a diagnosis.   Disability and impairment. Often there is a question about temporary disability - was it necessary for the patient to miss work because of the injuries? If so, for how long? Other times the question concerns permanent disability and impairment - to what degree, if any, will the patient be limited or unable to perform normal activities for the remainder of his or her life?   Apportionment. Is the patient being treated for more than one condition? If so, to what extent does each condition contribute to the need for treatment? I think most chiropractors were never taught in school how to determine apportionment. I know I didn't learn it there. I see records - and have seen this method recommended on this listserv - where the doc stops treatment for one injury when the patient sustains a second injury, saying they will go back to treating the first injury when the second one resolves. In terms of tissue damage and the healing process, this makes no sense, but it's easier than trying to apportion the percentage of treatment between the two injuries.   Location and nature of injury. If your patient goes to the ER shortly after an accident complaining of neck pain and later comes to you with neck pain and low back pain, the carrier might question whether the LBP resulted from the compensable injury. Also, I've seen many cases where the treating doctor gives a diagnosis for an area which wasn't injured and is not symptomatic, usually because "subluxations," segmental dysfunction, and increased muscle tone are found on exam. The nature of the injury can be questionable as well. If you diagnose a moderate to severe cervical sprain/strain, for instance, and then proceed to adjust the patient's neck, it might appear that your treatment is injuring the patient further. After all, you are saying they have a serious ligament injury (think of a "moderate to severe sprain" of the knee or ankle).   In my opinion, all of these reasons boil down to two major ones: DOCUMENTATION and COMMUNICATION. Most of these problems can be prevented by keeping accurate, legible, and complete chart records. I once heard a doctor complain that she didn't get paid enough to write good chart notes. I would say that if you don't keep good chart notes, you won't get paid.   So I'll step down off my soap box for now (sorry, no pun intended). I really would like to know from other readers how much of an IME problem you perceive in your own practices.   J. Burke, D.C.    >  > Storm clouds, the Oregon Chiropractic Association is being proactive and pre-emptive as per troubled areas in PIP including excessive IMEs, biased IMEs, file reviews and other forms of abuse on the “over side of the fence.‡ We do not wish to end up like Florida wherein you are reduced to having to receive a referral from a medical professional including a physician’s assistant and limits of care to $2,500†& brkbar;.Vern Saboe PS: Have you joined the fight colleagues? Have you joined the OCA? We need your financial help and your ideas call he OCA office and join today†& brkbar;503-256-1601, Vern Saboe if you have specific questions call me any Time 541-231-4528 Cell  >  >  >  > From: <mailto:%40>  [mailto: <mailto:%40> ] On Behalf Of ph Medlin  > Sent: Thursday, March 15, 2012 11:07 AM  > <mailto:%40>  > Subject: IME increase  >  >  >  >  >  > The increase as of late in IME’s has been enormous in our office. We have more patients going to IME’s than not at this point. I used to NEVER have an IME requested of my patients. There is something in the water. Anyone else noticing this to a high degree as of late?  >  >  >  > I mean cases that are 8 visits in with pain levels of 5-6 of 10 and they’re getting IMEd.......uuughhh.  >  >  >  > ph Medlin D.C.  >             Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 16, 2012 Report Share Posted March 16, 2012 Do all the treatment codes stay the same visit by visit, are all the charges the same and at the top of the allowable limits for every visit? This IS a "mill" even if it for just 2 or 3 MVA patients! **WHAT? I disagree adamantly. I’m not sure about your practice, but I’m a chiro and patients get adjusted on every visit here and the charge is the same and since I’m worth it, I feel charging to the full extent of what’s allowable is fair. Do things change as the patient progresses regarding exercise/rehab? Yep, but they still get an adjustment and some tissue work to loosen things up on every visit. It’s part of the therapeutic recovery. I also do ALL the work, except if they see our LMT. I do NOT run a mill and actually take offense at the insinuation. This may be just a coincidence and the number of IMEâ€s may drop in a few months. Who knows. The amount of PIP I see has also steadily increased, but I’ve got some colleagues who have responded off list who are also experiencing an uptick in these exams DESPITE performing the best “doctoring†there is out there. I also notice that most of the folks responding saying they haven’t noticed an increase in IME’s are outside of PDX. Not sure if that makes a difference. Folks, I think we’re giving adjusters wayy too much credit. Again, if you think that you are safe because you take measures that you perceive to be preventative in the ordering of these exams, I’m here to tell you you are not. We have not noticed ANY logical correlation to the exam or connection between patients. 5 visits in ordered, ordered at the end of treatment when patient has shown nothing but improvement and 0 VAS discharge etc. etc... Even NOT being ordered on patients where you may think it would be.......SO convincing ourselves this is only happening to bad doctors or PIP mills is misguided and wrong. Despite our stellar communication, narrative written reports upon every exam followed by call to adjuster, clear treatment plan, and our best estimation when MMI will be achieved, we are experiencing an interruption in our GOOD DOCTORING. Despite having an excellent record of getting people out of pain without exhausting PIP or signing them up for 30 visit tx plans, we are experiencing an interruption in our GOOD DOCTORING. Assuming it’s the other way around would be a blatant mistake and a slap in the face to many good Doctors of Chiropractic. ph Medlin D.C. From: Colwell Sent: Thursday, March 15, 2012 9:42 PM mjqpdc Cc: Subject: Re: IME increase Very good concise response . Thanks.I have not had an increase in IMEs within the last 2 or 3 years. I have had a couple that I disagreed with but in those cases there were grounds for professional disagreement.I do feel that the treating physician knows much more about the myriad clinical aspects of their patient's condition than any IME. So, because many IME opinions are so definite and result in such a dramatic effect on a patient's well being, it seems unfair that one opinion from only 1 day in a patient's life carries so much weight.Not withstanding this, if the treating doc does not document the complications, altered treatment approaches, refine the dx codes and appear to be managing their patient's care thoughtfully, it is a given that someone will get wind of this and start doing IMEs. Do all the treatment codes stay the same visit by visit, are all the charges the same and at the top of the allowable limits for every visit? This IS a "mill" even if it for just 2 or 3 MVA patients! Does every PI patient PIP out with only chiropractic care or is there consultation and referral patterns that show clinical decision making? Does everyone get massage or fascial release every visit? Does their family primary care provider get a note and a request for past medicals?I was in court last week on a PIP trial and the defense asked if I knew about this patients past LBP history.......I did not, despite the fact that it was her MD that referred her to me for the MVA injuries after 4 mo of PT hadn't helped! I hadn't asked either. It won't make much difference because the primary injuries were cervical and thoracic. Nevertheless I had a wake up call again!In short we will always have problems, but the more real doctoring we do the less there is to question.On 3/15/2012 7:23 PM, mjqpdc wrote: I'm not disputing Dr. Medlin's perception that the number of IMEs is increasing, only that there seems to be a one-sided view that continues to be expressed, namely that all chiropractors are good and IMEs are bad (with the exception of that ever-present "few" or, more recently "several" docs or "IME mills" who no one ever names). I doubt the reality can be presented in such dichotomous terms. Are any other docs on this listserv besides Dr. M experiencing this? Are there docs who have not experienced an increase? Are there docs on the listserv whose patients rarely if ever get sent for IMEs? If you believe you're experience an increase, have you looked at stats for previous years and compared them to the present to see if your perception is correct?I'm asking these questions in good faith. I think it's too easy to read someone's post, maybe see a couple of concurring posts, and assume that the problem is widespread. I really don't know, so I'm asking. I do only a few IMEs per month, and the number of IMEs I perform is much fewer than in the past, by my own choice, so I cannot judge these statements from my own experience. However, my experience tells me that there are many reasons IMEs are requested. It's not always the number of visits. If I saw a patient 8 times and the pain was still at 5-6, I would be concerned that the patient was not benefiting from my care. I might want a second opinion. Here are some reasons IMEs are requested:Causation and compensability. Sometimes the cause of the patient's injuries is in dispute. They may have had a previous problem and, whether or not it has anything to do with the current one, the insurer may have a question about it. Compensability is more of a concern in workers' compensation cases, as when the patient has degenerative disc disease and then exacerbates the problem at work (in Oregon this is called major versus material contributing cause). Medical necessity of treatment. Do the doctor's chart notes document medical necessity? Sometimes doctors put the cart before the horse, that is, rather than determining IF the patient would benefit from care and, if so, WHAT KIND of treatment is best for this patient, we try to build a case for treating the patient with "positive" findings. But there is no critical mass of positive findings beyond which treatment is necessarily justified. There has to be consistency between the history, mechanism of injury, exam findings, and the diagnosis. Usually a clinically meaningful cluster of findings leads to a diagnosis. Disability and impairment. Often there is a question about temporary disability - was it necessary for the patient to miss work because of the injuries? If so, for how long? Other times the question concerns permanent disability and impairment - to what degree, if any, will the patient be limited or unable to perform normal activities for the remainder of his or her life? Apportionment. Is the patient being treated for more than one condition? If so, to what extent does each condition contribute to the need for treatment? I think most chiropractors were never taught in school how to determine apportionment. I know I didn't learn it there. I see records - and have seen this method recommended on this listserv - where the doc stops treatment for one injury when the patient sustains a second injury, saying they will go back to treating the first injury when the second one resolves. In terms of tissue damage and the healing process, this makes no sense, but it's easier than trying to apportion the percentage of treatment between the two injuries. Location and nature of injury. If your patient goes to the ER shortly after an accident complaining of neck pain and later comes to you with neck pain and low back pain, the carrier might question whether the LBP resulted from the compensable injury. Also, I've seen many cases where the treating doctor gives a diagnosis for an area which wasn't injured and is not symptomatic, usually because "subluxations," segmental dysfunction, and increased muscle tone are found on exam. The nature of the injury can be questionable as well. If you diagnose a moderate to severe cervical sprain/strain, for instance, and then proceed to adjust the patient's neck, it might appear that your treatment is injuring the patient further. After all, you are saying they have a serious ligament injury (think of a "moderate to severe sprain" of the knee or ankle). In my opinion, all of these reasons boil down to two major ones: DOCUMENTATION and COMMUNICATION. Most of these problems can be prevented by keeping accurate, legible, and complete chart records. I once heard a doctor complain that she didn't get paid enough to write good chart notes. I would say that if you don't keep good chart notes, you won't get paid.So I'll step down off my soap box for now (sorry, no pun intended). I really would like to know from other readers how much of an IME problem you perceive in your own practices. J. Burke, D.C. >> Storm clouds, the Oregon Chiropractic Association is being proactive and pre-emptive as per troubled areas in PIP including excessive IMEs, biased IMEs, file reviews and other forms of abuse on the “over side of the fence.†We do not wish to end up like Florida wherein you are reduced to having to receive a referral from a medical professional including a physician’s assistant and limits of care to $2,500….Vern Saboe PS: Have you joined the fight colleagues? Have you joined the OCA? We need your financial help and your ideas call he OCA office and join today…503-256-1601, Vern Saboe if you have specific questions call me any Time 541-231-4528 Cell > > > > From: mailto:%40 [mailto:mailto:%40] On Behalf Of ph Medlin> Sent: Thursday, March 15, 2012 11:07 AM> mailto:%40> Subject: IME increase> > > > > > The increase as of late in IME’s has been enormous in our office. We have more patients going to IME’s than not at this point. I used to NEVER have an IME requested of my patients. There is something in the water. Anyone else noticing this to a high degree as of late?> > > > I mean cases that are 8 visits in with pain levels of 5-6 of 10 and they’re getting IMEd.......uuughhh.> > > > ph Medlin D.C.> Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 16, 2012 Report Share Posted March 16, 2012 Thank you Joe ..... very well stated. I too was somewhat offended by that statement. Dr. Burke appears to be painting with as broad a brush as he claims is being used against him. Judgement about cases from these docs, when hired by an interested party, will always be suspect. There is an idea of a system for choosing IMEs that pulls randomly from a state list that seems FAR fairer for both patient and doc ..... it appears that it will take legislation to achieve ..... which means time is involved. In the meantime, we appear to be stuck with this unfair and unjust mechanism. It seems that all and each are performing to their best ..... it is just that the lines of judgement are clouded with money interests. And the patient is thwarted. We need a system that chooses a doc to perform an IME from a random list, not driven by the money sources. SunnySunny Kierstyn, RN DC Fibromyalgia Care Center of Oregon 2677 Willakenzie Road, 7CEugene, Oregon, 97401541- 654-0850; Fx; 541- 654-0834www.drsunnykierstyn.com mjqpdc@...; johncc48@...CC: From: spinetree@...Date: Fri, 16 Mar 2012 09:53:42 -0700Subject: Re: IME increase Do all the treatment codes stay the same visit by visit, are all the charges the same and at the top of the allowable limits for every visit? This IS a "mill" even if it for just 2 or 3 MVA patients! **WHAT? I disagree adamantly. I’m not sure about your practice, but I’m a chiro and patients get adjusted on every visit here and the charge is the same and since I’m worth it, I feel charging to the full extent of what’s allowable is fair. Do things change as the patient progresses regarding exercise/rehab? Yep, but they still get an adjustment and some tissue work to loosen things up on every visit. It’s part of the therapeutic recovery. I also do ALL the work, except if they see our LMT. I do NOT run a mill and actually take offense at the insinuation. This may be just a coincidence and the number of IME”s may drop in a few months. Who knows. The amount of PIP I see has also steadily increased, but I’ve got some colleagues who have responded off list who are also experiencing an uptick in these exams DESPITE performing the best “doctoring” there is out there. I also notice that most of the folks responding saying they haven’t noticed an increase in IME’s are outside of PDX. Not sure if that makes a difference. Folks, I think we’re giving adjusters wayy too much credit. Again, if you think that you are safe because you take measures that you perceive to be preventative in the ordering of these exams, I’m here to tell you you are not. We have not noticed ANY logical correlation to the exam or connection between patients. 5 visits in ordered, ordered at the end of treatment when patient has shown nothing but improvement and 0 VAS discharge etc. etc... Even NOT being ordered on patients where you may think it would be.......SO convincing ourselves this is only happening to bad doctors or PIP mills is misguided and wrong. Despite our stellar communication, narrative written reports upon every exam followed by call to adjuster, clear treatment plan, and our best estimation when MMI will be achieved, we are experiencing an interruption in our GOOD DOCTORING. Despite having an excellent record of getting people out of pain without exhausting PIP or signing them up for 30 visit tx plans, we are experiencing an interruption in our GOOD DOCTORING. Assuming it’s the other way around would be a blatant mistake and a slap in the face to many good Doctors of Chiropractic. ph Medlin D.C. From: Colwell Sent: Thursday, March 15, 2012 9:42 PM mjqpdc Cc: Subject: Re: IME increase Very good concise response . Thanks.I have not had an increase in IMEs within the last 2 or 3 years. I have had a couple that I disagreed with but in those cases there were grounds for professional disagreement.I do feel that the treating physician knows much more about the myriad clinical aspects of their patient's condition than any IME. So, because many IME opinions are so definite and result in such a dramatic effect on a patient's well being, it seems unfair that one opinion from only 1 day in a patient's life carries so much weight.Not withstanding this, if the treating doc does not document the complications, altered treatment approaches, refine the dx codes and appear to be managing their patient's care thoughtfully, it is a given that someone will get wind of this and start doing IMEs. Do all the treatment codes stay the same visit by visit, are all the charges the same and at the top of the allowable limits for every visit? This IS a "mill" even if it for just 2 or 3 MVA patients! Does every PI patient PIP out with only chiropractic care or is there consultation and referral patterns that show clinical decision making? Does everyone get massage or fascial release every visit? Does their family primary care provider get a note and a request for past medicals?I was in court last week on a PIP trial and the defense asked if I knew about this patients past LBP history.......I did not, despite the fact that it was her MD that referred her to me for the MVA injuries after 4 mo of PT hadn't helped! I hadn't asked either. It won't make much difference because the primary injuries were cervical and thoracic. Nevertheless I had a wake up call again!In short we will always have problems, but the more real doctoring we do the less there is to question.On 3/15/2012 7:23 PM, mjqpdc wrote: I'm not disputing Dr. Medlin's perception that the number of IMEs is increasing, only that there seems to be a one-sided view that continues to be expressed, namely that all chiropractors are good and IMEs are bad (with the exception of that ever-present "few" or, more recently "several" docs or "IME mills" who no one ever names). I doubt the reality can be presented in such dichotomous terms. Are any other docs on this listserv besides Dr. M experiencing this? Are there docs who have not experienced an increase? Are there docs on the listserv whose patients rarely if ever get sent for IMEs? If you believe you're experience an increase, have you looked at stats for previous years and compared them to the present to see if your perception is correct?I'm asking these questions in good faith. I think it's too easy to read someone's post, maybe see a couple of concurring posts, and assume that the problem is widespread. I really don't know, so I'm asking. I do only a few IMEs per month, and the number of IMEs I perform is much fewer than in the past, by my own choice, so I cannot judge these statements from my own experience. However, my experience tells me that there are many reasons IMEs are requested. It's not always the number of visits. If I saw a patient 8 times and the pain was still at 5-6, I would be concerned that the patient was not benefiting from my care. I might want a second opinion. Here are some reasons IMEs are requested:Causation and compensability. Sometimes the cause of the patient's injuries is in dispute. They may have had a previous problem and, whether or not it has anything to do with the current one, the insurer may have a question about it. Compensability is more of a concern in workers' compensation cases, as when the patient has degenerative disc disease and then exacerbates the problem at work (in Oregon this is called major versus material contributing cause). Medical necessity of treatment. Do the doctor's chart notes document medical necessity? Sometimes doctors put the cart before the horse, that is, rather than determining IF the patient would benefit from care and, if so, WHAT KIND of treatment is best for this patient, we try to build a case for treating the patient with "positive" findings. But there is no critical mass of positive findings beyond which treatment is necessarily justified. There has to be consistency between the history, mechanism of injury, exam findings, and the diagnosis. Usually a clinically meaningful cluster of findings leads to a diagnosis. Disability and impairment. Often there is a question about temporary disability - was it necessary for the patient to miss work because of the injuries? If so, for how long? Other times the question concerns permanent disability and impairment - to what degree, if any, will the patient be limited or unable to perform normal activities for the remainder of his or her life? Apportionment. Is the patient being treated for more than one condition? If so, to what extent does each condition contribute to the need for treatment? I think most chiropractors were never taught in school how to determine apportionment. I know I didn't learn it there. I see records - and have seen this method recommended on this listserv - where the doc stops treatment for one injury when the patient sustains a second injury, saying they will go back to treating the first injury when the second one resolves. In terms of tissue damage and the healing process, this makes no sense, but it's easier than trying to apportion the percentage of treatment between the two injuries. Location and nature of injury. If your patient goes to the ER shortly after an accident complaining of neck pain and later comes to you with neck pain and low back pain, the carrier might question whether the LBP resulted from the compensable injury. Also, I've seen many cases where the treating doctor gives a diagnosis for an area which wasn't injured and is not symptomatic, usually because "subluxations," segmental dysfunction, and increased muscle tone are found on exam. The nature of the injury can be questionable as well. If you diagnose a moderate to severe cervical sprain/strain, for instance, and then proceed to adjust the patient's neck, it might appear that your treatment is injuring the patient further. After all, you are saying they have a serious ligament injury (think of a "moderate to severe sprain" of the knee or ankle). In my opinion, all of these reasons boil down to two major ones: DOCUMENTATION and COMMUNICATION. Most of these problems can be prevented by keeping accurate, legible, and complete chart records. I once heard a doctor complain that she didn't get paid enough to write good chart notes. I would say that if you don't keep good chart notes, you won't get paid.So I'll step down off my soap box for now (sorry, no pun intended). I really would like to know from other readers how much of an IME problem you perceive in your own practices. J. Burke, D.C. >> Storm clouds, the Oregon Chiropractic Association is being proactive and pre-emptive as per troubled areas in PIP including excessive IMEs, biased IMEs, file reviews and other forms of abuse on the “over side of the fence.†We do not wish to end up like Florida wherein you are reduced to having to receive a referral from a medical professional including a physician’s assistant and limits of care to $2,500….Vern Saboe PS: Have you joined the fight colleagues? Have you joined the OCA? We need your financial help and your ideas call he OCA office and join today…503-256-1601, Vern Saboe if you have specific questions call me any Time 541-231-4528 Cell > > > > From: mailto:%40 [mailto:mailto:%40] On Behalf Of ph Medlin> Sent: Thursday, March 15, 2012 11:07 AM> mailto:%40> Subject: IME increase> > > > > > The increase as of late in IME’s has been enormous in our office. We have more patients going to IME’s than not at this point. I used to NEVER have an IME requested of my patients. There is something in the water. Anyone else noticing this to a high degree as of late?> > > > I mean cases that are 8 visits in with pain levels of 5-6 of 10 and they’re getting IMEd.......uuughhh.> > > > ph Medlin D.C.> Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 16, 2012 Report Share Posted March 16, 2012 Yes, and the IME exam itself is actually a different topic than what I'm harping on here. It’s the IME order itself. Believe me, if there was a clear criteria to follow, we would conform to that. It’s such an ambiguous system in regards to the ordering..Sure there are elements beyond our treatment that cause the ordering of the exam, but these should be pretty rare and I know for a fact that they played no part in many of the exams ordered from our office. I wish for a more up front out in the open means of ordering these exams. I am weary of the mystery and the game of “avoid the IME” in which is impossible to win. ph Medlin D.C. From: Sunny Kierstyn Sent: Friday, March 16, 2012 10:13 AM joe medlin ; mjqpdc@... ; DC Cc: Subject: RE: IME increase Thank you Joe ..... very well stated. I too was somewhat offended by that statement. Dr. Burke appears to be painting with as broad a brush as he claims is being used against him. Judgement about cases from these docs, when hired by an interested party, will always be suspect. There is an idea of a system for choosing IMEs that pulls randomly from a state list that seems FAR fairer for both patient and doc ..... it appears that it will take legislation to achieve ..... which means time is involved. In the meantime, we appear to be stuck with this unfair and unjust mechanism. It seems that all and each are performing to their best ..... it is just that the lines of judgement are clouded with money interests. And the patient is thwarted. We need a system that chooses a doc to perform an IME from a random list, not driven by the money sources. Sunny Sunny Kierstyn, RN DC Fibromyalgia Care Center of Oregon 2677 Willakenzie Road, 7CEugene, Oregon, 97401541- 654-0850; Fx; 541- 654-0834www.drsunnykierstyn.com mjqpdc@...; johncc48@...CC: From: spinetree@...Date: Fri, 16 Mar 2012 09:53:42 -0700Subject: Re: IME increase Do all the treatment codes stay the same visit by visit, are all the charges the same and at the top of the allowable limits for every visit? This IS a "mill" even if it for just 2 or 3 MVA patients! **WHAT? I disagree adamantly. I’m not sure about your practice, but I’m a chiro and patients get adjusted on every visit here and the charge is the same and since I’m worth it, I feel charging to the full extent of what’s allowable is fair. Do things change as the patient progresses regarding exercise/rehab? Yep, but they still get an adjustment and some tissue work to loosen things up on every visit. It’s part of the therapeutic recovery. I also do ALL the work, except if they see our LMT. I do NOT run a mill and actually take offense at the insinuation. This may be just a coincidence and the number of IME”s may drop in a few months. Who knows. The amount of PIP I see has also steadily increased, but I’ve got some colleagues who have responded off list who are also experiencing an uptick in these exams DESPITE performing the best “doctoring” there is out there. I also notice that most of the folks responding saying they haven’t noticed an increase in IME’s are outside of PDX. Not sure if that makes a difference. Folks, I think we’re giving adjusters wayy too much credit. Again, if you think that you are safe because you take measures that you perceive to be preventative in the ordering of these exams, I’m here to tell you you are not. We have not noticed ANY logical correlation to the exam or connection between patients. 