If you don't want a five figure bill, don't send 5000 pages

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Re: If you don't want a five figure bill, don't send 5000 pages

Postby jobmdpsych on Tue Feb 05, 2019 9:44 pm

If all you care about is money, then you have no reason to complain.

But the argument that my position is selfish is insulting and absurd, since it is precisely the opposite.

I've already proven there is much that can be done clerically, and it's amazing that people keep bringing up absurd arguments of a personal nature.

If you think that socking away millions for reviewing boneheaded Kaiser records is a good way to use a creative mind and lead a meaningful life, good luck with that plan in life.
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Re: If you don't want a five figure bill, don't send 5000 pages

Postby jobmdpsych on Tue Feb 05, 2019 9:44 pm

bump
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Re: If you don't want a five figure bill, don't send 5000 pages

Postby jobmdpsych on Tue Feb 05, 2019 9:51 pm

Since you decided to personalize this, appliedpsych, I really think you need to examine your value system that money compensates for everything and therefore I should shut up.

If you actually are in the field of psychiatry or psychology, you ought realize there is more to life than money for nothing and that the human spirit prefers to engage in meaningful work. But maybe you're a boring person with a boring life and you don't mind. Or maybe you farm it out like so many and cynically bank a carry trade.

You could use the "you should be grateful" on the poorest 1% of California residents too, and most of our injured workers, because they are wealthier than 99% of the world and therefore you shouldn't complain. As a trained expert psychologist, how do you think that would go over?

Besides, the hourly in comp isn't a good as other medical endeavors, as some QMEs have realized, and have moved onto greener pastures.
Last edited by jobmdpsych on Tue Feb 05, 2019 11:26 pm, edited 1 time in total.
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Re: If you don't want a five figure bill, don't send 5000 pages

Postby jobmdpsych on Tue Feb 05, 2019 9:57 pm

Hey vampire,

Thanks for clarifying that the problem lies within the frictional costs of attorney procedural issues. But that doesn't solve the problem for the rest of us.

And you all wonder why people are quitting QME in droves. So much for appliedpsychs specious "you should be grateful" argument because a lot of doctors are throwing in the towel.

Let's revisit this in a year when the QME pool goes down another 25%.

BTW, I don't take well to smug and and snarky from anyone. No need at all for it. You accused me of being greedy, then a phony martyr. Can I be both at the same time? You're so confident yet your arguments make no sense at all.

But there is no way the carriers are going to let this last and they are going after it with the Rand proposal.
Last edited by jobmdpsych on Tue Feb 05, 2019 10:31 pm, edited 2 times in total.
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Re: If you don't want a five figure bill, don't send 5000 pages

Postby jobmdpsych on Tue Feb 05, 2019 10:07 pm

By the way I want to thank you all for your responses, snark and nastiness notwithstanding. I'm printing this thread and if I ever get grief from an insurance company, I can prove I tried and this is the pushback someone gets for honestly trying to reduce costs. I guess I am selfish in that I value time over money so if you think less of me for that, so be it.

And no one has bothered answering my question...if all of this is so necessary how and why do 49 other states resolve these issues so much more efficiently? That's the same question Rand is asking. I get the apportionment issue, but the medical records didn't explode when that changed, they exploded when PDF became standard.

SB899 was in 2005, the explosion in records didn't happen until much later so the explanation of apportionment by causation doesn't work. Horrible EHR after ACA such as Epic Systems also added hundreds of unnecessary pages earlier this decade. It was about 2012 that it started to get really out of hand though it seems like every year it gets worse.
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Re: If you don't want a five figure bill, don't send 5000 pages

Postby jpod on Wed Feb 06, 2019 7:34 am

I think the delay you perceive between passage of the new apportionment law and the records explosion is it takes time for the courts to unwind and rule upon the new legislation so it is understood and practitioners adjust to the new reality. It usually takes a decade for a new law to be finally ruled upon. The 90 day rule was instituted in 1989 yet the Supreme Court did not rule on it until 1998 I believe.
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Re: If you don't want a five figure bill, don't send 5000 pages

Postby jobmdpsych on Wed Feb 06, 2019 9:31 am

I have a question. When a lawyer finds out in a deposition that a QME doctor farmed out records for a review summary, what happens next?

There is a principle in industrial psychology, that beyond a certain point, detail has a detrimental effect on the quality of the end product.

Miles Davis' Kind of Blue was recorded in one take. Music critics can tell if a song is "overproduced". The same is true in technical reports. Think of a well written 20 page report vs. a 100 page report that will not really be read.
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Re: If you don't want a five figure bill, don't send 5000 pages

Postby mytwocents on Wed Feb 06, 2019 10:36 am

There is a middle ground here and a role for common sense. They call it medical-legal because it’s both a medical and a legal process. It’s up to the attorneys to determine what records are legally relevant for the doctor’s review. The attorneys may not always be able to determine what medical information is or is not relevant but they can certainly determine whether the records contain potentially relevant information at all, given the nature of the claim.

If it’s an admitted orthopedic injury, multiple personnel records of prior employers that contain no medical information are not relevant. Neither are employer or witness depositions for a Going and Coming Rule defense which isn’t a medical issue. Likewise stuff like “records of toe fungus treatment in 1993” as jobmdpsych pointed out, unless it’s a lower extremity injury or the applicant has testified in the deposition to facts that would make the records relevant.

Too often, the defense attorney takes a deposition, issues SDTs for every possible record, and packs the whole thing off to the doctor. In the olden days, defense attorneys were required to review and summarize SDT records for their clients. I don’t think that is a common practice any more.

On the other hand, there are also the doctors who hire a record reviewer to summarize the voluminous records, rely entirely on the summary, and then bill for the record reviewer's time at $250 an hour claiming to have done it all themselves.
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Re: If you don't want a five figure bill, don't send 5000 pages

Postby jobmdpsych on Wed Feb 06, 2019 11:02 am

Very sensible post.
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Re: If you don't want a five figure bill, don't send 5000 pages

Postby vampireinthenight on Wed Feb 06, 2019 2:15 pm

Post a solution that is actually more efficient and I'm all ears.

I guess this will come as a surprise to you, but there has always been a requirement under general privacy tenants that only reasonably relevant records be sent. This starts as an objection by AA to certain designated records from being used (and sometimes even discovered) in a case. Sometimes (rarely) this actually happens. Never is it more efficient overall when you are talking about costs.
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