Department of Industrial Relations

Industrial Medical Council Public Meeting

Holiday Inn, LAX

Thursday, Oct. 18, 2001

Members present:

Barry Halote, PhD. Michael Roback, M.D

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

Marvin Lipton, M.D. Richard Sommer, M.Phil., J.D.

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.

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

Richard Pitts, D.O.

Members absent:

Jonathan Ng, M.D., J.D

1. The meeting was called to order by Co-Chair Dr. Richard Pitts.

    1. Consent Agenda

a. Adoption of the Minutes and Notice of Actions: Dr. Pitts asked for a motion on the Draft Minutes and Notice of Action of the September 20, 2001 IMC meeting. Ms. Patsi Sinnott made some editorial changes.

Action: The Consent Agenda was approved unanimously.

b. Executive Medical Director's Report:

Dr. D. Allan MacKenzie indicated that his EMD report stands as written. At the Executive Committee Meeting, he announced that the IMC had signed a one-year renewal lease and was looking forward to signing a relocation lease sometime in the second quarter of the new year. Because of the heightened security concerns in the United States, the government in Sacramento advised us not to open the mail until all the Staff had been through a special course of mail training. This would not impact the turn around time for panels at the IMC. The Labor Code mandates 12 – 15 days to turn panels around. Traditionally, the IMC has done it two to three days, so this would not be a problem.

Another issue discussed was the budget, DIR asked its various agencies and divisions to contemplate a three, five and ten percent decrease in the general budget. The IMC proposals had

been accepted by DIR. However, in the 48 hours just prior to the Council Meeting, the IMC had been asked to consider a 15% scenario rather than the high of 10%, which had previously been demanded. As recently as yesterday we responded to the request.

The last point of discussion was the foot and ankle guidelines. A foot and ankle evaluation protocol had been completed in 1997, but was shelved because of other problems. Now it has been resurrected. Dr. Michael Roback appointed Dr. Glenn Ocker as the ad hoc lead for this project. Dr. Ocker has taken the materials given to him and fleshed it out. He is in the process of circulating it to the Council Members and shortly thereafter to the associations. Hopefully it will move forward in the usual rulemaking process.

c. DWC Report:

Mr. Richard Gannon, Administrative Director, DWC, introduced the DWC staff members who are working on the fee schedule and regulations and were present at the meeting: Jackie Schauer, Lead Attorney; Glenn Shore, Primary Policy Advisor; George Parisotto, Attorney; Blair MacGowan, DEU Manager, and Dennis Ehrhardt, DEU Supervisor.

Mr. Gannon reported that DWC is experiencing the same budget reaction problems as everybody else in the State Government. DWC started this year operating with a $5,000,000 deficit in the amount of money they get for their 1,000 positions that the state funds. DWC has a tremendous differential between what the positions are funded at and what they actually paid the people in the positions. That translates into about $5,000,000. DWC will be reducing staff if in fact this budget reduction comes to pass.

He reported that DWC has a very heavy schedule of rule making including the fee schedules that are part of the rule-making calendar. He hopes that they would be able to move through this as fast as they can. As these budget reductions come into play, the limited amount of personnel they have to move forward and implement fee schedules will present quite a challenge. He appreciated all of the work the IMC has done including several funding studies this year. If there is any more bad news coming up in these areas, DWC may ask for assistance again because it will be a struggle for the Division this year.

Ms. Schauer reported that they are in the middle of the rule making for the Official Medical Fee Schedules and Medical/Legal Fee Schedules and they had a 45-day comment period that ended October 1st. DWC staff are in the process of analyzing, compiling, summarizing comments and incorporating some of the suggestions into a revised modified proposals that they anticipate sending out in early November for another comment period. After that rule-making is completed, they hope that the CHSWC study on the In-Patient Hospital Fee Schedule would be finalized so

that it could be considered when making any changes that may be necessary for the In-Patient Fee Schedule. On Title 8 California Code of Regulations section 9785, Primary Treating Physician Reporting Regulations, a draft was distributed for discussion and they had received a small number of comments that were analyzed. They did not feel ready to move forward with regulatory proposals. She invited anyone who has further comments to send them in. They hope that this rule making would be completed in November.