5 visits in ordered, ordered at the end of treatment when patient has shown nothing but improvement and 0 VAS discharge etc. etc... Even NOT being ordered on patients where you may think it would be.......SO convincing ourselves this is only happening to bad doctors or PIP mills is misguided and wrong. Despite our stellar communication, narrative written reports upon every exam followed by call to adjuster, clear treatment plan, and our best estimation when MMI will be achieved, we are experiencing an interruption in our GOOD DOCTORING. Despite having an excellent record of getting people out of pain without exhausting PIP or signing them up for 30 visit tx plans, we are experiencing an interruption in our GOOD DOCTORING. Assuming it’s the other way around would be a blatant mistake and a slap in the face to many good Doctors of Chiropractic. ph Medlin D.C. From: Colwell Sent: Thursday, March 15, 2012 9:42 PM mjqpdc Cc: Subject: Re: IME increase Very good concise response . Thanks.I have not had an increase in IMEs within the last 2 or 3 years. I have had a couple that I disagreed with but in those cases there were grounds for professional disagreement.I do feel that the treating physician knows much more about the myriad clinical aspects of their patient's condition than any IME. So, because many IME opinions are so definite and result in such a dramatic effect on a patient's well being, it seems unfair that one opinion from only 1 day in a patient's life carries so much weight.Not withstanding this, if the treating doc does not document the complications, altered treatment approaches, refine the dx codes and appear to be managing their patient's care thoughtfully, it is a given that someone will get wind of this and start doing IMEs. Do all the treatment codes stay the same visit by visit, are all the charges the same and at the top of the allowable limits for every visit? This IS a "mill" even if it for just 2 or 3 MVA patients! Does every PI patient PIP out with only chiropractic care or is there consultation and referral patterns that show clinical decision making? Does everyone get massage or fascial release every visit? Does their family primary care provider get a note and a request for past medicals?I was in court last week on a PIP trial and the defense asked if I knew about this patients past LBP history.......I did not, despite the fact that it was her MD that referred her to me for the MVA injuries after 4 mo of PT hadn't helped! I hadn't asked either. It won't make much difference because the primary injuries were cervical and thoracic. Nevertheless I had a wake up call again!In short we will always have problems, but the more real doctoring we do the less there is to question.On 3/15/2012 7:23 PM, mjqpdc wrote: I'm not disputing Dr. Medlin's perception that the number of IMEs is increasing, only that there seems to be a one-sided view that continues to be expressed, namely that all chiropractors are good and IMEs are bad (with the exception of that ever-present "few" or, more recently "several" docs or "IME mills" who no one ever names). I doubt the reality can be presented in such dichotomous terms. Are any other docs on this listserv besides Dr. M experiencing this? Are there docs who have not experienced an increase? Are there docs on the listserv whose patients rarely if ever get sent for IMEs? If you believe you're experience an increase, have you looked at stats for previous years and compared them to the present to see if your perception is correct?I'm asking these questions in good faith. I think it's too easy to read someone's post, maybe see a couple of concurring posts, and assume that the problem is widespread. I really don't know, so I'm asking. I do only a few IMEs per month, and the number of IMEs I perform is much fewer than in the past, by my own choice, so I cannot judge these statements from my own experience. However, my experience tells me that there are many reasons IMEs are requested. It's not always the number of visits. If I saw a patient 8 times and the pain was still at 5-6, I would be concerned that the patient was not benefiting from my care. I might want a second opinion. Here are some reasons IMEs are requested:Causation and compensability. Sometimes the cause of the patient's injuries is in dispute. They may have had a previous problem and, whether or not it has anything to do with the current one, the insurer may have a question about it. Compensability is more of a concern in workers' compensation cases, as when the patient has degenerative disc disease and then exacerbates the problem at work (in Oregon this is called major versus material contributing cause). Medical necessity of treatment. Do the doctor's chart notes document medical necessity? Sometimes doctors put the cart before the horse, that is, rather than determining IF the patient would benefit from care and, if so, WHAT KIND of treatment is best for this patient, we try to build a case for treating the patient with "positive" findings. But there is no critical mass of positive findings beyond which treatment is necessarily justified. There has to be consistency between the history, mechanism of injury, exam findings, and the diagnosis. Usually a clinically meaningful cluster of findings leads to a diagnosis. Disability and impairment. Often there is a question about temporary disability - was it necessary for the patient to miss work because of the injuries? If so, for how long? Other times the question concerns permanent disability and impairment - to what degree, if any, will the patient be limited or unable to perform normal activities for the remainder of his or her life? Apportionment. Is the patient being treated for more than one condition? If so, to what extent does each condition contribute to the need for treatment? I think most chiropractors were never taught in school how to determine apportionment. I know I didn't learn it there. I see records - and have seen this method recommended on this listserv - where the doc stops treatment for one injury when the patient sustains a second injury, saying they will go back to treating the first injury when the second one resolves. In terms of tissue damage and the healing process, this makes no sense, but it's easier than trying to apportion the percentage of treatment between the two injuries. Location and nature of injury. If your patient goes to the ER shortly after an accident complaining of neck pain and later comes to you with neck pain and low back pain, the carrier might question whether the LBP resulted from the compensable injury. Also, I've seen many cases where the treating doctor gives a diagnosis for an area which wasn't injured and is not symptomatic, usually because "subluxations," segmental dysfunction, and increased muscle tone are found on exam. The nature of the injury can be questionable as well. If you diagnose a moderate to severe cervical sprain/strain, for instance, and then proceed to adjust the patient's neck, it might appear that your treatment is injuring the patient further. After all, you are saying they have a serious ligament injury (think of a "moderate to severe sprain" of the knee or ankle). In my opinion, all of these reasons boil down to two major ones: DOCUMENTATION and COMMUNICATION. Most of these problems can be prevented by keeping accurate, legible, and complete chart records. I once heard a doctor complain that she didn't get paid enough to write good chart notes. I would say that if you don't keep good chart notes, you won't get paid.So I'll step down off my soap box for now (sorry, no pun intended). I really would like to know from other readers how much of an IME problem you perceive in your own practices. J. Burke, D.C. >> Storm clouds, the Oregon Chiropractic Association is being proactive and pre-emptive as per troubled areas in PIP including excessive IMEs, biased IMEs, file reviews and other forms of abuse on the “over side of the fence.†We do not wish to end up like Florida wherein you are reduced to having to receive a referral from a medical professional including a physician’s assistant and limits of care to $2,500….Vern Saboe PS: Have you joined the fight colleagues? Have you joined the OCA? We need your financial help and your ideas call he OCA office and join today…503-256-1601, Vern Saboe if you have specific questions call me any Time 541-231-4528 Cell > > > > From: mailto:%40 [mailto:mailto:%40] On Behalf Of ph Medlin> Sent: Thursday, March 15, 2012 11:07 AM> mailto:%40> Subject: IME increase> > > > > > The increase as of late in IME’s has been enormous in our office. We have more patients going to IME’s than not at this point. I used to NEVER have an IME requested of my patients. There is something in the water. Anyone else noticing this to a high degree as of late?> > > > I mean cases that are 8 visits in with pain levels of 5-6 of 10 and they’re getting IMEd.......uuughhh.> > > > ph Medlin D.C.> Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 16, 2012 Report Share Posted March 16, 2012  Have any of you clever little IME'ers considered THIS? PERHAPS the increase in IME's is simply the Ins industry gathering intel/ammunition/statistics against chiropractic that will be presented to the legislature next term in order to ELIMINATE PIP coverage in Oregon?! (hello...any light bulbs coming on???). PERHAPS...the docs in this state who are performing these questionable/non-questionable IME's are just playing into the hands of the very industry that will cut their financial throat once they get the "stats" they need...(i.e., in Oregon 90% of the chiropractic claims that went through "IME" were found to be providing care that was either "not reasonable" or "not medically necessary"). How would THAT look to the legislature??? EVERY IME I've ever seen has recommended a CUT IN CARE...(even if they eventually pay...they still have that crappy little piece of paper "on record"). Except one IME from an MD who THOUGHT he was cutting care by recommending 1 tx a week, whereas we had already decreased tx to 1-2 times a month. So....we INCREASED CARE--per his recommendation--to 4 tx a month (HEY...he's the expert!! What do I know??). So, the ins industry can use the fact that EVERY IME cuts care to create the "illusion" with the legislature that EVERY chiropractor claim has over-utilization. Combine that with the horrific stats from the "true" PIP Mills...and we could literally be "IME'ing" ourselves right out of PIP coverage in Oregon. Wake up profession, and stop cutting your's and your brethren's throats (financially speaking of course). Because if the cut PIP...YOU don't get to perform any more IME's!! (:-) M. s, D.C. IME increase> > > > > > The increase as of late in IME’s has been enormous in our office. We have more patients going to IME’s than not at this point. I used to NEVER have an IME requested of my patients. There is something in the water. Anyone else noticing this to a high degree as of late?> > > > I mean cases that are 8 visits in with pain levels of 5-6 of 10 and they’re getting IMEd.......uuughhh.> > > > ph Medlin D.C.> Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 16, 2012 Report Share Posted March 16, 2012 Dr. Medlin and all others. The problem with the insurance company ordering an IME is that most patients will just drop out of care by virtue of the IME being ordered and the insurance company stating if the IME finds against the treating doc, then care will be denied and payment will be withheld. It works, most every time. Surely this can't be the underlying intent? Unless the patient is represented by a good attorney they usually just drop off the face of the earth missing much needed care. I am not an attorney, but this seems like a bad faith interference. At the Bowen/Pendleton seminar yesterday, the topic of IMEs came up. What was mentioned and brought to light was a way to at least be in the loop with regards to IMEs. This is to have your patient sign a UCC Lien and Assignment. This is then sent to the insurance company, both the at-fault and patient PIP carrier. You don't need to file the UCC Lien, just have the patient sign it. When the insurance company gets copied by Certified Mail, they will then be put under a different set of rules. You then have the right to be notified when an IME is going to be ordered, and you can then inform the insurer how you expect the IME to be done and what parameters are to be met. You also will be put in front of the line for payment, rather than at the back of the bus. The insurer then is required to send you a copy of the IME when it is done, and they can't say it isn't any of your business. If you haven't seen any of Mr. Bowen or Pendleton's stuff, you all should attend. Hope this information is helpful. Grice, DC Albany, OR On 3/16/2012 10:35 AM, ph Medlin wrote: Yes, and the IME exam itself is actually a different topic than what I'm harping on here. It’s the IME order itself. Believe me, if there was a clear criteria to follow, we would conform to that. It’s such an ambiguous system in regards to the ordering..Sure there are elements beyond our treatment that cause the ordering of the exam, but these should be pretty rare and I know for a fact that they played no part in many of the exams ordered from our office. I wish for a more up front out in the open means of ordering these exams. I am weary of the mystery and the game of “avoid the IME” in which is impossible to win. ph Medlin D.C. From: Sunny Kierstyn Sent: Friday, March 16, 2012 10:13 AM joe medlin ; mjqpdc@... ; DC Cc: Subject: RE: IME increase Thank you Joe ..... very well stated. I too was somewhat offended by that statement. Dr. Burke appears to be painting with as broad a brush as he claims is being used against him. Judgement about cases from these docs, when hired by an interested party, will always be suspect. There is an idea of a system for choosing IMEs that pulls randomly from a state list that seems FAR fairer for both patient and doc .... it appears that it will take legislation to achieve ..... which means time is involved. In the meantime, we appear to be stuck with this unfair and unjust mechanism. It seems that all and each are performing to their best ..... it is just that the lines of judgement are clouded with money interests. And the patient is thwarted. We need a system that chooses a doc to perform an IME from a random list, not driven by the money sources. Sunny Sunny Kierstyn, RN DC Fibromyalgia Care Center of Oregon 2677 Willakenzie Road, 7C Eugene, Oregon, 97401 541- 654-0850; Fx; 541- 654-0834 www.drsunnykierstyn.com mjqpdc@...; johncc48@... CC: From: spinetree@... Date: Fri, 16 Mar 2012 09:53:42 -0700 Subject: Re: IME increase Do all the treatment codes stay the same visit by visit, are all the charges the same and at the top of the allowable limits for every visit? This IS a "mill" even if it for just 2 or 3 MVA patients! **WHAT? I disagree adamantly. I’m not sure about your practice, but I’m a chiro and patients get adjusted on every visit here and the charge is the same and since I’m worth it, I feel charging to the full extent of what’s allowable is fair. Do things change as the patient progresses regarding exercise/rehab? Yep, but they still get an adjustment and some tissue work to loosen things up on every visit. It’s part of the therapeutic recovery. I also do ALL the work, except if they see our LMT. I do NOT run a mill and actually take offense at the insinuation. This may be just a coincidence and the number of IME”s may drop in a few months. Who knows. The amount of PIP I see has also steadily increased, but I’ve got some colleagues who have responded off list who are also experiencing an uptick in these exams DESPITE performing the best “doctoring” there is out there. I also notice that most of the folks responding saying they haven’t noticed an increase in IME’s are outside of PDX. Not sure if that makes a difference. Folks, I think we’re giving adjusters wayy too much credit. Again, if you think that you are safe because you take measures that you perceive to be preventative in the ordering of these exams, I’m here to tell you you are not. We have not noticed ANY logical correlation to the exam or connection between patients. 