Department of Industrial Relations

Industrial Medical Council Public Meeting

Holiday Inn, Los Angeles

Thursday, June 15, 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:

Marvin Lipton, MD Michael Roback, MD

Maria Mayoral, MD Paul E. Wakim, DO

Ira Monosson, MD Benjamin Yang, CA, OMD

Richard Pitts, DO Gayle Walsh, DC

Glenn Repko, PhD

Members absent:

Hubert T. Greenway, Jr., MD Jonathan Ng, MD

Robert Larsen, MD Richard Sommer, M.Phil., JD

Steven Nagelberg, MD Lawrence Tain, DC

Patsi Sinnott, PT, MPH

2. Consent Agenda:

a. Executive Medical Director's Monthly Report:

Dr. D. Allan MacKenzie indicated his EMD report stood as written.

1) California Forum for Workplace Health and Safety in Workers' Compensation in California.

Dr. MacKenzie reported that the Commission on Health and Safety in Workers' Compensation (CHSWC or Commission) will be sponsoring a forum and is inviting the Industrial Medical Council to participate. By way of background, Dr. MacKenzie stated that the Commission and the IMC have collaborated successfully in the past on such endeavors. In response to questions posted by the Council Members on what this Forum is about and why there is a need for the IMC to participate, Ms. Christine Baker, Executive Officer of CHSWC, was invited to do a presentation at today's meeting.

Ms. Baker, in her slide presentation, invited the IMC to participate both in developing this program and to financially assist the Commission in this project. She stated that Director Steve Smith and Deputy Director Suzanne P. Marria have embraced the idea of creating a forum for employers and stake holders to discuss injury prevention, return to work and the role of the physician in these efforts. The California Forum for Workplace Health and Safety is going to be a public educational program focused on workplace injury prevention, safety

and return-to-work. There will be presentations, discussions and various workshops over a two-day period, hosted by DIR and the CHSWC to be held on February 8-9, 2001 in South San Francisco. She discussed the various objectives of CHSWC and what they hoped to attain. She also presented the draft program/agenda overview of this forum to the Council. She then thanked the IMC for considering to co-sponsor this program.

In response to Dr. Marvin Lipton's question, Ms. Baker stated that QME credit would be given to attendees. Dr. Pitts asked about the financial support and she responded that they need $17-20,000. Dr. MacKenzie said that the IMC, being an educational as well as a regulatory organization, may wish to help support the project. He stated that the first step is to make the request, the second would be for the Council to agree in principle and the third step for the IMC Staff to explore this further.

MOTION: That the IMC participate, endorse and provide financial assistance within the limits of IMC capabilities to the CHSWC project. Motion: Dr. Michael Roback & friendly amendment by Dr. Ira Monosson, Second: Dr. Glenn Repko.

ACTION: Motion adopted.

2) Dr. MacKenzie announced the resignation of Dr. Robert Goldberg. In 1993, the Governor appointed him to the position physician of occupational medicine on the Council. Dr. Goldberg co-chaired the Treatment Guidelines Committee. He was re-appointed to a second four year term. Because of the pressure of other professional demands on his time he has submitted his resignation.

MOTION: That the Council formally recognized Dr. Goldberg's work in the form of a plaque and asked that he attend next month's meeting to receive it. Motion: Dr. Gayle Walsh, Second: Dr. Repko

ACTION: Motion passed.

b. Minutes of the Meeting

MOTION: That the Minutes of the Meetings from April 20th and May 18th 2000 be approved. Motion: Dr. Walsh, Second:

ACTION: Motion passed and the Consent Agenda was also approved.

c. DWC Report:

Dr. Pitts recognized the presence of Mr. Richard Gannon, Administrative Director of the Division of Workers' Compensation (DWC). He then introduced Dr. Mayoral and Dr. Yang to the Mr. Gannon.

Mr. Gannon discussed the DWC current plans for the revision of the fee schedules and he outlined several areas in which the IMC's assistance would be invaluable as DWC proceeds towards the biennial fee schedule revision:

1) Inpatient Fee Schedule: DWC is preparing a Notice of Rulemaking to revise the schedules which would address immediate problems like the exemption of hardware/instrumentation cost from spinal surgery and the establishment of an outlier formula in which hospitalizations which charges five times greater will be exempted from the schedule. They are going to consider what further revisions may be appropriate in the biennial revision due in 2001, like up-dating to current DRGs, assessing the data including hospital discharge data and will request specific additional data from payor and provider communities.

