Department of Industrial Relations

Industrial Medical Council Public Meeting

Best Western Grosvenor Hotel, So. San Francisco

Thursday, May 17, 2001

Members present:

Barry Halote, PhD. Michael Roback, M.D.

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

Maria Mayoral, M.D. Richard Sommer, Esq.

Ira Monosson, M.D. Lawrence Tain, D.C.

Steven Nagelberg, M.D. Paul E. Wakim, D.O.

Jonathan Ng, M.D. Gayle Walsh, D.C.

Glenn Ocker, DPM, MS Benjamin Yang, C.A. OMD

Richard Pitts, D.O.

Members absent:

Marvin Lipton, M.D.

    1. The meeting was called to order by Co-Chair Dr. Richard Pitts at 9:30 AM. He mentioned that there would be a discussion regarding the need for a meeting in July.

Presentation by the Lewin Group

For the benefit of the public, Mr. Sommer gave background on fee schedule issues that have been going one for the past eight years. When he first came on board as an IMC Council Member, there was not an RBRVS type system for workers' comp. He had previously worked for the Workers' Compensation Senate Committee with Casey Young and received the history on the workers' comp schedule. He said the first original RVS in the U.S. was in 1964 for the workers' comp schedule. Today, the problem is that no one wants to change it and no one can live with it. It's a combination of RV codes that have not been re-measured as relative values to each other. The current fee schedule relative value scale has been patched for many years. Many processes have been tried. After two years of non-stop public meetings for the 1999 revision, it was clear that we have a fee schedule that no longer works.

Mr. Sommer clarified what was not going to be discussed at the meeting – compensation and conversion factors. What will be discussed is the relative value of one medical procedure or treatment versus another. He asked if the care in workers comp is somehow different from the rest of care delivered in healthcare that warrants some difference in the E&M codes. He stressed that this is not a time and motion study. Also, the study will look at the entire population outside of workers' comp and compare it to workers' comp to see if there is a significant difference. We will try to rely upon the techniques that the federal payment systems have used and other state payment systems have used and developed over time. He stated that there was a possibility that the E&M study could fail and not come to any conclusions. He reminded everyone that values could go up or down, but we must live with the facts if we are going to move ahead.

Dr. Susan McKenzie introduced Dr. Allen Dobson from the Lewin Group, a former director of research at the Health Care Financing Administration (HCFA) during the time when the RBRVS was developed and adopted by HCFA for using the Medicare Fee Schedule. He is one of the country's leading experts on healthcare issues and the RBRVS. Accompanying him was Dr. Lane Koenig who is the analyst who will do the numerical analysis for the RBRVS study and the proposed E&M study, and Dr. Joan DaVanzo who is the project manager for both studies. Dr. McKenzie stated that the RFP for the RBRVS studies were bid through a competitive process and she is pleased that we awarded the contract with the Lewin Group. She stated that she expected the Council to vote on the E&M study after the presentation.

Dr. Allen Dobson gave a talk on "A Proposal to Conduct A Study of the Relative Work Content of Evaluation and Management Codes," prepared for the IMC. He stated he will talk about the E&M Study, how it works and how it will be put together and the things that need to be done for the next several months to get it completed. The major question to ask is whether the physician work in delivering E&M services in workers' compensation differ from that in the non-workers' compensation environment? This will not be compared to Medicare but to non-workers' compensation practice. After that work is done, it will be up to various government organizations to decide whether the study results are compelling enough to change the E&M work values in the RBRVS for use in the OMFS. He clarified that when he mentions the "Medicare Fee Schedule," he really means to say the resource based relative value scale, a set of relatives that reflect the general population, not just Medicare. He provided handouts to follow his slide presentation (attached in Section 3-table of contents). Mr. Sommer reminded the Council that the vote today would be to grant the study to the Lewin Group. It will be very focussed and carefully done. It does not include many codes. He informed the audience that this was the first time that anyone in the United States has done this comparison. They are trying to contact providers from around the State to be included to participate to make it a representative study. The floor was opened for questions. Discussion ensued.

Mr. Sommer: Motion: move to give the contract to the Lewin Group to do the E&M contract. Seconded: Dr. Roback. Discussion ensued.

Action: Passes unanimously.

Dr. Susan McKenzie stated that there was another study, the RBRVS Study, which is the study to analyze the data that is needed to move to the RBRVS. This study looks at the impact of adopting a new relative value scale on physicians and other health care providers. She introduced Dr. Lane Koenig to give his presentation on "California Workers' Compensation RBRVS Study" (attached in Section 3-table of contents). He spoke of the purpose of the study - the OMFS' rates and transition to a RBRVS. Following the presentation the floor was opened for questions. Discussion ensued.

    1. Consent Agenda

a. Adoption of the Minutes and Notice of Actions: The Co-Chair, Dr. Nagelberg, asked for a motion on the Draft Minutes and Notice of Action of the April 19, 2001 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 stated that the EMD report lists the status of our mandates and that they are up to date. He informed the audience that the Executive Committee had evolved a strategy for the Council's edits on the Physician's

Guide, 3rd Edition. Also, that when the chapters are received by the Council Members that they need to make the changes expeditiously.

Dr. MacKenzie noted that a significant number of Council Members had suggested that the Council take its mid summer break in July but then, the Council had voted to select August, because the fee schedule deliverables were expected in July. When it became apparent that this delivery date was unrealistic (i.e. premature), the Executive Committee once again agreed that we 'go dark' in July.

He noted that, during the last month, the major task occupying the IMC staff has been the QME exam validation survey. IMC staff had a 2-hour telephone conference with CPS recently and managed to clarify the survey and cut it down to a more concise size. It will still take 1 – 1� hours to accurately complete. Also discussed was an incentive for QMEs to complete the survey.