5 visits in ordered, ordered at the end of treatment when patient has shown nothing but improvement and 0 VAS discharge etc. etc... Even NOT being ordered on patients where you may think it would be.......SO convincing ourselves this is only happening to bad doctors or PIP mills is misguided and wrong. Despite our stellar communication, narrative written reports upon every exam followed by call to adjuster, clear treatment plan, and our best estimation when MMI will be achieved, we are experiencing an interruption in our GOOD DOCTORING. Despite having an excellent record of getting people out of pain without exhausting PIP or signing them up for 30 visit tx plans, we are experiencing an interruption in our GOOD DOCTORING. Assuming it’s the other way around would be a blatant mistake and a slap in the face to many good Doctors of Chiropractic. ph Medlin D.C. From: Colwell Sent: Thursday, March 15, 2012 9:42 PM mjqpdc Cc: Subject: Re: [From OregonDCs] IME increase Very good concise response . Thanks. I have not had an increase in IMEs within the last 2 or 3 years. I have had a couple that I disagreed with but in those cases there were grounds for professional disagreement. I do feel that the treating physician knows much more about the myriad clinical aspects of their patient's condition than any IME. So, because many IME opinions are so definite and result in such a dramatic effect on a patient's well being, it seems unfair that one opinion from only 1 day in a patient's life carries so much weight. Not withstanding this, if the treating doc does not document the complications, altered treatment approaches, refine the dx codes and appear to be managing their patient's care thoughtfully, it is a given that someone will get wind of this and start doing IMEs. Do all the treatment codes stay the same visit by visit, are all the charges the same and at the top of the allowable limits for every visit? This IS a "mill" even if it for just 2 or 3 MVA patients! Does every PI patient PIP out with only chiropractic care or is there consultation and referral patterns that show clinical decision making? Does everyone get massage or fascial release every visit? Does their family primary care provider get a note and a request for past medicals? I was in court last week on a PIP trial and the defense asked if I knew about this patients past LBP history.......I did not, despite the fact that it was her MD that referred her to me for the MVA injuries after 4 mo of PT hadn't helped! I hadn't asked either. It won't make much difference because the primary injuries were cervical and thoracic. Nevertheless I had a wake up call again! In short we will always have problems, but the more real doctoring we do the less there is to question. On 3/15/2012 7:23 PM, mjqpdc wrote: I'm not disputing Dr. Medlin's perception that the number of IMEs is increasing, only that there seems to be a one-sided view that continues to be expressed, namely that all chiropractors are good and IMEs are bad (with the exception of that ever-present "few" or, more recently "several" docs or "IME mills" who no one ever names). I doubt the reality can be presented in such dichotomous terms. Are any other docs on this listserv besides Dr. M experiencing this? Are there docs who have not experienced an increase? Are there docs on the listserv whose patients rarely if ever get sent for IMEs? If you believe you're experience an increase, have you looked at stats for previous years and compared them to the present to see if your perception is correct? I'm asking these questions in good faith. I think it's too easy to read someone's post, maybe see a couple of concurring posts, and assume that the problem is widespread. I really don't know, so I'm asking. I do only a few IMEs per month, and the number of IMEs I perform is much fewer than in the past, by my own choice, so I cannot judge these statements from my own experience. However, my experience tells me that there are many reasons IMEs are requested. It's not always the number of visits. If I saw a patient 8 times and the pain was still at 5-6, I would be concerned that the patient was not benefiting from my care. I might want a second opinion. Here are some reasons IMEs are requested: Causation and compensability. Sometimes the cause of the patient's injuries is in dispute. They may have had a previous problem and, whether or not it has anything to do with the current one, the insurer may have a question about it. Compensability is more of a concern in workers' compensation cases, as when the patient has degenerative disc disease and then exacerbates the problem at work (in Oregon this is called major versus material contributing cause). Medical necessity of treatment. Do the doctor's chart notes document medical necessity? Sometimes doctors put the cart before the horse, that is, rather than determining IF the patient would benefit from care and, if so, WHAT KIND of treatment is best for this patient, we try to build a case for treating the patient with "positive" findings. But there is no critical mass of positive findings beyond which treatment is necessarily justified. There has to be consistency between the history, mechanism of injury, exam findings, and the diagnosis. Usually a clinically meaningful cluster of findings leads to a diagnosis. Disability and impairment. Often there is a question about temporary disability - was it necessary for the patient to miss work because of the injuries? If so, for how long? Other times the question concerns permanent disability and impairment - to what degree, if any, will the patient be limited or unable to perform normal activities for the remainder of his or her life? Apportionment. Is the patient being treated for more than one condition? If so, to what extent does each condition contribute to the need for treatment? I think most chiropractors were never taught in school how to determine apportionment. I know I didn't learn it there. I see records - and have seen this method recommended on this listserv - where the doc stops treatment for one injury when the patient sustains a second injury, saying they will go back to treating the first injury when the second one resolves. In terms of tissue damage and the healing process, this makes no sense, but it's easier than trying to apportion the percentage of treatment between the two injuries. Location and nature of injury. If your patient goes to the ER shortly after an accident complaining of neck pain and later comes to you with neck pain and low back pain, the carrier might question whether the LBP resulted from the compensable injury. Also, I've seen many cases where the treating doctor gives a diagnosis for an area which wasn't injured and is not symptomatic, usually because "subluxations," segmental dysfunction, and increased muscle tone are found on exam. The nature of the injury can be questionable as well. If you diagnose a moderate to severe cervical sprain/strain, for instance, and then proceed to adjust the patient's neck, it might appear that your treatment is injuring the patient further. After all, you are saying they have a serious ligament injury (think of a "moderate to severe sprain" of the knee or ankle). In my opinion, all of these reasons boil down to two major ones: DOCUMENTATION and COMMUNICATION. Most of these problems can be prevented by keeping accurate, legible, and complete chart records. I once heard a doctor complain that she didn't get paid enough to write good chart notes. I would say that if you don't keep good chart notes, you won't get paid. So I'll step down off my soap box for now (sorry, no pun intended). I really would like to know from other readers how much of an IME problem you perceive in your own practices. J. Burke, D.C. > > Storm clouds, the Oregon Chiropractic Association is being proactive and pre-emptive as per troubled areas in PIP including excessive IMEs, biased IMEs, file reviews and other forms of abuse on the “over side of the fence.†We do not wish to end up like Florida wherein you are reduced to having to receive a referral from a medical professional including a physician’s assistant and limits of care to $2,500….Vern Saboe PS: Have you joined the fight colleagues? Have you joined the OCA? We need your financial help and your ideas call he OCA office and join today…503-256-1601, Vern Saboe if you have specific questions call me any Time 541-231-4528 Cell > > > > From: mailto:%40 [mailto:mailto:%40] On Behalf Of ph Medlin > Sent: Thursday, March 15, 2012 11:07 AM > mailto:%40 > Subject: IME increase > > > > > > The increase as of late in IME’s has been enormous in our office. We have more patients going to IME’s than not at this point. I used to NEVER have an IME requested of my patients. There is something in the water. Anyone else noticing this to a high degree as of late? > > > > I mean cases that are 8 visits in with pain levels of 5-6 of 10 and they’re getting IMEd.......uuughhh. > > > > ph Medlin D.C. > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 16, 2012 Report Share Posted March 16, 2012 Yes I have seen in my practice an increase in IME's. I rarely had any for years now over the last 6-8 months I have had three. Two from one company. Specifically I will not name the company but on one case they called for a paper review because they questioned my apportionment. The MD did a paper review and admitted he did not have my notes from ths Ins. company but with every other doc's notes decided her condition was not the MVC's fault. I appealed and they did not change their opinion. The other case I treated was at the end of treatment, approx. 2 weeks away form being stationary. Attornyes have them both. Some MD reviewer is going to cost the insurance company way more than all the doc's fees on the first one. Brad Rethwill DC Eugene > > > > Storm clouds, the Oregon Chiropractic Association is being proactive and pre-emptive as per troubled areas in PIP including excessive IMEs, biased IMEs, file reviews and other forms of abuse on the “over side of the fence.†We do not wish to end up like Florida wherein you are reduced to having to receive a referral from a medical professional including a physician’s assistant and limits of care to $2,500….Vern Saboe PS: Have you joined the fight colleagues? Have you joined the OCA? We need your financial help and your ideas call he OCA office and join today…503-256-1601, Vern Saboe if you have specific questions call me any Time 541-231-4528 Cell > > > > > > > > From: [mailto: ] On Behalf Of ph Medlin > > Sent: Thursday, March 15, 2012 11:07 AM > > > > Subject: IME increase > > > > > > > > > > > > The increase as of late in IME’s has been enormous in our office. We have more patients going to IME’s than not at this point. I used to NEVER have an IME requested of my patients. There is something in the water. Anyone else noticing this to a high degree as of late? > > > > > > > > I mean cases that are 8 visits in with pain levels of 5-6 of 10 and they’re getting IMEd.......uuughhh. > > > > > > > > ph Medlin D.C. > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 16, 2012 Report Share Posted March 16, 2012 Brad, I believe if this doctor made any conclusion on incomplete data, ie he didn't have your notes, then he has committed a form of insurance fraud. I am not an attorney, but I would send him to the Insurance Commissioner, or his board for review. If he doesn't review all data, his report is misleading, at the very least and is probably a fundamentally flawed IME report. Ron Grice, DC Albany, OR On 3/16/2012 11:09 AM, bradrethwilldc wrote: Yes I have seen in my practice an increase in IME's. I rarely had any for years now over the last 6-8 months I have had three. Two from one company. Specifically I will not name the company but on one case they called for a paper review because they questioned my apportionment. The MD did a paper review and admitted he did not have my notes from ths Ins. company but with every other doc's notes decided her condition was not the MVC's fault. I appealed and they did not change their opinion. The other case I treated was at the end of treatment, approx. 2 weeks away form being stationary. Attornyes have them both. Some MD reviewer is going to cost the insurance company way more than all the doc's fees on the first one. Brad Rethwill DC Eugene > > > > Storm clouds, the Oregon Chiropractic Association is being proactive and pre-emptive as per troubled areas in PIP including excessive IMEs, biased IMEs, file reviews and other forms of abuse on the “over side of the fence.