2) Outpatient Fee Schedule: to move to an RBRVS based fee schedule in the next revision. IMC's assistance in two areas would be extremely be helpful in the following:

a) Evaluation of the fiscal impact of changing to an RBRVS based fee schedule i.e. to conduct a study comparing reimbursement levels for a "market-basket" of workers' comp. medical services under the current OMFS versus under RBRVS options.

b) Evaluation of ground rule issues in moving to an RBRVS.

Mr. Gannon expressed his appreciation to IMC and Dr. Susan McKenzie who has initiated the study to evaluate physician's work for E&M services, putting together the RFP and the initial discussions regarding physical medicine ground rules. DWC would like to work with the IMC in getting more information as DWC progress and move forward hoping to meet the April 1, 2001 schedule.

Lastly, Mr. Gannon announced the DWC plans to inaugurate a pilot project on resolving medical billing dispute strictly on accepted cases and would deal with issues in the coding and payment for services. Issues relating to medical necessity or late payment will not be included. This process would be held in San Bernardino County and Contra Costa County and for services provided between April 1 and June 30th. The period of time to submit would be July 1st to Sept. 30th. Ms. Suzanne Honor, the supervisor for the Northern California Regional Center, will be the project manager and she could answer any questions on the process. Parties who are interested in participating would be required to submit a Request for Billing Dispute Resolution Form and Instruction that explain the documentation that must accompany each request including services on the other party. Forms are available at the DWC website or by mail. Mr. Gannon said they hope to gain some insights into some problems of down coding and over billing.

d. Legislative Report

Dr. Pitts called on Mr. James Fisher to give an update on the legislative issues. Mr. Fisher reported on the following updates: 1) AB 776, or the Calderon Bill, which affects QME qualifications passed the Assembly. It was sent back to the Assembly for concurrence and minor changes. 2) AB 2301, the CPS bill that allows them to continue to test QMEs should be coming out of the Senate. 3) AB 2543, which would modify AB 435, that prohibited employers, their insurance companies or their third party administrators from obtaining medical information did not make it. Dr. Pitts commended Mr. Fisher on the analysis he has done on what's going on in the Legislature.

Mr. Carl Brakensiek, of CSIMS, suggested, given the unanimous passage of AB 776 in the Assembly, that perhaps the Council would authorize the Executive Medical Director to write a letter to the Governor urging him to sign the Bill.

Dr. MacKenzie agreed to do it with the concurrence of the Council. He explained that previously, the Council has not taken any action on activities going on in the Legislature but this was something that affected the Council and they should take a stand and give an interpretation to the Governor's office. The feeling was the Council should not to take a stand on vague issues because no matter how it worked out, they would get some criticism. However, AB 776 is important to the Council as a regulatory agency because the IMC Staff will otherwise have a hard time regulating the QMEs and QME process after 2003. Originally, this was a bill to decrease QME hours from 12 hours every two years to 6 hours and slowly but surely it became redirected into a bill which did not decrease the hours but changed the qualifications for Qualified Medical Evaluators. The bill vitally affects the way the Council functions, to which we can regulate and would allow us to regulate the QME process more effectively and set and maintain standards. He believed that there should be a resolution from the Council endorsing this bill.

Discussions ensued on the pros and cons of writing to the Governor in support of the AB 776.

MOTION: That the IMC should have a resolution to write a letter of support for AB 776 to the Governor because it is vital to the education and regulation of QMEs . Motion: Dr. Roback, Second: Dr. Walsh

ACTION: Motion approved.

Mr. David Kizer stated, by next month, to probably direct the Education Committee to begin to look at some other components for the Continuing Education so we could do them together because the bill will take effect on January 1, 2001, assuming the Governor will sign it.

3. Education Committee Report:

Dr. Walsh, chairperson of the Education Committee, reported that there were two issues discussed at the Committee meeting:

a) The first was the draft document that outlined the proposed changes for how we review continuing education course providers. The Committee received several good suggestions: Some of these changes are:

1) Page 1 item 3 - Continuing Education Requirement. It was suggested that course providers already submit a list of QMEs who attended their program. This list would be put in the QMEs' files and the QMEs sign under penalty of perjury that they attended the 12 hour course.

2) Page 2 item 5 - Continuing Education Activities: It was suggested that Members auditing programs will get credit from the Council and not from the program sponsor.

3) Page 5 item 6 -Program Content: The issue that QME needed to be part of the planning for education activities was eliminated. Deficiencies in reports should be included in course content. Billing, coding, and marketing material are not part of the education material for continuing education. Although they may be part of a course, you can not get credit for that hour if you did billing issues.

