Medical Peer Review in Georgia Workers Compensation
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1 Medical Peer Review in Georgia Workers Compensation June 20 th, 2013 CARLOCK, COPELAND & STAIR Fifth Annual General Liability & WC Seminar Presented by Mitchell S. Nudelman, MD, JD, FCLM Chief Medical Officer MedicalDirectorSolutions. Specializing in Complex Claims 1
2 What is meant by Peer Review? When one practitioner, ii who is in the same or similar or otherwise applicable specialty analyzes, critiques or provides an assessment of the clinical decision-making or charges of another practitioner MedicalDirectorSolutions. Specializing in Complex Claims 2
3 Goal of the Peer Review: Is always to ascertain the (medical) truth th of the matter asserted MedicalDirectorSolutions. Specializing in Complex Claims 3
4 Non WC or Liability Applications info Hospital Privileges Board of Medicine licensure issues Managed Care UR/QA Disability Determinations Medicare/Medicaid Fraud Professional Negligence Any time that a medical opinion may result in a benefit or award to a claimant MedicalDirectorSolutions. Specializing in Complex Claims 4
5 Most Common Peer Review Issues Overview of the case for early case management Relatedness/Causation (medical) Pain management services Medications Interventional procedures Implantables Rehabilitation ti services Request for surgery DME Exacerbation of Pre-X condition MedicalDirectorSolutions. Specializing in Complex Claims 5
6 What is the purpose for the Peer Review? Assistance in understanding the medical aspects of the claim road map for internal use Preparation and perhaps sharing at settlement t negotiations or medication Hearing to controvert Sentinel effect of difficult providers MedicalDirectorSolutions. Specializing in Complex Claims 6
7 What is the scope of the review? Necessity of medical, pharmacy, surgical or other services requested or already performed Medical causation Aggravation/exacerbation of pre-existing existing condition When is the claimant back to baseline? PPD Change in Provider Remendations for diagnosis or treatment Physician to physician contact MedicalDirectorSolutions. Specializing in Complex Claims 7
8 Cost Benefit Analysis Medical review is expensive: Don t let personal feeling get in the way of settling when performing this analysis. Depending upon the purpose and scope of the review, is it worth the time and cost? Can the PR/IME process be bifurcated? Does it need to be the same consultant? MedicalDirectorSolutions. Specializing in Complex Claims 8
9 The Essence of Credible Analysis The opinion of 10,000 men is of no value if none of them know anything about the subject. ~ Marcus Aurelius The practice of medicine is an art, based on science Medicine is a science of uncertainty and an art of probability. ~ Sir William Osler MedicalDirectorSolutions. Specializing in Complex Claims 9
10 CHOOSING AN EXPERT: So then what makes an expert qualified so as to be credible and reliable? MedicalDirectorSolutions. Specializing in Complex Claims 10
11 Dr. Ruth apparently has a lot of education training & experience! education, training & experience! MedicalDirectorSolutions MedicalDirectorSolutions. Specializing in Complex Claims 11
12 Do you remember the movie... Federal Rule 702 requires: knowledge, skill, experience, training or education on g ultimate issue In certain fields experience is the predominant, if not sole, basis for a great deal of reliable expert testimony MedicalDirectorSolutions MedicalDirectorSolutions. Specializing in Complex Claims 12
13 Daubert & Rule 702 Scientific Test for Reliability Federal Rule 702 was amended in 2000 to codify and structure the "Daubert trilogy" it included provisions that a witness may only testify if: 1) the testimony is based upon sufficient facts or data 2) the testimony is the product of reliable principles and methods, and 3) the witness has applied the principles and methods reliably to the facts of the case." MedicalDirectorSolutions. Specializing in Complex Claims 13
14 2005 Georgia Legislature Created a new rule on the admissibility of expert testimony loosely based on the federal Daubert rule Georgia s New Expert Witness Rule: Daubert & More, Robert E. Shields and Leslie J. Bryan, Georgia Bar Journal, October 2005 MedicalDirectorSolutions. Specializing in Complex Claims 14
15 Galileo s Revenge: Junk Science in the Courtroom (Daubert) eliminates i t the spitting contest t between dueling doctors and other experts It prevents awards based on junk science When applied to medicine, it moves the art of medicine from snake oils and potions to an art founded in science. ~Peter William Huber MedicalDirectorSolutions. Specializing in Complex Claims 15
16 An Introduction to Evidence Based Medicine MedicalDirectorSolutions. Specializing in Complex Claims 16
17 MedicalDirectorSolutions. Specializing in Complex Claims 17
18 Excuse me WHAT was that? MedicalDirectorSolutions. Specializing in Complex Claims 18
19 IME or Peer File Review MedicalDirectorSolutions. Specializing in Complex Claims 19
20 What is the medical question at issue? Is it a Matter of (Medical) Fact? OR Is it a Matter of (Medical) Law? MedicalDirectorSolutions. Specializing in Complex Claims 20
21 Peer Review Committees approved by the Board are as follows: MedicalDirectorSolutions. Specializing in Complex Claims 21
22 MedicalDirectorSolutions. Specializing in Complex Claims 22
23 Criteria for payment of treatment/tests under the WC statute MedicalDirectorSolutions. Specializing in Complex Claims 23
24 Rule 205: No precertification or advance authorization except a WC MCO certified by the Board SO THEN, PEER REVIEW IS NOT THE SAME AS PRECERTIFICATION, ALTHOUGH PRECERTIFICATION MAY REQUIRE PEER REVIEW! MedicalDirectorSolutions. Specializing in Complex Claims 24
25 Rule 205: The Medical Provider may initiate advance authorization MedicalDirectorSolutions. Specializing in Complex Claims 25
26 Controvert: Burden of Proof MedicalDirectorSolutions. Specializing in Complex Claims 26
27 Rule 205: Dispute on Medical Necessity of Treatment Does is matter if the procedure was already performed? Maybe not by board rule, but in practice if the service was performed it is less likely to be found not necessary, or unrelated to the alleged injury at issue MedicalDirectorSolutions. Specializing in Complex Claims 27
28 MedicalDirectorSolutions. Specializing in Complex Claims 28
29 MedicalDirectorSolutions. Specializing in Complex Claims 29
30 Rule 205 (b)(3)(2): In the event of a dispute as to the necessity and/or reasonableness of services already rendered, the procedure listed in Board Rule 203(c) shall be followed. MedicalDirectorSolutions. Specializing in Complex Claims 30
31 MedicalDirectorSolutions. Specializing in Complex Claims 31
32 Some Ethical Considerations in Peer Review Stretching the Truth of the (Medical) Matter Asserted Findings not being shared with claimant The review reveals psychiatric i issues -what to do? Harm due to breach in standard of care disclose? Filing a Board of Medicine plaint against an ATP is this ethical and feasible? Can employer do alone - or does it require the claimant s consent? MedicalDirectorSolutions. Specializing in Complex Claims 32
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