latest WCAB proposed rules changes (California)

[jobmdpsych]

Rules of Practice and Procedure
Section Number 10300 - 10995

The DIR website has a forum for commentary but it's not working. Comments are due by 7/5/19. Let me know if anyone has a working link.

Supposedly this would postpone any chance a QME would have of collecting unpaid bills until the case settles.

Frankly, given the age of many remaining QMEs and AMEs, and how long it takes cases to settle (sometimes decades), this seems to be a cynical attempt to delay paying balances until the doctor is retired or dead, reducing the chance that it ever gets paid.

Another one way bill in search of a problem to solve, IMHO.

[appliedpsych]

So true as to how long to settle now. I had a neuropsych consult yesterday on a case with DOI of 2007 (yes, 12 years ago) that still has not settled.

Whatever happened to those proposed QME billing and fee changes from last year? Anyone heard?

[jobmdpsych]

Anyone have a working link to the comments site?

[jobmdpsych]

That's nothing. I just did a reeval on a case with injuries from literally the last century.

This kind of thing would require you and your estate to keep a collection system and billing address in place long after you retire and die. It's absurd and deeply cynical.

Kind of liking selling out injured workers to build on an incomplete high speed rail line on farmers' land that you never paid them for. For the benefit of billionaire contractors and senators' husbands.

[jobmdpsych]

OK the comments list is working.

Sadly, too many of them are cut and paste from a widely dispersed email I received.

I know that the author was trying to help, but the carbon copy approach actually has a detrimental effect by making us look too lazy and unconcerned to express our own individual viewpoint. It also fuels the criticism by ICs that too much of reports are copy and paste and they're they go again.

My post should be coming up soon and it takes no prisoners. My point was that many of us will die before we ever collect, which is really the cynical point of these regs.

Please don't copy and paste it though you may pile on the outrage.

[DrDoc]

Here we go with the latest proposed version:

https://www.dir.ca.gov/dwc/ForumDocs/Re ... i=75441604

[jobmdpsych]

My submitted comment to DWC. I don't know what happened to my comment on wcc main page but it got cut off.

"I will focus on what I consider to be the two major issues as others will doubtlessly dig into the details:

The fees for no-shows are too low and subject to abuse by insurance companies. No-shows and last-minute cancellations are devastating to a clinical practice. Time set aside for psychiatric medical-legal examinations is typically four hours. There is no reason that this should be at the same rate as a cancelled orthopedic appointment or shorter evaluation since three or four times the amount of time is set aside. 550 dollars does not come close to compensating for losing a half a day of clinic patients or other work. It also does not compensate for records reviewed in advance of the appointment, as this can take hours. In many instances, per diem rental costs are 200-300 dollars so half of that fee is lost in sunk costs. Cancels, no-shows, and last minute reschedules are the bane of QME work and the reason a lot of people just decide to quit. No one can run a practice that way.

A ten percent cost of living increase is grossly inadequate and there is no torturing of California inflation statistic that can honestly claim only 10 percent inflation since 2005. A more realistic figure (excluding housing which has doubled or tripled) would be at least 50%. Even the meager COLA adjustments given to CalPers retirees at the lowest level, 2 percent, would yield a compounded 30% increase since 2005. To offer QMEs a third of that is insulting and completely divorced from the empirical reality of the cost of living and practicing in California.

Please consider fair compensation for no-shows and an honest and fair COLA adjustment in the payment schedule.

On the plus side, I do like the elimination of complexity factors, which is basically unrelated to the actual effort and time put into the work product.

There are other issues that I have including 400 pages of record review not paid for vs. 50 in Nevada but I chose to focus on the most problematic issues first."

[DrDoc]

I agree. Those are important factors and require adjustment. But, at the end of the day, simply looking at what is proposed, the numbers simply do not add up. The hours required for a proper psychiatric evaluation, when compared to the proposed flat fees, would simply make it economically unfeasible to stay afloat. Overhead would eat up perhaps 50% under these proposed flat fees. The current system is terrible, but one can earn a reasonable fee, after performing figurative somersaults and backflips.

The proposed rate would be far less than what an average entry-level clinical psychiatric position in a large metropolitan area in California would pay. The proposed payment scheme for review of medical records is so blatantly ridiculous, that I find it hard to comment on it in black-and-white. If the medical records consisted of six deposition transcripts alone, one would not hit the 400 page mark. If the records consisted of Kaiser boilerplate nonsense, numerous PR-2 reports (saying the same thing over and over), and padded nonsense reports from questionable evaluators, it would not be surprising for the page count to be in the thousands.

And then there is the recent proposal of removing any avenue for QME/AME to receive due process, have their day in court, if the insurance carrier simply decides not to pay for the work until the case has closed. It’s a sad day when the term “Kafkarsque” is not hyperbole.

[jobmdpsych]

The idea of making payment for no-shows discretionary is laughable. We all know what that means.

But I'll go along if paying my work comp premiums is discretionary too. Shoe on the other foot.

This is so one-sided and unfair it's a joke. A 30-40 percent COLA gets us back to even, and they're proposing 10. Try that with the state employees see how that goes.