†We do not wish to end up like Florida wherein you are reduced to having to receive a referral from a medical professional including a physician’s assistant and limits of care to $2,500….Vern Saboe PS: Have you joined the fight colleagues? Have you joined the OCA? We need your financial help and your ideas call he OCA office and join today…503-256-1601, Vern Saboe if you have specific questions call me any Time 541-231-4528 Cell > > > > > > > > From: [mailto: ] On Behalf Of ph Medlin > > Sent: Thursday, March 15, 2012 11:07 AM > > > > Subject: IME increase > > > > > > > > > > > > The increase as of late in IME’s has been enormous in our office. We have more patients going to IME’s than not at this point. I used to NEVER have an IME requested of my patients. There is something in the water. Anyone else noticing this to a high degree as of late? > > > > > > > > I mean cases that are 8 visits in with pain levels of 5-6 of 10 and they’re getting IMEd.......uuughhh. > > > > > > > > ph Medlin D.C. > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 16, 2012 Report Share Posted March 16, 2012 I'm in with that Sunny. That effort started about 15 years ago with a certification course but, as I recall, it died because ther was no legilative mandate that the ins cos needed to use the new system. They wanted to use the old 'in their favor' system. I don't know when it died but Vern would be a good resource for looking into this again. Colwell On 3/16/2012 10:13 AM, Sunny Kierstyn wrote: Thank you Joe ..... very well stated. I too was somewhat offended by that statement. Dr. Burke appears to be painting with as broad a brush as he claims is being used against him. Judgement about cases from these docs, when hired by an interested party, will always be suspect. There is an idea of a system for choosing IMEs that pulls randomly from a state list that seems FAR fairer for both patient and doc ..... it appears that it will take legislation to achieve ..... which means time is involved. In the meantime, we appear to be stuck with this unfair and unjust mechanism. It seems that all and each are performing to their best ..... it is just that the lines of judgement are clouded with money interests. And the patient is thwarted. We need a system that chooses a doc to perform an IME from a random list, not driven by the money sources. Sunny Sunny Kierstyn, RN DC Fibromyalgia Care Center of Oregon 2677 Willakenzie Road, 7C Eugene, Oregon, 97401 541- 654-0850; Fx; 541- 654-0834 www.drsunnykierstyn.com mjqpdc@...; johncc48@... CC: From: spinetree@... Date: Fri, 16 Mar 2012 09:53:42 -0700 Subject: Re: IME increase Do all the treatment codes stay the same visit by visit, are all the charges the same and at the top of the allowable limits for every visit? This IS a "mill" even if it for just 2 or 3 MVA patients! **WHAT? I disagree adamantly. I’m not sure about your practice, but I’m a chiro and patients get adjusted on every visit here and the charge is the same and since I’m worth it, I feel charging to the full extent of what’s allowable is fair. Do things change as the patient progresses regarding exercise/rehab? Yep, but they still get an adjustment and some tissue work to loosen things up on every visit. It’s part of the therapeutic recovery. I also do ALL the work, except if they see our LMT. I do NOT run a mill and actually take offense at the insinuation. This may be just a coincidence and the number of IME”s may drop in a few months. Who knows. The amount of PIP I see has also steadily increased, but I’ve got some colleagues who have responded off list who are also experiencing an uptick in these exams DESPITE performing the best “doctoring” there is out there. I also notice that most of the folks responding saying they haven’t noticed an increase in IME’s are outside of PDX. Not sure if that makes a difference. Folks, I think we’re giving adjusters wayy too much credit. Again, if you think that you are safe because you take measures that you perceive to be preventative in the ordering of these exams, I’m here to tell you you are not. We have not noticed ANY logical correlation to the exam or connection between patients. 5 visits in ordered, ordered at the end of treatment when patient has shown nothing but improvement and 0 VAS discharge etc. etc... Even NOT being ordered on patients where you may think it would be.......SO convincing ourselves this is only happening to bad doctors or PIP mills is misguided and wrong. Despite our stellar communication, narrative written reports upon every exam followed by call to adjuster, clear treatment plan, and our best estimation when MMI will be achieved, we are experiencing an interruption in our GOOD DOCTORING. Despite having an excellent record of getting people out of pain without exhausting PIP or signing them up for 30 visit tx plans, we are experiencing an interruption in our GOOD DOCTORING. Assuming it’s the other way around would be a blatant mistake and a slap in the face to many good Doctors of Chiropractic. ph Medlin D.C. From: Colwell Sent: Thursday, March 15, 2012 9:42 PM mjqpdc Cc: Subject: Re: IME increase Very good concise response . Thanks. I have not had an increase in IMEs within the last 2 or 3 years. I have had a couple that I disagreed with but in those cases there were grounds for professional disagreement. I do feel that the treating physician knows much more about the myriad clinical aspects of their patient's condition than any IME. So, because many IME opinions are so definite and result in such a dramatic effect on a patient's well being, it seems unfair that one opinion from only 1 day in a patient's life carries so much weight. Not withstanding this, if the treating doc does not document the complications, altered treatment approaches, refine the dx codes and appear to be managing their patient's care thoughtfully, it is a given that someone will get wind of this and start doing IMEs. Do all the treatment codes stay the same visit by visit, are all the charges the same and at the top of the allowable limits for every visit? This IS a "mill" even if it for just 2 or 3 MVA patients! Does every PI patient PIP out with only chiropractic care or is there consultation and referral patterns that show clinical decision making? Does everyone get massage or fascial release every visit? Does their family primary care provider get a note and a request for past medicals? I was in court last week on a PIP trial and the defense asked if I knew about this patients past LBP history.......I did not, despite the fact that it was her MD that referred her to me for the MVA injuries after 4 mo of PT hadn't helped! I hadn't asked either. It won't make much difference because the primary injuries were cervical and thoracic. Nevertheless I had a wake up call again! In short we will always have problems, but the more real doctoring we do the less there is to question. On 3/15/2012 7:23 PM, mjqpdc wrote: I'm not disputing Dr. Medlin's perception that the number of IMEs is increasing, only that there seems to be a one-sided view that continues to be expressed, namely that all chiropractors are good and IMEs are bad (with the exception of that ever-present "few" or, more recently "several" docs or "IME mills" who no one ever names). I doubt the reality can be presented in such dichotomous terms. Are any other docs on this listserv besides Dr. M experiencing this? Are there docs who have not experienced an increase? Are there docs on the listserv whose patients rarely if ever get sent for IMEs? If you believe you're experience an increase, have you looked at stats for previous years and compared them to the present to see if your perception is correct? I'm asking these questions in good faith. I think it's too easy to read someone's post, maybe see a couple of concurring posts, and assume that the problem is widespread. I really don't know, so I'm asking. I do only a few IMEs per month, and the number of IMEs I perform is much fewer than in the past, by my own choice, so I cannot judge these statements from my own experience. However, my experience tells me that there are many reasons IMEs are requested. It's not always the number of visits. If I saw a patient 8 times and the pain was still at 5-6, I would be concerned that the patient was not benefiting from my care. I might want a second opinion. Here are some reasons IMEs are requested: Causation and compensability. Sometimes the cause of the patient's injuries is in dispute. They may have had a previous problem and, whether or not it has anything to do with the current one, the insurer may have a question about it. Compensability is more of a concern in workers' compensation cases, as when the patient has degenerative disc disease and then exacerbates the problem at work (in Oregon this is called major versus material contributing cause). Medical necessity of treatment. Do the doctor's chart notes document medical necessity? Sometimes doctors put the cart before the horse, that is, rather than determining IF the patient would benefit from care and, if so, WHAT KIND of treatment is best for this patient, we try to build a case for treating the patient with "positive" findings. But there is no critical mass of positive findings beyond which treatment is necessarily justified. There has to be consistency between the history, mechanism of injury, exam findings, and the diagnosis. Usually a clinically meaningful cluster of findings leads to a diagnosis. Disability and impairment. Often there is a question about temporary disability - was it necessary for the patient to miss work because of the injuries? If so, for how long? Other times the question concerns permanent disability and impairment - to what degree, if any, will the patient be limited or unable to perform normal activities for the remainder of his or her life? Apportionment. Is the patient being treated for more than one condition? If so, to what extent does each condition contribute to the need for treatment? I think most chiropractors were never taught in school how to determine apportionment. I know I didn't learn it there. I see records - and have seen this method recommended on this listserv - where the doc stops treatment for one injury when the patient sustains a second injury, saying they will go back to treating the first injury when the second one resolves. In terms of tissue damage and the healing process, this makes no sense, but it's easier than trying to apportion the percentage of treatment between the two injuries. Location and nature of injury. If your patient goes to the ER shortly after an accident complaining of neck pain and later comes to you with neck pain and low back pain, the carrier might question whether the LBP resulted from the compensable injury. Also, I've seen many cases where the treating doctor gives a diagnosis for an area which wasn't injured and is not symptomatic, usually because "subluxations," segmental dysfunction, and increased muscle tone are found on exam. The nature of the injury can be questionable as well. If you diagnose a moderate to severe cervical sprain/strain, for instance, and then proceed to adjust the patient's neck, it might appear that your treatment is injuring the patient further. After all, you are saying they have a serious ligament injury (think of a "moderate to severe sprain" of the knee or ankle). In my opinion, all of these reasons boil down to two major ones: DOCUMENTATION and COMMUNICATION. Most of these problems can be prevented by keeping accurate, legible, and complete chart records. I once heard a doctor complain that she didn't get paid enough to write good chart notes. I would say that if you don't keep good chart notes, you won't get paid. So I'll step down off my soap box for now (sorry, no pun intended). I really would like to know from other readers how much of an IME problem you perceive in your own practices. J. Burke, D.C. > > Storm clouds, the Oregon Chiropractic Association is being proactive and pre-emptive as per troubled areas in PIP including excessive IMEs, biased IMEs, file reviews and other forms of abuse on the “over side of the fence.†We do not wish to end up like Florida wherein you are reduced to having to receive a referral from a medical professional including a physician’s assistant and limits of care to $2,500….Vern Saboe PS: Have you joined the fight colleagues? Have you joined the OCA? We need your financial help and your ideas call he OCA office and join today…503-256-1601, Vern Saboe if you have specific questions call me any Time 541-231-4528 Cell > > > > From: mailto:%40 [mailto:mailto:%40] On Behalf Of ph Medlin > Sent: Thursday, March 15, 2012 11:07 AM > mailto:%40 > Subject: IME increase > > > > > > The increase as of late in IME’s has been enormous in our office. We have more patients going to IME’s than not at this point. I used to NEVER have an IME requested of my patients. There is something in the water. Anyone else noticing this to a high degree as of late? > > > > I mean cases that are 8 visits in with pain levels of 5-6 of 10 and they’re getting IMEd.......uuughhh. > > > > ph Medlin D.C. > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 16, 2012 Report Share Posted March 16, 2012 Had one this last week that falls into that category: w/c injury with a lot of drama in the beginning due to the fact that the patient grabbed an ice back as soon as the muscle spasmed and, in spite of the employer's STRONG insistence that she go to occ med, she came here. We got notice of an IME less than 5 days later that was ascheduled less than 2 weeks into care. Haven't yet seen his report (requiring her to travel to Portland) but he never did get our notes ..... it will be fascinating to see what he says. SunnySunny Kierstyn, RN DC Fibromyalgia Care Center of Oregon 2677 Willakenzie Road, 7CEugene, Oregon, 97401541- 654-0850; Fx; 541- 654-0834www.drsunnykierstyn.com bradrethwilldc@...CC: From: rongrice@...Date: Fri, 16 Mar 2012 11:41:35 -0700Subject: Re: Re: IME increase Brad, I believe if this doctor made any conclusion on incomplete data, ie he didn't have your notes, then he has committed a form of insurance fraud. I am not an attorney, but I would send him to the Insurance Commissioner, or his board for review. If he doesn't review all data, his report is misleading, at the very least and is probably a fundamentally flawed IME report. Ron Grice, DC Albany, OR On 3/16/2012 11:09 AM, bradrethwilldc wrote: Yes I have seen in my practice an increase in IME's. I rarely had any for years now over the last 6-8 months I have had three. Two from one company. Specifically I will not name the company but on one case they called for a paper review because they questioned my apportionment. The MD did a paper review and admitted he did not have my notes from ths Ins. company but with every other doc's notes decided her condition was not the MVC's fault. I appealed and they did not change their opinion. The other case I treated was at the end of treatment, approx. 