Lastly, he discussed the logistics of travel by Council Members to and from the meetings through the SFO and LAX airports. Research has been done on moving the Southern California meeting to the region surrounding the Burbank Airport since it appears they have more "on-time" flights.

c. DWC Report:

Mr. Richard Gannon gave an update on the rules that his division anticipates reviewing this year. There are fifteen subjects on the Rule-Making calendar this year. On the upcoming agenda for June – Regulation 9785, Reporting Duties of the Primary Treating Physician. These changes were brought to his attention by the California Applicant's Attorney Association following a court of appeals decision with an applicant named Rushing and the Centennial Hospital Group. When the primary treating physician discharges an employee from further treatment, and there is a dispute concerning the need for continuing treatment, certain things will happen. There are concerns that the court interpretation does not follow the customary words used by a physician in trying to describe the need for treatment from the point of the report forward. Mr. Gannon reported a meeting was held with members of the IMC and himself to discuss potential ways to go. An advisory committee of interested persons will be selected sometime in June. He discussed the progress of the Inpatient Hospital Fee Schedule. Before making the change to RBRVS, the DWC will wait until the Lewin Group completes their reports and the proper advisory committees have made recommendations. He said they will be going forward with an interim revision of the OMF. Miss Sue Honor then brought everyone up to date on these issues.

b. IMC/DWC Liaison Work Group Report:

Dr. Michael Roback informed that a meeting was held with the WCAB and DEU on Reg 9785 and the Tenent case. He noted that the medical community has not written its reports to coincide with what might have been their legal intent. He further elaborated on this. Discussion ensued.

    1. Education Committee Report and Recommendations for Action

Dr. Walsh reported that the Committee had reviewed requests for continuing education course providers and recommended approval for the following: California Workers Compensation Defense Attorneys Assoc. They have a 1�- hour course called the "Sequellae of Physical Injuries Psychiatric and Pain." Comdex Incorporated, a renewal, for 6-hour distance learning program entitled "The Art of Report Writing in Workers Compensation." Staff felt that Professional CE Incorporated, an 18-hour distance learning program, does not meet the State's requirement of being focused on workers compensation disability and do not recommend approval.

Dr. Walsh: Motion: To approve the courses of California Workers Compensation Defense Attorneys Assoc. (1� hours) and Comdex Incorporated (6-hours) and to not approve Professional CE Incorporated.

It was seconded.

Action: Motion passes.

Dr. Walsh reported that the regulations have been reviewed through the legal process and have gone our for a 40-day comment period on both the course writing material/programs and the continuing education regulations. On the last 15-day comment period, there were minor changes that strengthened the oversight of the programs.

Dr. Walsh: Motion: Based on these two changes, the Committee recommends that sections 11.5, 50, 55, 118, 119, 104 go out for an additional 15-day comment period.

It was seconded.

Action: Motion passes.

Dr. Walsh report that the regulation sections amendments to sections 10, 11,11.1,14 and 100 and are ready to be submitted to OAL to be put into effect.

Dr. Walsh: Motion: The committee recommends approval of these sections.

It was seconded.

Action: Motion passes.

Dr. Walsh reported that the discussed in Committee was the QME survey from CPS. She noted consensus that we try to get QMEs to respond by offering a reduction of the QME fees for 2001/2002 year by a rebate of $110 after the QMEs complete the survey. This will allow a good return rate in order to have the proper information to ensure the testing is valid and so that we can be confident that the knowledge, skills and abilities are appropriate for this test. This rebate will be covered because the IMC does have an excessive IMF fund balance.

Dr. Walsh: Motion: The committee moved the approval of the fee reduction of $110 for this budget year at the completion of the CPS survey by the QMEs.

It was seconded.

Action: Motion passes.

Dr. Walsh reported that the excessive fund balance would help with other educational needs. At times, Council Members will have proposals on treatment guidelines, or issues on new procedures and it would be valuable to have the IMC connected to an online reference site where IMC staff, Council Members and QMEs could get access to keep updated on the most recent information. She requested that IMC staff research the cost and the procedures involved and to bring a proposal back to the next Council meeting. Dr. MacKenzie mentioned a couple of sites that the IMC currently uses as references.

The Council meeting closed for a closed meeting. The meeting resumed at 12:55pm.

d. Discipline Committee Report:

Nothing to report.

4. Announcements

Dr. Pitts announced that the next meeting will be on June 21, 2001 in Los Angeles.

Meeting adjourned at 1:00pm.

Thursday, May 17, 2001

IMC Staff present:

Lety Buenviaje Susan McKenzie, M.D.

James Fisher Teidi Padua

Elizabeth Ignacio Anne Searcy, M.D

David Kizer, Esq Lucy Suchijul

Allan MacKenzie, M.D. Joanne Van Raam

Sylvia Martell Larry Williams

Helen Nubla Francine Wooley

DIR Staff:

Suzanne Honor, DWC

Irina Nemirovsky, CHSWC

Janice Yapdiangco, CHSWC

Members of the public present:

Arthur Azevedo, Green & Azevedo Steve Papinchak, Workers' Comp Adv

Carl Brakensiek, CSIMS Diane Przepiorski, COA

Sherry Clark, CMA Brenda Ramirez, State Fund

Rea Crane,CWCI Sharon Rohrback, OPSC

Linda Coltrin, CA Chiropractic Assoc. B. Stanfield, CCA

Doug Hikawa, Priority CompNet Alex Swedlow, CW CI

Bill Hutchins, eRehab Peggy Sugermon, CAAA

Jennifer Orosz, HNC Insurance Solution David Willat, CCA