Department of Industrial Relations

Industrial Medical Council Public Meeting

Best Western Grosvenor Hotel, So. San Francisco

Thursday, January 18, 2001

1. The meeting was called to order by Co-Chair Dr. Steven Nagelberg at 10:15A.M.

Members present:

Robert Larsen, M.D. Patricia Sinnott, PT, MPH

Marvin Lipton, M.D. Richard Sommer, Esq.

Maria Mayoral, M.D. Lawrence Tain, D.C.

Ira Monosson, M.D. Paul E. Wakim, D.O.

Steven Nagelberg, M.D. Gayle Walsh, D.C.

Michael Roback, M.D.

Members absent:

Jonathan Ng, M.D.

Richard Pitts, D.O.

Glenn Repko, Ph.D.

Benjamin Yang, C.A. OMD

    1. Consent Agenda
    2. a. Adoption of the Minutes and Notice of Actions: The Co-Chair, Dr. Nagelberg, asked for a motion on the minutes of the December 14, 2000 IMC meeting.

      ACTION: The Consent Agenda was approved unanimously.

      b. Executive Medical Director's Report:

      Dr. D. Allan MacKenzie indicated that his EMD report stood as written. He synopsized what was discussed at the Executive meeting regarding the 12-hour course, including the already completed 4-hour distant learning session and the agenda for the upcoming 8-hour live session. He also announced that the Med Legal Report Writing Course live sessions will take place on February 3 in San Francisco and February 24 at UCLA in Southern California.

      c. DWC Report:

      Mr. Richard Gannon commented that DEU is working on the consistency of the raters' interpretations of QME reports. He stated that he was glad to see that the QME Report Survey emphasizes that the survey scores very technical, regulatory items, and that very few med legal reports are unratable. Also he noted that the quality of medical reports is improving significantly and is primarily due to the efforts of the IMC reviewing reports and giving feedback to AMEs & QMEs. He commented that this was an important exercise and that the success the IMC is having is commendable. Also, he stated that the results are valuable to judges in the system who are reviewing these reports and trying to make sense out of them in order to award benefits.

      The DEU is also working on the consistency in rating these reports. He discussed the special 3-day training held in Southern California in November 2000 in which they worked through various complex issues including how to best approach various ratings in complex cases. They also discussed how various non-scheduled ratings should be addressed in order to achieve better consistency which will help improve the quality of the reports and then the translation of that report into an actual rating. It will also help the dispute resolution process. Mr. Gannon stated that some changes were made in the DWC regulations and added that there were public hearings in September 2000.

      He commented on the continued work toward the revisions in the various fee schedules specifically the In-patient Hospital Fee Schedule. He discussed its inadequacies and that they are looking at the "cost outliers." Comments were added to their rule-making file and the time for looking at those comments expired Monday, January 15. Regarding the OMFS, Sue Honor is overseeing the changes that are needed for the biennial revision and the things that can be put off pending the anticipated change over to an RBRVS based system. Ms. Honor then went over the list of changes. Discussion ensued.

      Mr. Gannon was asked about the process that will be used for this change. He responded that a meeting was going to be set up by the end of the month to get all parties, including the IMC, together to schedule hearings. They are identifying the staff that will be needed to do the anticipated work. There will be extensive meetings over the next three-four weeks to get a sense of what needs to be done, and to identify the community representatives that need to be involved.

      Dr. MacKenzie asked a process question: if the DWC is putting together the fee schedule to deal with interim problems, would it be called "interim fee schedule". Also, if it went into effect right away and we do push on to a migration to RBRVS, would the RBRVS based fee schedule 'kick-in' when it was complete or would the DWC wait for a two-year cycle, biennial requirement?

      Mr. Gannon responded that he anticipated that the revision to RBRVS would kick-in as soon it becomes available.

      Mr. Sommer reiterated Mr. Gannon's response by stating that the fee schedule is on two tracks. One is to get the patching done and out into the public, and the second track, which will take longer, is how to implement all the revised relative values. Mr. Gannon agreed. Discussion ensued.

      Dr. Roback stated since DWC is having problems with staff and budget, that perhaps the IMC can be of some assistance in terms of liens. Dr. Roback asked if the IMC is assisting in this study.

      Mr. Gannon stated that DWC/WCAB had expressed a need. The group is looking at the process, identifying the persons that they want to talk, to get an understanding of that. They will be interested in talking to individuals who have liens. Conclusion: The AD suggested that he could probably get the people on the RAND study to come and make a presentation (at our next meeting in Los Angeles in February) on where they're going, what they're finding out and what involvement they would like to see from the IMC. IMC members agreed that the more information the better so that they can analyze and help solve the problem. Dr. Roback asked if there was some way to develop communication with judges to find out if our examination guidelines are helping anyone? Mr. Gannon affirmed that there is a way. He stated it would be valuable for us to get a cross section of presiding judges and working judges to answer these questions.