2 weeks away form being stationary. Attornyes have them both. Some MD reviewer is going to cost the insurance company way more than all the doc's fees on the first one. Brad Rethwill DC Eugene > > > > Storm clouds, the Oregon Chiropractic Association is being proactive and pre-emptive as per troubled areas in PIP including excessive IMEs, biased IMEs, file reviews and other forms of abuse on the “over side of the fence.†We do not wish to end up like Florida wherein you are reduced to having to receive a referral from a medical professional including a physician’s assistant and limits of care to $2,500….Vern Saboe PS: Have you joined the fight colleagues? Have you joined the OCA? We need your financial help and your ideas call he OCA office and join today…503-256-1601, Vern Saboe if you have specific questions call me any Time 541-231-4528 Cell > > > > > > > > From: [mailto: ] On Behalf Of ph Medlin > > Sent: Thursday, March 15, 2012 11:07 AM > > > > Subject: IME increase > > > > > > > > > > > > The increase as of late in IME’s has been enormous in our office. We have more patients going to IME’s than not at this point. I used to NEVER have an IME requested of my patients. There is something in the water. Anyone else noticing this to a high degree as of late? > > > > > > > > I mean cases that are 8 visits in with pain levels of 5-6 of 10 and they’re getting IMEd.......uuughhh. > > > > > > > > ph Medlin D.C. > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 16, 2012 Report Share Posted March 16, 2012 I just want to point out that I did not make the statement that offended Drs. Kierstyn and Medlin. Nonetheless, I think the problem is not limited to a few offices, even if the doctor’s intent is honorable. J. Burke, D.C. From: Sunny Kierstyn <skrndc1@...> joe medlin <spinetree@...>; mjqpdc@...; DC <johncc48@...> Cc: < > Sent: Friday, March 16, 2012 10:13 AM Subject: RE: IME increase Thank you Joe ..... very well stated. I too was somewhat offended by that statement. Dr. Burke appears to be painting with as broad a brush as he claims is being used against him. Judgement about cases from these docs, when hired by an interested party, will always be suspect. There is an idea of a system for choosing IMEs that pulls randomly from a state list that seems FAR fairer for both patient and doc ..... it appears that it will take legislation to achieve ..... which means time is involved. In the meantime, we appear to be stuck with this unfair and unjust mechanism. It seems that all and each are performing to their best ..... it is just that the lines of judgement are clouded with money interests. And the patient is thwarted. We need a system that chooses a doc to perform an IME from a random list, not driven by the money sources. SunnySunny Kierstyn, RN DC Fibromyalgia Care Center of Oregon 2677 Willakenzie Road, 7CEugene, Oregon, 97401541- 654-0850; Fx; 541- 654-0834www.drsunnykierstyn.com mjqpdc@...; johncc48@...CC: From: spinetree@...Date: Fri, 16 Mar 2012 09:53:42 -0700Subject: Re: IME increase Do all the treatment codes stay the same visit by visit, are all the charges the same and at the top of the allowable limits for every visit? This IS a "mill" even if it for just 2 or 3 MVA patients! **WHAT? I disagree adamantly. I’m not sure about your practice, but I’m a chiro and patients get adjusted on every visit here and the charge is the same and since I’m worth it, I feel charging to the full extent of what’s allowable is fair. Do things change as the patient progresses regarding exercise/rehab? Yep, but they still get an adjustment and some tissue work to loosen things up on every visit. It’s part of the therapeutic recovery. I also do ALL the work, except if they see our LMT. I do NOT run a mill and actually take offense at the insinuation. This may be just a coincidence and the number of IMEâ€s may drop in a few months. Who knows. The amount of PIP I see has also steadily increased, but I’ve got some colleagues who have responded off list who are also experiencing an uptick in these exams DESPITE performing the best “doctoring†there is out there. I also notice that most of the folks responding saying they haven’t noticed an increase in IME’s are outside of PDX. Not sure if that makes a difference. Folks, I think we’re giving adjusters wayy too much credit. Again, if you think that you are safe because you take measures that you perceive to be preventative in the ordering of these exams, I’m here to tell you you are not. We have not noticed ANY logical correlation to the exam or connection between patients. 5 visits in ordered, ordered at the end of treatment when patient has shown nothing but improvement and 0 VAS discharge etc. etc... Even NOT being ordered on patients where you may think it would be.......SO convincing ourselves this is only happening to bad doctors or PIP mills is misguided and wrong. Despite our stellar communication, narrative written reports upon every exam followed by call to adjuster, clear treatment plan, and our best estimation when MMI will be achieved, we are experiencing an interruption in our GOOD DOCTORING. Despite having an excellent record of getting people out of pain without exhausting PIP or signing them up for 30 visit tx plans, we are experiencing an interruption in our GOOD DOCTORING. Assuming it’s the other way around would be a blatant mistake and a slap in the face to many good Doctors of Chiropractic. ph Medlin D.C. From: Colwell Sent: Thursday, March 15, 2012 9:42 PM mjqpdc Cc: Subject: Re: IME increase Very good concise response . Thanks.I have not had an increase in IMEs within the last 2 or 3 years. I have had a couple that I disagreed with but in those cases there were grounds for professional disagreement.I do feel that the treating physician knows much more about the myriad clinical aspects of their patient's condition than any IME. So, because many IME opinions are so definite and result in such a dramatic effect on a patient's well being, it seems unfair that one opinion from only 1 day in a patient's life carries so much weight.Not withstanding this, if the treating doc does not document the complications, altered treatment approaches, refine the dx codes and appear to be managing their patient's care thoughtfully, it is a given that someone will get wind of this and start doing IMEs. Do all the treatment codes stay the same visit by visit, are all the charges the same and at the top of the allowable limits for every visit? This IS a "mill" even if it for just 2 or 3 MVA patients! Does every PI patient PIP out with only chiropractic care or is there consultation and referral patterns that show clinical decision making? Does everyone get massage or fascial release every visit? Does their family primary care provider get a note and a request for past medicals?I was in court last week on a PIP trial and the defense asked if I knew about this patients past LBP history.......I did not, despite the fact that it was her MD that referred her to me for the MVA injuries after 4 mo of PT hadn't helped! I hadn't asked either. It won't make much difference because the primary injuries were cervical and thoracic. Nevertheless I had a wake up call again!In short we will always have problems, but the more real doctoring we do the less there is to question.On 3/15/2012 7:23 PM, mjqpdc wrote: I'm not disputing Dr. Medlin's perception that the number of IMEs is increasing, only that there seems to be a one-sided view that continues to be expressed, namely that all chiropractors are good and IMEs are bad (with the exception of that ever-present "few" or, more recently "several" docs or "IME mills" who no one ever names). I doubt the reality can be presented in such dichotomous terms. Are any other docs on this listserv besides Dr. M experiencing this? Are there docs who have not experienced an increase? Are there docs on the listserv whose patients rarely if ever get sent for IMEs? If you believe you're experience an increase, have you looked at stats for previous years and compared them to the present to see if your perception is correct?I'm asking these questions in good faith. I think it's too easy to read someone's post, maybe see a couple of concurring posts, and assume that the problem is widespread. I really don't know, so I'm asking. I do only a few IMEs per month, and the number of IMEs I perform is much fewer than in the past, by my own choice, so I cannot judge these statements from my own experience. However, my experience tells me that there are many reasons IMEs are requested. It's not always the number of visits. If I saw a patient 8 times and the pain was still at 5-6, I would be concerned that the patient was not benefiting from my care. I might want a second opinion. Here are some reasons IMEs are requested:Causation and compensability. Sometimes the cause of the patient's injuries is in dispute. They may have had a previous problem and, whether or not it has anything to do with the current one, the insurer may have a question about it. Compensability is more of a concern in workers' compensation cases, as when the patient has degenerative disc disease and then exacerbates the problem at work (in Oregon this is called major versus material contributing cause). Medical necessity of treatment. Do the doctor's chart notes document medical necessity? Sometimes doctors put the cart before the horse, that is, rather than determining IF the patient would benefit from care and, if so, WHAT KIND of treatment is best for this patient, we try to build a case for treating the patient with "positive" findings. But there is no critical mass of positive findings beyond which treatment is necessarily justified. There has to be consistency between the history, mechanism of injury, exam findings, and the diagnosis. Usually a clinically meaningful cluster of findings leads to a diagnosis. Disability and impairment. Often there is a question about temporary disability - was it necessary for the patient to miss work because of the injuries? If so, for how long? Other times the question concerns permanent disability and impairment - to what degree, if any, will the patient be limited or unable to perform normal activities for the remainder of his or her life? Apportionment. Is the patient being treated for more than one condition? If so, to what extent does each condition contribute to the need for treatment? I think most chiropractors were never taught in school how to determine apportionment. I know I didn't learn it there. I see records - and have seen this method recommended on this listserv - where the doc stops treatment for one injury when the patient sustains a second injury, saying they will go back to treating the first injury when the second one resolves. In terms of tissue damage and the healing process, this makes no sense, but it's easier than trying to apportion the percentage of treatment between the two injuries. Location and nature of injury. If your patient goes to the ER shortly after an accident complaining of neck pain and later comes to you with neck pain and low back pain, the carrier might question whether the LBP resulted from the compensable injury. Also, I've seen many cases where the treating doctor gives a diagnosis for an area which wasn't injured and is not symptomatic, usually because "subluxations," segmental dysfunction, and increased muscle tone are found on exam. The nature of the injury can be questionable as well. If you diagnose a moderate to severe cervical sprain/strain, for instance, and then proceed to adjust the patient's neck, it might appear that your treatment is injuring the patient further. After all, you are saying they have a serious ligament injury (think of a "moderate to severe sprain" of the knee or ankle). In my opinion, all of these reasons boil down to two major ones: DOCUMENTATION and COMMUNICATION. Most of these problems can be prevented by keeping accurate, legible, and complete chart records. I once heard a doctor complain that she didn't get paid enough to write good chart notes. I would say that if you don't keep good chart notes, you won't get paid.So I'll step down off my soap box for now (sorry, no pun intended). I really would like to know from other readers how much of an IME problem you perceive in your own practices. J. Burke, D.C. >> Storm clouds, the Oregon Chiropractic Association is being proactive and pre-emptive as per troubled areas in PIP including excessive IMEs, biased IMEs, file reviews and other forms of abuse on the “over side of the fence.� We do not wish to end up like Florida wherein you are reduced to having to receive a referral from a medical professional including a physician’s assistant and limits of care to $2,500….Vern Saboe PS: Have you joined the fight colleagues? Have you joined the OCA? We need your financial help and your ideas call he OCA office and join today…503-256-1601, Vern Saboe if you have specific questions call me any Time 541-231-4528 Cell > > > > From: mailto:%40 [mailto:mailto:%40] On Behalf Of ph Medlin> Sent: Thursday, March 15, 2012 11:07 AM> mailto:%40> Subject: IME increase> > > > > > The increase as of late in IME’s has been enormous in our office. We have more patients going to IME’s than not at this point. I used to NEVER have an IME requested of my patients. There is something in the water. Anyone else noticing this to a high degree as of late?> > > > I mean cases that are 8 visits in with pain levels of 5-6 of 10 and they’re getting IMEd.......uuughhh.> > > > ph Medlin D.C.> Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 16, 2012 Report Share Posted March 16, 2012 (from moderator) (and all): I object to the language you use in first line of your post. Let's make sure we keep this discussion professional. You can be emotional about and issue and still be professional as well. Thanks. > > > > Storm clouds, the Oregon Chiropractic Association is being proactive and pre-emptive as per troubled areas in PIP including excessive IMEs, biased IMEs, file reviews and other forms of abuse on the  " over side of the fence.