Mr. Gannon responded to Dr. Marvin Lipton's question regarding freestanding surgery centers as being covered under the fee schedule. Mr. Gannon said it was in the legislation that was vetoed. They are in the process of doing the interim study and would work on the In-Patient Hospital Fee Schedule as soon as they are done with the transition to the RBRVS. The Governor's veto message indicates that he is looking forward to implementing effective medical cost containment measures. This was the reason why ambulatory surgery centers fee schedule was being considered in the legislation. It is one of the things that DWC has on their agenda but there are certain things that they will not be able to do if they have to take more cost cutting.

Lastly, Mr. Gannon stated that Rand's report on the judicial study is in its final stages. There will be public meetings conducted by Rand to present their preliminary draft results for the community for feedback and then final results would be published towards the end of the year. The hearings are scheduled for Monday, November 5th in WCAB office in Van Nuys and Thursday, November 8th at DIR headquarters in San Francisco. The committee's recommendations for changes on rules and policies will be posted on the web site for the community to have the opportunity to examine and comment on proposals.

d. Legislative Report:

Mr. James Fisher reported that the Governor went through the bills on his desk after the close of the session. He vetoed SB 71 and a couple of bills principally AB 1176. Many of the bills that went through his desk were signed. AB 1194 that dealt with nurse practitioners and PAs, somewhat similar to the bill last year, was passed and signed. A complete report would be given at the next meeting.

3. Education Committee Report and Recommendations for Action:

Dr. Walsh reported that the Regulation package was approved last month by the Office of Administrative Law and became effective between the end of September and beginning of October. There are copies of the current regulations for Continuing Education and the 12-hour report writing course and the forms that go with it in the current Public Meeting Packet.

On continuing education, Dr. Walsh reported that the approved period for new (and renewal) providers for continuing education programs and the report writing programs are for two years and one year for Chiropractic IDE programs. The Committee recommended approval for the following five programs. The California Acupuncture Medical Association-a program for 6 hours disability evaluation with combined disability. The American Academy of Disability Evaluating Physicians (Approved four out of nine courses: 10.5 hrs. for Skills Developed in Seminars; 12 hrs for Soft Tissue Injury Revisited; 11 hrs for Return to Work Course, and 12 hrs for Report Writing Skills Program.). The California Chiropractic Association-44 hrs for an IDE Program and 12 hrs for a Report Writing Course Program. The International Chiropractic Association of California-renewed for an IDE Program. The Academy of Forensic and Industrial Chiropractic Consultants-6 hr. continuing education program.

Dr. Walsh: Motion: To approve the renewals of the above five providers for continuing education.

It was seconded.

Action: Motion passes.

Dr. Walsh reported that Mr. Fisher had drafted a letter that would explain the new regulations to make it easier to understand the application process and that this will go out to providers. The Committee is still working on an auditing process for the courses. It had been recommended that they meet with the providers of the 12 hour report writing courses early next year to get an assessment of the requirements that the Council imposed and see how its going.

Dr. Ira Monosson asked if the result of the September 15, 2001 QME Competency Examination would be discuss.

Dr. MacKenzie responded that the results of the examinations turned out to be an aberration. It had the lowest pass rate and the highest standard error of measurement ever and, for those who were successful, there was a lower mean score. In discussion with the CPS psychologist who maintains the QME Exam, the feeling was although random error is acceptable this was a systematic error and is unacceptable. Dr. MacKenzie said that after each exam, there is a remake exam which is put together for those who have special circumstance or special appeals. In this particular exam, we not only have the appeals and the no shows, (four days after Sept. 11th, people who would be coming from other states were not able to travel to take it), but also those who failed would also be considered for the remake exam. Dr. MacKenzie asked Dr. Bruce Davis for substantiation and this has been forwarded to all Council Members.

Also, Dr. Barry Halote initially thought that giving a make-up exam for that large group was not appropriate but after looking at the statistics he has changed his opinion.

