Department of Industrial Relations

Industrial Medical Council Public Meeting

Best Western, Grosvenor, SSF

Thursday, May 18, 2000

1. The meeting was called to order by Co-Chair Dr. Richard Pitts at 10:30 A.M.

A quorum was present.

Members present:

Robert Larsen, MD Richard Pitts, DO

Marvin Lipton, MD Patricia Sinnott, PT, MPH

Maria Mayoral, MD Lawrence Tain, DC

Steven Nagelberg, MD Paul E. Wakim, DO

Jonathan Ng, MD Benjamin Yang, CA, OMD

Members absent:

Robert Goldberg, MD Michael Roback, MD

Hubert T. Greenway, Jr., MD Richard Sommer, Esq.

Ira Monosson, MD Gayle Walsh, DC

Glenn Repko, Ph.D

2. Consent Agenda:

a. Adoption of the Minutes and Notice of Actions: The Co Chair, Dr. Richard Pitts, asked for a motion on the minutes of the April 20, 2000, IMC meeting. Ms. Sinnott recommended that the approval of the April minutes be deferred until the next meeting.

b. Executive Medical Director's Monthly Report:

Dr. D. Allan MacKenzie indicated his EMD report stood as written. He commented on several issues. 1) AB 776, a bill regarding Med-Legal report writing and other IMC QME issues is moving along. Mr. Brakensiek informed him that the amendments sent by the Council were accepted by the bill author Assembly Member, Thomas Calderon, and 2) AB 2301, the bill dealing with the Cooperative Personnel Services' (CPS) ability to administer the QME proficiency exam was expected to move to a floor vote.

Dr. MacKenzie was requested by Ms. Christine Baker, Director of the Commission for Health & Safety in Workers' Compensation, to announce the Commission's proposal to host a meeting for the California Forum for Work Place Health & Safety in February, 2001. The IMC was also asked to co-sponsor this meeting. This issue will be brought up during the next meeting in June once more information is obtained.

c. Legislative Update:

Dr. Pitts called on Mr. Fisher to give an update on the legislative issues. But first Dr. MacKenzie had to introduce Mr. James Fisher, Esq. as the new IMC Staff Counsel. Mr. Fisher has some thirteen (13) years experience in the DIR Director's Office Legal Unit, after which he spent some four (4) years as an attorney for one of the major defense law firms in the City of San Francisco.

Mr. Fisher reported on the following updates: 1) AB 776 would pass in the Committee today after some discussion of moving it till Monday; 2) SB 129 would be going to a conference committee; 3) Senator Speier's Bill SB 1903 on Medical Information Privacy would be on its second reading; 4) the Bill on Nurse Practitioners and PA's, SB 1977 has been amended and would be going to a third reading. It looks like it would be going to pass the Senate relatively quickly, and 5) AB 2301 has been amended, it specifically provides for CPS to do the QME testing that we require (as do other State Agencies) and it looks like it will be pass quickly.

The May 2nd hearing on AB 2543 which is an attempt to modify last years AB 435 (Corbett) was canceled and it appears this Bill may not be moving quickly on the legislature. Mr. Fisher was not sure if there would any changes.

Dr. Robert Larsen asked how the Privacy Bill would affect physicians, patients and other third parties in the workers' compensation system. Mr. Fisher responded that Senator Speier's SB 1903 would impose actual damages and punitive damages for knowing willful violations. He said he was not sure that it changes the parameters of the Confidentiality of Medical Information Act. He thought that it works more in increasing penalty than broadening or restricting the intent of the Act.