Materials should not be promoted or sold from the podium. The course can have an extra room that has supplies and materials that people could purchase. There should not be any financial interest or financial consideration in the course.

4) Page 3 item 7 -Teaching Methods: It was recommended that the courses be tiered for beginning, intermediate and advance levels.

5) Page 3 item 8 - Distance Learning Program: Pre-testing was discussed, what we could do, how it would interact in, how could it take place. It was suggested to eliminate the pre-test and only do the post test. Another suggestion was to find out how to make sure people are reviewing material on the post test.

Page 4, item 8, last paragraph talked about only getting credit for taking a course one time.

6) Page 4, item 9 - Accreditation of Providers: One concept was that we do not want national organizations giving credit for a course that is not related to California workers' comp. Some kind of sponsorship with the local or California based organization is being suggested.

Second paragraph talked about the infrastructure of providers. It was suggested that the provider must have to demonstrate they have infrastructure in place and recognized expertise in education.

7) The Committee is going to work more on three concepts: application for accreditation, review of new programs and reaccreditation.

8) Course hours – The Committee recommends that it should stay at 50 min/hour. This includes the time for taking a test..

9) Page 6, item 8 - Attendance Records: it was suggested that physicians have to sign in to a program but signature pages need not to be turned in to the Council.

10) Audits – The Committee will try to make it clear on who will gets credit, who pays for the audits, and try to keep things so there is no an obligation that the auditor has to do.

Dr. Pitts recognized both Dr. Walsh and Dr. McKenzie for the work done in the Education Committee.

b) The second issue was that the Committee recommended approval of several course providers for Continuing Education.

MOTION: To approve one new provider and renewals of several course providers for continuing education: 1) California Society of Physical Medicine and Rehab; 2) California Musculoskeletal Medicine; 3) Insurance Educational Association; 4) Podiatry and Workers' Comp 5) International Chiropractors Association of California; 6) Center for Occupational Environmental Health, UC Berkeley; 7) California Orthopedic Association, Tape Program (6 hours & 3 hour programs); 8) American College of Chiropractic Orthopedists; 9) Joel Sherman - Critical Issues in Permanent Disability, and 10) California Chiropractic Association. Motion: Dr. Walsh, Second: Dr. Roback.

ACTION: Adopted.

4. Fee Schedule Committee Report:

Dr. Susan McKenzie, on behalf of Mr. Richard. Sommer, chairperson of the Committee, stated that the Committee was not able to have a meeting. She said that the E&M RFP proposals are expected on Monday, June 19, 2000.

Dr. Pitts reminded the Council that a quorum is needed for the next month's meeting because some Members will not be present. Discussion ensued regarding whether Members who could not attend would able to be in a telephonic attendance because of compelling issues to be voted on. Mr. Fisher briefed the Council on how this telephonic voting could be done and its legality. This process would be an exemption and one time only because of a matter of urgency and compelling issues to be voted upon.

5. Discipline Committee Report:

Dr. Pitts announced that there would be a lengthy Discipline Committee closed session to discuss possible litigation and personnel issues and at which time when the door opens, any action taken will be announced

The room was cleared and the closed session began.11:40.

The open session resumed at 12:40.

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 announced that the next IMC Public Meeting will on July 20, 2000, in South San Francisco.

7. Meeting adjourned at 12:45 P.M.

IMC Staff present:

Gerry Evans, Spc. Inv. Allan MacKenzie, M.D.

Mila Diadula Susan McKenzie, M.D.

Sylvia Martinez Anne Searcy, M.D.

Larry Williams, Mgr. James D. Fisher, Esq.

David A. Kizer, Esq.

DWC Staff present:

Richard Gannon, AD

Sue Honor, Supervising WCC


Christine Baker, Exec. Officer

Members of the public present:

Carl Brakensiek, CSIMS Michael Pulley, Workers' Comp Adv

Brenda Ramirez, SCIF Diane Przepiorski, COA

Cheryl Hanger, Intracorp. Joe Solancuo, Care Solutions

Michael Sackett, D.C., LACC Richard Kriet, SSORC

Jennifer Orosz, HNC Insurance Solution Linda Coltrin, CCA

Ronena Summers, Claimrelief Advocacy Network Wendy Hardy, BSC

Doug Hikawa, Priority CompNet Craig Morris, DC, AFICC Ken Young, Pres. OPSC Katie Vu, CorVel

Kimberly Wishwell, Wiswell Consulting Grp. Pam Guiles, CorVel Corp.

Glenn Ocker, DPM Patty Siglock, LOM