†We do not wish to end up like Florida wherein you are reduced to having to receive a referral from a medical professional including a physician’s assistant and limits of care to $2,500….Vern Saboe PS: Have you joined the fight colleagues? Have you joined the OCA? We need your financial help and your ideas call he OCA office and join today…503-256-1601, Vern Saboe if you have specific questions call me any Time 541-231-4528 Cell > > > > > > > > From: mailto:%40 [mailto:mailto:%40] On Behalf Of ph Medlin > > Sent: Thursday, March 15, 2012 11:07 AM > > mailto:%40 > > Subject: IME increase > > > > > > > > > > > > The increase as of late in IME’s has been enormous in our office. We have more patients going to IME’s than not at this point. I used to NEVER have an IME requested of my patients. There is something in the water. Anyone else noticing this to a high degree as of late? > > > > > > > > I mean cases that are 8 visits in with pain levels of 5-6 of 10 and they’re getting IMEd.......uuughhh. > > > > > > > > ph Medlin D.C. > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 16, 2012 Report Share Posted March 16, 2012 2 recent experiences. Background: I don't hardly ever get IMEd, perhaps once or twice per year, so it is difficult to say if there is a change. But in last 2 months , we had a DC paper review by a DC in Louisiana? on a very straightforward PIP USAA case. It was an absolutely horrendous piece of work, in my opinion complete with retroactive 'divinations', etc. I have never found out what triggered it, but my suspicion is that perhaps Massage Envy was running their STM bills up the flagpole. (patient was referred out for some STM) I do not like that Massage Envy company but the patient was herself a knowledgeable LMT who had prior worked with this LMT so I referred her out for very reasonable course of STM care. Second case was/is very interesting...it was an absolute charade and hatchet job (in my professional opinion) by a retired orthopedic surgeon in Salem, also complete with retroactive " backward in time " divination, etc BTW, patient is Mexican and does not speak English and INsurer would not pay for translator for the IME...so, I made some calls and convinced one of my patients (who is a medical translator) to go down there by assuring her that the case was rock-solid and she would get paid, heh heh, she has not been paid yet either. Hilariously, IME doc pronounced her with no problems , no injuries, full range or motion, full strength, etc (she had not been able to abduct her arm above 90 degrees for many weeks). His report also directly contradicted a local orthopedist, Tom Croy, to whom she was previusly referred to by me (apparently the IME doc did not read the orthopod's report). In the end, I told her she had to get an MRI, (we were about to send her for one, when she got cut off) she went around to her neighbors and family and scraped up $500 cash!! She brought it in an envelop to my office to show me with a list of the folks she borrowed it from. Makes my eyes tear up, thinking about the shenanigans this lady had to put up with. Great lady, single mom, her 3 kids are outstanding students at Elementary school and my teach-patients know and heavily respect this lady as a model parent. I sent her down to Lebanon to get her $500. cash shoulder MRI and guess what?..MRI shows substantial objective findings of trauma. Those finding are unfortunate in that she will likely need surgery, but at least she will get the care she is legally obliged to get. I understand the need for IMEs of course, but there ARE hacks and there are hatchet jobs being done everyday in this state by people who either are evil, or have no souls. That is my humble and (to the best of my ability ) professional opinion. > > The increase as of late in IME’s has been enormous in our office. We have more patients going to IME’s than not at this point. I used to NEVER have an IME requested of my patients. There is something in the water. Anyone else noticing this to a high degree as of late? > > I mean cases that are 8 visits in with pain levels of 5-6 of 10 and they’re getting IMEd.......uuughhh. > > ph Medlin D.C. > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 16, 2012 Report Share Posted March 16, 2012 Hey Joe,The battle between insurance companies, treating docs, and IMEs is more generic than personal. Each has their special interests. Treating docs try to do their best as they understand patient needs; insurers try to maximize company profits, without which their annual stock indexes fall to increase; IME docs try to bring best practices to field docs and patients, for the most part. Trial lawyers make insurance companies stand up to their contractual responsibilities to the customer/patient. Academics set the groundwork for best practice guidelines. Insurance commissioners create a facade of patient advocacy against out-of-bounds behaviors. Lobbyists for docs and insurers try to keep their supporting organization's best interests at the bargaining table by any means necessary.As it's been for generations in America, it's what anyone can get away with that manifests in reality, with checks-and-balances to slow down rampant injustice. The real battle is to change the dominant business-as-usual paradigm from dog-eat-dog to treating others as we would be treated. To date so far, going back to the earliest Prophets, humanity has failed to live up to this sustainable principle. In the meantime, the dogs do whatever they will. What do we do? We must play our hand and do the best for the patient that we can, relying on those others (lobbyists, fellow docs, IMEers, academics, researchers, and so on) as we must to keep things in balance. As long as private insurers are profit-driven such problems will continue to disrespect patients and all concerned. It's business; it's not personal. Remember? Sears, DC, IAYT1218 NW 21st AvePortland, Oregon 97209v: 503-225-0255f: 503-525-6902www.docbones.com On Mar 16, 2012, at 9:53 AM, ph Medlin wrote: Do all the treatment codes stay the same visit by visit, are all the charges the same and at the top of the allowable limits for every visit? This IS a "mill" even if it for just 2 or 3 MVA patients! **WHAT? I disagree adamantly. I’m not sure about your practice, but I’m a chiro and patients get adjusted on every visit here and the charge is the same and since I’m worth it, I feel charging to the full extent of what’s allowable is fair. Do things change as the patient progresses regarding exercise/rehab? Yep, but they still get an adjustment and some tissue work to loosen things up on every visit. It’s part of the therapeutic recovery. I also do ALL the work, except if they see our LMT. I do NOT run a mill and actually take offense at the insinuation. This may be just a coincidence and the number of IMEâ€s may drop in a few months. Who knows. The amount of PIP I see has also steadily increased, but I’ve got some colleagues who have responded off list who are also experiencing an uptick in these exams DESPITE performing the best “doctoring†there is out there. I also notice that most of the folks responding saying they haven’t noticed an increase in IME’s are outside of PDX. Not sure if that makes a difference. Folks, I think we’re giving adjusters wayy too much credit. Again, if you think that you are safe because you take measures that you perceive to be preventative in the ordering of these exams, I’m here to tell you you are not. We have not noticed ANY logical correlation to the exam or connection between patients. 5 visits in ordered, ordered at the end of treatment when patient has shown nothing but improvement and 0 VAS discharge etc. etc... Even NOT being ordered on patients where you may think it would be.......SO convincing ourselves this is only happening to bad doctors or PIP mills is misguided and wrong. Despite our stellar communication, narrative written reports upon every exam followed by call to adjuster, clear treatment plan, and our best estimation when MMI will be achieved, we are experiencing an interruption in our GOOD DOCTORING. Despite having an excellent record of getting people out of pain without exhausting PIP or signing them up for 30 visit tx plans, we are experiencing an interruption in our GOOD DOCTORING. Assuming it’s the other way around would be a blatant mistake and a slap in the face to many good Doctors of Chiropractic. ph Medlin D.C. From: Colwell Sent: Thursday, March 15, 2012 9:42 PM mjqpdc Cc: Subject: Re: IME increase Very good concise response . Thanks.I have not had an increase in IMEs within the last 2 or 3 years. I have had a couple that I disagreed with but in those cases there were grounds for professional disagreement.I do feel that the treating physician knows much more about the myriad clinical aspects of their patient's condition than any IME. So, because many IME opinions are so definite and result in such a dramatic effect on a patient's well being, it seems unfair that one opinion from only 1 day in a patient's life carries so much weight.Not withstanding this, if the treating doc does not document the complications, altered treatment approaches, refine the dx codes and appear to be managing their patient's care thoughtfully, it is a given that someone will get wind of this and start doing IMEs. Do all the treatment codes stay the same visit by visit, are all the charges the same and at the top of the allowable limits for every visit? This IS a "mill" even if it for just 2 or 3 MVA patients! Does every PI patient PIP out with only chiropractic care or is there consultation and referral patterns that show clinical decision making? Does everyone get massage or fascial release every visit? Does their family primary care provider get a note and a request for past medicals?I was in court last week on a PIP trial and the defense asked if I knew about this patients past LBP history.......I did not, despite the fact that it was her MD that referred her to me for the MVA injuries after 4 mo of PT hadn't helped! I hadn't asked either. It won't make much difference because the primary injuries were cervical and thoracic. Nevertheless I had a wake up call again!In short we will always have problems, but the more real doctoring we do the less there is to question.On 3/15/2012 7:23 PM, mjqpdc wrote: I'm not disputing Dr. Medlin's perception that the number of IMEs is increasing, only that there seems to be a one-sided view that continues to be expressed, namely that all chiropractors are good and IMEs are bad (with the exception of that ever-present "few" or, more recently "several" docs or "IME mills" who no one ever names). I doubt the reality can be presented in such dichotomous terms. Are any other docs on this listserv besides Dr. M experiencing this? Are there docs who have not experienced an increase? Are there docs on the listserv whose patients rarely if ever get sent for IMEs? If you believe you're experience an increase, have you looked at stats for previous years and compared them to the present to see if your perception is correct?I'm asking these questions in good faith. I think it's too easy to read someone's post, maybe see a couple of concurring posts, and assume that the problem is widespread. I really don't know, so I'm asking. I do only a few IMEs per month, and the number of IMEs I perform is much fewer than in the past, by my own choice, so I cannot judge these statements from my own experience. However, my experience tells me that there are many reasons IMEs are requested. It's not always the number of visits. If I saw a patient 8 times and the pain was still at 5-6, I would be concerned that the patient was not benefiting from my care. I might want a second opinion. Here are some reasons IMEs are requested:Causation and compensability. Sometimes the cause of the patient's injuries is in dispute. They may have had a previous problem and, whether or not it has anything to do with the current one, the insurer may have a question about it. Compensability is more of a concern in workers' compensation cases, as when the patient has degenerative disc disease and then exacerbates the problem at work (in Oregon this is called major versus material contributing cause). Medical necessity of treatment. Do the doctor's chart notes document medical necessity? Sometimes doctors put the cart before the horse, that is, rather than determining IF the patient would benefit from care and, if so, WHAT KIND of treatment is best for this patient, we try to build a case for treating the patient with "positive" findings. But there is no critical mass of positive findings beyond which treatment is necessarily justified. There has to be consistency between the history, mechanism of injury, exam findings, and the diagnosis. Usually a clinically meaningful cluster of findings leads to a diagnosis. Disability and impairment. Often there is a question about temporary disability - was it necessary for the patient to miss work because of the injuries? If so, for how long? Other times the question concerns permanent disability and impairment - to what degree, if any, will the patient be limited or unable to perform normal activities for the remainder of his or her life? Apportionment. Is the patient being treated for more than one condition? If so, to what extent does each condition contribute to the need for treatment? I think most chiropractors were never taught in school how to determine apportionment. I know I didn't learn it there. I see records - and have seen this method recommended on this listserv - where the doc stops treatment for one injury when the patient sustains a second injury, saying they will go back to treating the first injury when the second one resolves. In terms of tissue damage and the healing process, this makes no sense, but it's easier than trying to apportion the percentage of treatment between the two injuries. Location and nature of injury. If your patient goes to the ER shortly after an accident complaining of neck pain and later comes to you with neck pain and low back pain, the carrier might question whether the LBP resulted from the compensable injury. Also, I've seen many cases where the treating doctor gives a diagnosis for an area which wasn't injured and is not symptomatic, usually because "subluxations," segmental dysfunction, and increased muscle tone are found on exam. The nature of the injury can be questionable as well. If you diagnose a moderate to severe cervical sprain/strain, for instance, and then proceed to adjust the patient's neck, it might appear that your treatment is injuring the patient further. After all, you are saying they have a serious ligament injury (think of a "moderate to severe sprain" of the knee or ankle). In my opinion, all of these reasons boil down to two major ones: DOCUMENTATION and COMMUNICATION. Most of these problems can be prevented by keeping accurate, legible, and complete chart records. I once heard a doctor complain that she didn't get paid enough to write good chart notes. I would say that if you don't keep good chart notes, you won't get paid.So I'll step down off my soap box for now (sorry, no pun intended). I really would like to know from other readers how much of an IME problem you perceive in your own practices. J. Burke, D.C. >> Storm clouds, the Oregon Chiropractic Association is being proactive and pre-emptive as per troubled areas in PIP including excessive IMEs, biased IMEs, file reviews and other forms of abuse on the “over side of the fence.