Dr. Larsen commented that we need take a close look at that this issue. Interested parties who paying for treatment and making decision on benefits on the workers' comp. system take it for granted that there is nothing confidential once a person files a claim. The Legislature and the Courts do not seem to see it that way. More of the State and the Federal legislation were emphasizing confidentiality and the person's rights. There was a recent bill that became law as of January 1st. Provider who released all psychotherapy records to another provider or third party has to guarantee that those records will either be returned by a certain date or be destroyed. Physicians have no control over this kind of things. There are many who were in favor of the idea of a person's rights and liberties being protected. Someone should take a look at what Ms. Speier's intentions in regards to protecting workers' privacy versus being able to communicate effectively and make decisions.

d. Minutes of April 20, 2000

Ms. Patsi Sinnott said there were some clarification on the minutes. On page 2, last paragraph, she thought that ISIS should be ICIS and on page 4, paragraph 3, the name of Dr. Jewel Saal should be Joel Saal. So she requested the approval of the minutes be on hold until the next meeting.

e. DWC Report:

Ms. Peggy Sugarman, Chief Deputy Administrative Director of Division of Workers' Compensation, spoke on behalf of Mr. Dick Gannon, Adm. Director and Dr. Linda Rudolph. Ms. Sugarman said that she had a legal backup in the presence of Mr. Jim Robbins, Esq. and Ms.

Mallika, a newly hired DWC economist who will help analyze the different fee schedules. Ms. Sugaman announced that there were continuing discussion on the inpatient hospital fee schedule. At the last meeting, they discussed the growing concern of the hospitals about costs not being covered in the maximum fee schedule. DWC are proceeding quickly in proposing some regulatory changes to the hospital fee schedule in two areas: 1) The proposal to remove the instrumentation from the five (5) DRGs in spinal surgeries and suggesting putting them in durable medical equipment as one fix, and, 2) to establish some sort of cost of outliers system that were being studied They want to move as quickly as they can in the regulatory process this summer to get some of these taken care of.

Ms. Sugarman thought it made more sense to study the entire hospital fee schedule since it has been in existence for little over a year. It was causing some growing concerns and it was suggested that a study be conducted with CWCI and the Health & Safety Commission. DWC would like to proceed with the more comprehensive look at the hospital fee schedule and would be working on a study outline. If they are able to come up with a better solution to the current schedule, they would go to a sooner revision than this upcoming small fix.

She added that they are proceeding with pilot project on medical bill dispute resolution. DWC is trying to find a way to respond to the issues of resolving medical bill disputes on a more administrative level or trying to figure out a way to do that without forcing providers to always go file a lien at the Workers' Comp Appeals Board. This pilot project will give additional information on whether a voluntary system would work in trying to help people figure out how the fee schedule should be applied. The Pilot will start on July 1st up to September 30th, for services rendered between April 1st of 2000 and June 30th in Contra Costa County and in San Bernardino County is where this pilot project would occur. Ms. Suzanne Honor Bangroft would be heading up the pilot, training the reviewers for this voluntary system. This would not be a binding decision but they expect to: get the referrals; to have the other side agree to have us take a look and make a recommendation as to what the bill should be according to the fee schedule and issue this recommendation. This will tell a lot about what's going on in terms of the disputed area from the fee schedule and whether or not a system like this would work on a more longer term basis.


Consent agenda was approved and the Minutes of the Meeting for April 20, 2000 were deferred for the next month meeting.

3. Education Committee Report:

Dr. Susan McKenzie, on behalf of Dr. Gayle Walsh, chairperson of the Education Committee, reported that at the Committee meeting, the Committee continued to work on a draft document which would strengthen the continuing education program for QMEs. She received a number of very valuable suggestions from people who attended the meeting and hoped to re-draft that document and be able to get it to the Council within the next month or two.

4. Fee Schedule Committee Report:

Dr. Susan McKenzie, on behalf of Mr. Richard. Sommer, chairperson of the Committee, reported that the Committee held a meeting today. Attendees two topics: 1) the E&M RFP which was advertised on the internet, and 2) the remaining tasks for the OMFS revision. A number of E&M packets were sent out to potential bidders who were asked to submit written questions for written response by last Monday. No questions were submitted.