    3. Committee Reports:

a. Fee Schedule Committee Report

Mr. Richard Sommer reported that there were two items, which needed to be discussed. The first issue is that we need to get the RFP contract process completed. He stated there was a 30-day delay but anticipated that within 30-days the recommendation would be approved by DGS and work would begin on the RBRVS project. The second issues was to move to take some of the funds allocated for the Fee Schedule Committee, specifically $24,000, to help pay for DWC's license to use the CPT codes.

Mr. Sommer: Motion: To approve the usage of funds allocated for the Fee Schedule Committee, specifically $24,000, to pay for DWC's license to use the CPT codes.

Seconded: Dr. Roback.

Action: Motion passed unanimously.

b. Education Committee Report and Recommendations for action

Dr. Walsh reported that the Committee had reviewed requests for continuing education course providers and recommended approval of four renewals for the following: Compwrite, Professional Site Seminars, PMA Enterprise, and the California Orthopedic Association. These are all renewals of the same program that they have been giving in the last year.

Dr. Walsh: Motion: To approve the renewal of four QME continuing education course providers.

Seconded: Dr. Wakim.

Action: Motion passes unanimously.

Dr. Walsh reported that the Committee had discussed the issue of whether current QMEs can receive continuing education credit for taking the Med Legal Report Writing Course.

Dr. Walsh: Motion: That the Council allow credit for QMEs to take the Med Legal Report Writing Course as a continuing education credit.

Seconded: Dr. Wakim. Dr. Nagelberg asked for discussion.

Discussion ensued whether there will be a fee and it was affirmed. A question was raised on how many hours credit will be given. Dr. Walsh responded there would be 4-hours distance learning, plus 8-hours as a single day program and the question was raised whether or not the current regulation limits the number of hours one can get in a day to 6-hours. Dr. Walsh was not sure where the regulation stood. Dr. Nagelberg turned to Mr. Fisher and Mr. Fisher responded that there was no specific limitation. He stated that there is a 6-hour limitation for distance learning per program.

Dr. Walsh stated that the Committee is recommending that the Council give credit for the course. Dr. Tain wanted to recommend that the tapes be approved as a distance learning 4-hour credit as well.

Dr. Nagelberg suggested a vote to give credit for the course and then to have the Education Committee to recommendation a format. Discussion ensued.

Dr. Walsh stated that if approved, giving credit is the first issue. The second issue is number of hours credit to be given. There is a 4-hour distance learning aspect to the program that we do allow in the regulations, so if we do give credit we should give credit for the 4-hours. There is also an 8-hour didactic session, which would meet all of the requirements that our current regulations have. She stated she would allow 8-hours for that and approve all 12 hours of the program once we vote to give any credit. Dr. Wakim suggested that we move to approve this before the February 3rd and February 24th Med Legal Report Writing Course.

Dr. Walsh: Motion: To give continuing education credit for completing the IMC med legal report writing program.

Dr. Larsen had a question on the motion that is pending. Dr. Roback stated he saw a conflict of interest. He has always been against presenting courses that compete with courses that we are regulating. He did not feel it was good position for a regulatory body to be in.

Ms. Sinnott commented that the Labor Code makes us responsible for establishing criteria and making sure that QMEs are properly educated. It is appropriate for us to create courses, give courses, charge for the courses and assume because we are establishing credentials and qualifications for the course, that we should be in the same position to approve our own courses because we are establishing minimum guidelines. The third point is that we have already received 200 requests from QMEs to take the disability report writing course. The background to the requirement for the course is that there's a perceived deficit in the report writing skills of the population of QMEs. She stated we should vote to approve continuing education courses for already credentialed QMEs.

Dr. MacKenzie stated that he interpreted the original intent of the Legislature to require continuing education for QMEs to keep them current. Also, it wasn't specifically to create a cottage industry for community providers to give courses. The intent of AB 776 is to improve the quality of med legal reports throughout the state. When the mandate came down and the Council voted on it in August 2000, we waited for course providers to apply to give this course for the new QMEs effective 1/1/2001. None did, so the IMC is stepping up to the plate and providing this course on relatively short notice. The IMC has become a default provider. Dr. MacKenzie reminded the Council that there were 600 QMEs who left the QME program in one quarter. When individually surveyed, they stated that their main reason for leaving was that many of the QME courses offered had very little value. Discussion ensued. Dr. Nagelberg asked for the motion on the table to be repeated.

