Law Offices of Ainbinder & Pratt
A QME PROGRAM AUDIT
So far 2019 has been a sleepy year for California workers comp developments.
But that may be changing.
The California Legislature’s Joint Legislative Audit Committee has now approved a request that the California State Auditor investigate the DIR/DWC’s oversight of the California QME system. The audit request, filed by California Assemblywoman Blanca Rubio (D-West Covina) can be seen here:
Rubio’s February 21. 2019 letter lays out many of the recent problems with the QME system. These include dwindling QME numbers, longer wait times to see QMEs, and alleged application of “underground regulations” to delay and/or deny reappointment to scores of QMEs. Her request also alleges irregularities in the reappointment process, charging that some stakeholders may have improperly influenced the QME reappointment process and actions by the state-contracted IBR vendor.
A recent letter from DWC Administrative Director George Parisotto does not oppose the audit request but does suggest “a narrowed and targeted scope”. Parisotto’s letter can be found here:
On the issue of the dwindling number of QMEs, Parisotto makes an interesting observation about the overall problem of not enough doctors in California. He claims that the ratio of QMEs to panel requests is 2% whereas the ratio of doctors in California to California residents is .3%.
This may be true, but is small comfort to many workers and attorneys who see substantial delays in scheduling a QME and getting a report. The workers’ comp system is experiencing an epidemic of cases where multiple panels need to be issued in order to receive an exam and report, creating delays and frustration.
I’ve written about QME issues on a number of occasions. For example, in 2017, I covered the simmering dispute about QME recertification and the lawsuit filed by several physicians whose certification was delayed or denied:
After widespread stakeholder input on possible QME payment changes, RAND issued a 2018 draft report that discussed possible changes to the QME payment system:
My commentary on that is here:
So the takeaway is that we have a troubled QME system which is in flux. How fee schedule changes are designed and implemented could accelerate QME departures from the system or help stanch the exodus.
The State Auditor’s report will be a welcome addition to analysis of the current QME system.