Dr. McKenzie announced that there would be a bidder's conference on June 2, 2000. This public meeting would be optional for the bidders but they could come and ask any questions about the RFP. Written proposals should be submitted by June 19. The IMC would have a small committee to score these proposals. The proposals that receive a passing grade will go on to oral presentations. The bidder who obtains the highest score will be the bidder to be recommended to the Council. The Council would vote on awarding the contract to the bidder at its July meeting

Dr. McKenzie said that the RFP is meant to find a bidder to review the E & M section and to make the E&M section fair for workers' comp in the State of California. The Committee plans to set up a task force on the Physical Medicine Section, which was not revised the last time. It will set up a task force on the ground rules which will review at revisions that may be necessary and on the Medicare payment rules that need to be pulled in to the schedule for RBRVS. The Committee discussed doing another study to look at the impact of going to RBRVS on the medical specialties..

Dr. MacKenzie said that Dr. Susan McKenzie's critical path planning had been detoured several times in the past but this should culminate by a vote in July or otherwise would be put off for another cycle. On the issue of a July versus an August Meeting, it is critical to have one in July so that the next fee schedule will not be pushed back. She said that only the Council can award the contract.

Dr. Steven Nagelberg asked if the IMC could agree now on whatever the Committee decides.

Mr. Fisher responded that there might be some issue whether the bidder who wins the process is responsible "bidder". The Council should make a considered decision about who that highest bidder is and make a determination if they are responsible or not which may need a review of the Council to do that.

Dr. MacKenzie asked Dr. Susan McKenzie if she had any position on whether the Council could delegate to the IMC Staff finalizing the final bidder. Dr. Susan McKenzie responded that they are going to recommend a final bidder. In terms of delegating the final authority, she thought it is a legal matter and could not comment on this.

Dr. Marvin Lipton briefed Mr. Fisher with past history. He said that there was some controversy about the awarding of a contract and wondered how much we would expose ourselves to criticism, if we were to reflexly approve in advance the recommendation of the Committee and therefore, denying the other people who did not meet the criteria of the Committee, if they never got the full hearing of the full Council Members. Dr. Pitts responded that this issue would be left with Mr. Fisher to explore.

5 Discipline Committee Report:

Dr. Pitts announced that there would be a lengthy Discipline Committee closed session at which time when the door opens, any action taken will be announced. He stated that this falls under the section of the Government Code that requires IMC to have a closed session because discussion would be about possible litigation.

The room was cleared and the closed session began.10:50.

The open session resumed at 11:50.

Dr. Pitts stated that during the closed session, the Council had a discussion regarding pending litigation. No action was taken by the Council

6. Announcement:

Dr. Pitts read the letter sent by Mr. Richard Gannon, Administrative Director of DWC. Mr. Gannon apologized for not attending the IMC Meeting. In his letter, Mr. Gannon reemphasized his commitment to adopting a Resource Based Relative Value System (RBRVS) with the next revision of the official medical fee schedule.

Dr. Pitts announced that the next IMC Public Meeting will on June 15, 2000, in Los Angeles. He will not be able to attend so Dr. Steven Nagelberg will chair the meeting.

7. Meeting adjourned at 12:10 P.M.

Thursday, May 18, 2000

IMC Staff present:

Diana Cornell Allan MacKenzie, M.D.

Mila Diadula Anne Searcy, M.D.

Elizabeth Ignacio David A. Kizer, Esq.

Irah Lagura James D. Fisher, Esq.

Mark Schelling Susan McKenzie, M.D.

Cynthia Tse Gerry Evans, Spc. Inv.

DWC Staff present:

Peggy Sugarman, Chief Deputy Admin. Dir.

James Robbins, Esq.

Mallika Rajapaksa

Members of the public present:

Carl Brakensiek, CSIMS Michael Pulley, Workers' Comp Adv

Arthur Azevedo, Green & Azevedo Diane Przepiorski

Doug Hikawa, Priority CompNet Philipp Lippe, MD, CMA, CANS Ken Young, Pres. OPSC Susan Taylor, Palo Alto Med Fndtn

C. L. Swezey, CHSWC Linda Coltrin, CCA

Rea Crane, CWCI Mary Campbell, Camino Med Grp

Jennifer Orosz, HNC Insurance Solutions Alan Kimelman, M.D.

Richard Knet, Sport, Spine & Ortho James Musick, ICAC

Bill Hutchins, e-Rehab Diane Harroun, Reviewco

David Willat, D.C.