Dr. Walsh: Motion: to give credit to existing QMEs.

Ms. Sinnott added 'but not without the criteria of how much credit for which of the QMEs or how many times they could take the course.' Mr. Fisher made a suggestion of amending the regulation to reflect that if you are going to give credit for a report writing course that the course has to meet a higher level of complexity than a course generally approved under Section 11.5. Discussion ensued regarding how much credit and how many times can one take the course.

Dr. Walsh stated that the motion is not just for the IMC course but for any course. Can a report writing course be given continuing education credit at the same time? She noted that she was not specifically addressing IMC's program on this motion. The next motion will be to whether or not we want to approve the IMC course and for how many hours. She then clarified the motion and restated it.

Dr. Walsh: Motion: Will the IMC approve continuing education credit for any report writing course. Discussion ensued to focus on the IMC report writing course. Dr. Mayoral commented that they should receive some credit however, she was concerned about QMEs that have already been in the system for some time, taking the courses over and over just to receive credit for re-certification. She suggested having a QME writing report seminar for beginners and then a second one for more complex issues.

Dr. Wakim asked to amend the motion: Motion: That the IMC approve providing 8-hour didactic course and a 4-hour distance learning course for new QME applicants into the system. He was advised that this was not an amendment, but voting "no" to the motion. Motion is repeated one last time.

Dr. Walsh: Motion: That the IMC approve continue education credit for med legal report writing courses. Dr. Nagelberg asked for those in favor with a raise of hands. 10 hands.

Action: Motion passes.

Dr. Walsh reported that the Committee had one other provider who was to give a course in med legal report writing - Livingston-Lopez. They are a current continuing education provider and have brought forward a course that offers 4-hours distance learning, and 8-hours didactic session. The question that was raised by the Committee was that the syllabus for the 8-hours was not included and whether they planned to distribute the hours according to the current regulations. Until that is received from them, we will need to table recommending the approval of this course. Also needed is information as to when the course will be given.

Dr. Walsh also reported that the Committee had recommended for approval, the core content of the IMC 8-hours didactic session. The agenda for the 8-hour course was outlined by Dr. MacKenzie. The Committee recommended approval of 12-hours, 8-hours didactic, 4-hours distance learning.

Dr. Walsh: Motion: That the Council approve 12-hours of continue education credit.

Seconded: Dr. Larson. He then asked to discuss it.

Dr. Larsen stated that Dr. Monosson's recommendation needs to be added as an amendment that this is a 'one time' credit allowed. No QME gets to take this every two years and get credit for his continuing education requirement. He also stated the course was basic and that the Council should go with either 6-hours or 8-hours. Dr. Nagelberg asked him to make a motion and a formal recommendation as to whether it be 6-hours or 8-hours.

Ms. Sinnott moved to defer this motion and to continue discussion to the next IMC public meeting due to a lot of background information that is needed. Discussion ensued.

Dr. Walsh amended the motion: Motion: QMEs can take the IMC's 12-hour MLRWC program and receive 8-hours of continuing QME education credit on a one time basis only. A vote was taken. 9 approved, 1 opposed.

Action: Motion passes.

Dr. MacKenzie commented that he felt it was important to have voted on an alternate course provider for the 12-hour report writing course. The rationale being some individuals who could not manage the time to take the IMC report writing course, yet they needed to fulfill the requirements of AB 776.

Dr. Walsh reported that there had been some public hearings on the report writing regulations. She stated that the committee was responding to some of the comments and that some changes were made in the packet.

Dr. Walsh: Motion: That the Committee recommended an additional 15-day comment period as indicated in the packet.

Seconded: Dr. Larson.

Action: Motion passes unanimously.

c. Discipline Committee Report

No meeting was held.

4. Announcements

Dr. Nagelberg announced that the next meeting will be held on February 15, 2001 in Los Angeles.

Meeting adjourned at 12:03P.M.

IMC Staff present:

Gerry Evans Sylvia Martell

James Fisher, Esq. Susan McKenzie, M.D.

David Kizer, Esq. Anne Searcy, M.D

Allan MacKenzie, M.D. Larry Williams

DIR Staff present:

Richard Gannon, Administrative Director

Suzanne Honor,

C.L. Swezey

Members of the public present:

Linda Coltrin, CA Chiropractic Assoc. Michael Pulley, Workers' Comp Adv

Rea Crane, CWCI Diane Przepiorski, COA

Doug Hikawa, Priority CompNet Brenda Ramirez, State Fund

Bill Hutchins, e-Rehab M. Udin, EMG

James Musick, ICAC Joseph Zammuto, OPSC