Ms. Sinnott said that it is important to clarify what Dr. Davis said. He said that a high failure rate is an indicator but not proof of a problem. What was going on is an impression that something went wrong but there was no proof that there was a systematic error in the presentation or the taking of the test. Ms. Sinnott said that what we don't know whether the population of test takers was different from the population of the test takers who took it before. This high failure rate may be totally attributable to something entirely different than the events of Sept. 11th or other personal stresses. She thought that this gives the Council an opportunity to look at some analysis of test taking that might be done in the future and would help us understand who's failing and why they are failing and that this warrants more discussion possibly first in the Education Committee and then in the full Council.

Dr. Robert Larsen stated that in statistics there is never proof, there is only probability and with a high standard error of measurement, it is a very large indicator that there is a systematic error.

Dr. MacKenzie said that the Council and the Community are always trying to recruit qualified medical evaluators or to help us do the tasks. Secondly, the Council had always been a benevolent understanding organization, doing everything possible to broach our agenda forward in the interest of injured workers.

Dr. Larsen said that the Council supports what the Executive and Education Committee has done. He said that the standard error of measurement has been going up. The pass rate has gone down for some time, so if we give this again the next round, we should be mindful if we end up with a pass rate [for example] of 60 or 65% and we are seeing a trend that has more to do with either the candidates that we have, the way they are preparing for the test or the test that we are giving. At that point we need to reconsider, because the solution would not be for us to give make up exam again.

4. Fee Schedule Committee Report:

Dr. Susan McKenzie introduced the principal consultants from the Lewin Group, Dr. Allen Dobson and Dr. Lane Koenig. They are both health economists and are well known for their work on medical reimbursement issues. They presented the impact analysis for the RBRVS Study. Handouts were also distributed before the presentation.


California Workers' Compensation RBRVS Study

Presented to the Industrial Medical Council

Presented by:

Allen Dobson, Ph.D. and Lane Koenig, Ph.D.

The Lewin Group

II. Question and Answer Part:

The members of the public and the Council Members participated in Q&A part of the presentation.

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

5. Discipline Committee Report:

After deliberation, no decision was made during the closed session, so nothing to report.

6 Announcements:

Dr. Larsen announced that he brought an article written by Jerrold M. Post, M.D. "Terrorist on Trial: The Context of Political Crime" that is worth reading. For those interested to receive a copy, just write their names and addresses and the IMC Staff would mail it to them.

Dr. Pitts announced that the next meeting would be on November 15, 2001 in South San Francisco.

Meeting adjourned at 1:00 p.m.

Thursday, October 18, 2001

IMC Staff presents:

Lety Buenviaje Allan MacKenzie, M.D., Exec.Med.Dir.

Milagros Diadula Susan McKenzie, M.D.

James Fisher, Esq. Anne Searcy, M.D

David Kizer, Esq Larry Williams

DIR/DWC Staff present:

Suzanne P. Marria, Asst. Director, DIR

Richard Gannon, Adm. Director, DWC

Jackie Schauer, Esq.

George Parisotto, Esq.

Glenn Shore, Primary Policy Advisor;

Blair MacGowan, DEU Manager

Dennis Ehrhardt, DEU Supervisor.

Members of the public present:

Rea Crane, CWCI Brenda Ramirez, State Comp. Ins. Fund

Linda Cotrin, CCA Diane Przepiorski, CA Ortho. Assoc.

Frank Navarro, CMA Philipp M. Lippe, M.D., CANS

Bill Hutchins, WorkWell Systems Barbara Stanfield, CCA

Jenifer Brockmay, Inter Community Medical Benita Gagne, Intercommunity Medical

Donald Motzin Jan Nguyen, CCn

Robert Meredith, MD, CMA, CANS Stacy Jones, Independent Consultants

Jennifer Orosz, HNC Software Shari Palmer, Med. Intelligence Systems

Kim Moss, MIS Brenda Manson, Corvel

Debbie Fredricks, Corvell Doug Hikawa, Priority Compnet