†We do not wish to end up like Florida wherein you are reduced to having to receive a referral from a medical professional including a physician’s assistant and limits of care to $2,500….Vern Saboe PS: Have you joined the fight colleagues? Have you joined the OCA? We need your financial help and your ideas call he OCA office and join today…503-256-1601, Vern Saboe if you have specific questions call me any Time 541-231-4528 Cell > > > > From: mailto:%40 [mailto:mailto:%40] On Behalf Of ph Medlin> Sent: Thursday, March 15, 2012 11:07 AM> mailto:%40> Subject: IME increase> > > > > > The increase as of late in IME’s has been enormous in our office. We have more patients going to IME’s than not at this point. I used to NEVER have an IME requested of my patients. There is something in the water. Anyone else noticing this to a high degree as of late?> > > > I mean cases that are 8 visits in with pain levels of 5-6 of 10 and they’re getting IMEd.......uuughhh.> > > > ph Medlin D.C.> Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 16, 2012 Report Share Posted March 16, 2012 Thanks , Well said. It’s indeed good to remember that and to keep our eye on where our talents and primary concerns lie: Helping patients with the problems in which they present. ph Medlin D.C. From: Sears Sent: Friday, March 16, 2012 2:46 PM ph Medlin Cc: mjqpdc ; Colwell ; Subject: Re: IME increase Hey Joe, The battle between insurance companies, treating docs, and IMEs is more generic than personal. Each has their special interests. Treating docs try to do their best as they understand patient needs; insurers try to maximize company profits, without which their annual stock indexes fall to increase; IME docs try to bring best practices to field docs and patients, for the most part. Trial lawyers make insurance companies stand up to their contractual responsibilities to the customer/patient. Academics set the groundwork for best practice guidelines. Insurance commissioners create a facade of patient advocacy against out-of-bounds behaviors. Lobbyists for docs and insurers try to keep their supporting organization's best interests at the bargaining table by any means necessary. As it's been for generations in America, it's what anyone can get away with that manifests in reality, with checks-and-balances to slow down rampant injustice. The real battle is to change the dominant business-as-usual paradigm from dog-eat-dog to treating others as we would be treated. To date so far, going back to the earliest Prophets, humanity has failed to live up to this sustainable principle. In the meantime, the dogs do whatever they will. What do we do? We must play our hand and do the best for the patient that we can, relying on those others (lobbyists, fellow docs, IMEers, academics, researchers, and so on) as we must to keep things in balance. As long as private insurers are profit-driven such problems will continue to disrespect patients and all concerned. It's business; it's not personal. Remember? Sears, DC, IAYT 1218 NW 21st Ave Portland, Oregon 97209 v: 503-225-0255 f: 503-525-6902 www.docbones.com On Mar 16, 2012, at 9:53 AM, ph Medlin wrote: Do all the treatment codes stay the same visit by visit, are all the charges the same and at the top of the allowable limits for every visit? This IS a "mill" even if it for just 2 or 3 MVA patients! **WHAT? I disagree adamantly. I’m not sure about your practice, but I’m a chiro and patients get adjusted on every visit here and the charge is the same and since I’m worth it, I feel charging to the full extent of what’s allowable is fair. Do things change as the patient progresses regarding exercise/rehab? Yep, but they still get an adjustment and some tissue work to loosen things up on every visit. It’s part of the therapeutic recovery. I also do ALL the work, except if they see our LMT. I do NOT run a mill and actually take offense at the insinuation. This may be just a coincidence and the number of IMEâ€s may drop in a few months. Who knows. The amount of PIP I see has also steadily increased, but I’ve got some colleagues who have responded off list who are also experiencing an uptick in these exams DESPITE performing the best “doctoring†there is out there. I also notice that most of the folks responding saying they haven’t noticed an increase in IME’s are outside of PDX. Not sure if that makes a difference. Folks, I think we’re giving adjusters wayy too much credit. Again, if you think that you are safe because you take measures that you perceive to be preventative in the ordering of these exams, I’m here to tell you you are not. We have not noticed ANY logical correlation to the exam or connection between patients. 5 visits in ordered, ordered at the end of treatment when patient has shown nothing but improvement and 0 VAS discharge etc. etc... Even NOT being ordered on patients where you may think it would be.......SO convincing ourselves this is only happening to bad doctors or PIP mills is misguided and wrong. Despite our stellar communication, narrative written reports upon every exam followed by call to adjuster, clear treatment plan, and our best estimation when MMI will be achieved, we are experiencing an interruption in our GOOD DOCTORING. Despite having an excellent record of getting people out of pain without exhausting PIP or signing them up for 30 visit tx plans, we are experiencing an interruption in our GOOD DOCTORING. Assuming it’s the other way around would be a blatant mistake and a slap in the face to many good Doctors of Chiropractic. ph Medlin D.C. From: Colwell Sent: Thursday, March 15, 2012 9:42 PM mjqpdc Cc: Subject: Re: IME increase Very good concise response . Thanks.I have not had an increase in IMEs within the last 2 or 3 years. I have had a couple that I disagreed with but in those cases there were grounds for professional disagreement.I do feel that the treating physician knows much more about the myriad clinical aspects of their patient's condition than any IME. So, because many IME opinions are so definite and result in such a dramatic effect on a patient's well being, it seems unfair that one opinion from only 1 day in a patient's life carries so much weight.Not withstanding this, if the treating doc does not document the complications, altered treatment approaches, refine the dx codes and appear to be managing their patient's care thoughtfully, it is a given that someone will get wind of this and start doing IMEs. Do all the treatment codes stay the same visit by visit, are all the charges the same and at the top of the allowable limits for every visit? This IS a "mill" even if it for just 2 or 3 MVA patients! Does every PI patient PIP out with only chiropractic care or is there consultation and referral patterns that show clinical decision making? Does everyone get massage or fascial release every visit? Does their family primary care provider get a note and a request for past medicals?I was in court last week on a PIP trial and the defense asked if I knew about this patients past LBP history.......I did not, despite the fact that it was her MD that referred her to me for the MVA injuries after 4 mo of PT hadn't helped! I hadn't asked either. It won't make much difference because the primary injuries were cervical and thoracic. Nevertheless I had a wake up call again!In short we will always have problems, but the more real doctoring we do the less there is to question.On 3/15/2012 7:23 PM, mjqpdc wrote: I'm not disputing Dr. Medlin's perception that the number of IMEs is increasing, only that there seems to be a one-sided view that continues to be expressed, namely that all chiropractors are good and IMEs are bad (with the exception of that ever-present "few" or, more recently "several" docs or "IME mills" who no one ever names). I doubt the reality can be presented in such dichotomous terms. Are any other docs on this listserv besides Dr. M experiencing this? Are there docs who have not experienced an increase? Are there docs on the listserv whose patients rarely if ever get sent for IMEs? If you believe you're experience an increase, have you looked at stats for previous years and compared them to the present to see if your perception is correct?I'm asking these questions in good faith. I think it's too easy to read someone's post, maybe see a couple of concurring posts, and assume that the problem is widespread. I really don't know, so I'm asking. I do only a few IMEs per month, and the number of IMEs I perform is much fewer than in the past, by my own choice, so I cannot judge these statements from my own experience. However, my experience tells me that there are many reasons IMEs are requested. It's not always the number of visits. If I saw a patient 8 times and the pain was still at 5-6, I would be concerned that the patient was not benefiting from my care. I might want a second opinion. Here are some reasons IMEs are requested:Causation and compensability. Sometimes the cause of the patient's injuries is in dispute. They may have had a previous problem and, whether or not it has anything to do with the current one, the insurer may have a question about it. Compensability is more of a concern in workers' compensation cases, as when the patient has degenerative disc disease and then exacerbates the problem at work (in Oregon this is called major versus material contributing cause). Medical necessity of treatment. Do the doctor's chart notes document medical necessity? Sometimes doctors put the cart before the horse, that is, rather than determining IF the patient would benefit from care and, if so, WHAT KIND of treatment is best for this patient, we try to build a case for treating the patient with "positive" findings. But there is no critical mass of positive findings beyond which treatment is necessarily justified. There has to be consistency between the history, mechanism of injury, exam findings, and the diagnosis. Usually a clinically meaningful cluster of findings leads to a diagnosis. Disability and impairment. Often there is a question about temporary disability - was it necessary for the patient to miss work because of the injuries? If so, for how long? Other times the question concerns permanent disability and impairment - to what degree, if any, will the patient be limited or unable to perform normal activities for the remainder of his or her life? Apportionment. Is the patient being treated for more than one condition? If so, to what extent does each condition contribute to the need for treatment? I think most chiropractors were never taught in school how to determine apportionment. I know I didn't learn it there. I see records - and have seen this method recommended on this listserv - where the doc stops treatment for one injury when the patient sustains a second injury, saying they will go back to treating the first injury when the second one resolves. In terms of tissue damage and the healing process, this makes no sense, but it's easier than trying to apportion the percentage of treatment between the two injuries. Location and nature of injury. If your patient goes to the ER shortly after an accident complaining of neck pain and later comes to you with neck pain and low back pain, the carrier might question whether the LBP resulted from the compensable injury. Also, I've seen many cases where the treating doctor gives a diagnosis for an area which wasn't injured and is not symptomatic, usually because "subluxations," segmental dysfunction, and increased muscle tone are found on exam. The nature of the injury can be questionable as well. If you diagnose a moderate to severe cervical sprain/strain, for instance, and then proceed to adjust the patient's neck, it might appear that your treatment is injuring the patient further. After all, you are saying they have a serious ligament injury (think of a "moderate to severe sprain" of the knee or ankle). In my opinion, all of these reasons boil down to two major ones: DOCUMENTATION and COMMUNICATION. Most of these problems can be prevented by keeping accurate, legible, and complete chart records. I once heard a doctor complain that she didn't get paid enough to write good chart notes. I would say that if you don't keep good chart notes, you won't get paid.So I'll step down off my soap box for now (sorry, no pun intended). I really would like to know from other readers how much of an IME problem you perceive in your own practices. J. Burke, D.C. >> Storm clouds, the Oregon Chiropractic Association is being proactive and pre-emptive as per troubled areas in PIP including excessive IMEs, biased IMEs, file reviews and other forms of abuse on the “over side of the fence.†We do not wish to end up like Florida wherein you are reduced to having to receive a referral from a medical professional including a physician’s assistant and limits of care to $2,500….Vern Saboe PS: Have you joined the fight colleagues? Have you joined the OCA? We need your financial help and your ideas call he OCA office and join today…503-256-1601, Vern Saboe if you have specific questions call me any Time 541-231-4528 Cell > > > > From: mailto:%40 [mailto:mailto:%40] On Behalf Of ph Medlin> Sent: Thursday, March 15, 2012 11:07 AM> mailto:%40> Subject: IME increase> > > > > > The increase as of late in IME’s has been enormous in our office. We have more patients going to IME’s than not at this point. I used to NEVER have an IME requested of my patients. There is something in the water. Anyone else noticing this to a high degree as of late?> > > > I mean cases that are 8 visits in with pain levels of 5-6 of 10 and they’re getting IMEd.......uuughhh.> > > > ph Medlin D.C.> Quote Link to comment Share on other sites More sharing options...
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