CA Fed Art Pulaski’s Legislative Director Angie Wei Helped Lead Attack On Injured Workers

CA Fed Art Pulaski’s Legislative Director Angie Wei Helped Lead Attack On Injured Workers In California Through Pushing Insurance Supported SB 863

Labor’s Comp Expert Stepped On Toes To Make Reform Deal

https://www.workcompcentral.com//news/story/id/d216a9cba385bd32942f211e3d217225b096accf

WorkComp Central
December 10, 2014

Senate Bill 863 was the product of years of work by Angie Wei.
The legislative director of California Labor Federation, the firery Wei had an eye towards reform since the 2004 passage of Senate Bill 899, which decreased permanent disability benefits by about 60% according to the Workers’ Compensation Insurance Rating Bureau.

“There was a shared analysis between employers and workers that injured workers were pretty screwed under permanent disability schedule,” she said.

In 2005, Wei was appointed to serve on the Commission on Health and Safety and Workers’ Compensation. With Wei on board and growing discontent from various stakeholders, the commission became the launching pad for SB 863.

Wei, along with the other members of the commission, heard reports year after year about the state of workers’ compensation-workers struggling to get medical care amid multi-year delays, costs increasing for employers and unpredictable court decisions making the system volatile. Wei trae off chairing the commission with Sean McNally, then a representative of the sefl-insured Grimmway Farms, and formed a working relationship with him.

Labor representatives and employers were both eager to tackle the issues coming before the commission, she said, and the opportunity to address them all at once in the form of a reform bill allowed the sides to leverage an increase in permanent disability benefits with cost decreases in other areas.

“The only way to achieve significant benefit increase was to tackle a number of significant issues and not do all the one-offs,” she said.

In 2009, they decided it was time to pursue reform. One of labor’s major interests was restoring permanent disability benefits, while employers were interested in gaining more control over medical care and driving down costs. But the initial efforts got leaked, and after legislators and other critics go ahold of the plans, they fell apart.

In 2011, Wei and McNally tried again. They agreed that the two original stakeholders in workers’ compensation-the employers and the employees-should be the only two voices at the table before the bill went public. Representatives of the attorneys, medical professionals, copy services, managed-care organizations and other groups were not invited.

“Angie and Sean were the two quarterbacks for both sides and I think they were really the leaders for both parties in terms of focusing our attention and bringing us together.” said Martin Brady, executive director of the Schools Insurance Authority and one of the employer representatives in the negotiations.

The negotiations took about a year, with the various representatives meeting in Sacramento to weigh their options. According to Baker, the negotiations fell apart and came back together several times.

“(Wei and McNally) were sitting at opposition sides of the table but they were able to come back, even if they disagreed. They were able to come back and work things out,” Baker said. “It takes strength to do that.”

When the bill finally hit the Legislature in August, it was a surprise. “I don’t think that anybody though we would get to a deal and that the deal with be adopted by the Legislature,” Wei said.

The employer-employee approach to the negotiations proved to be controversial. Dan Mora, present of the applicant copy shop Gemini Duplication, has been a vocal critic of the copy service fee schedule mandated under the bill. The fee schedule calls for a flat fee paid to noncontracted copy shops instead of letting them bill for the procurement and preparation of documents used as evidence in workers’ compensation hearings.

He said he didn’t respect the approach Wei, McNally and the others involved in the negotiations took in crafting such a large reform bill and called Wei a “bully” for her part in leading the efforts.

“That’s how I would characterize her, as a bully. She’s profane, she’s unprofessional. In meetings, she would drop f-bombs Mora said.

Baker said Wei’s approach to the process was driven by her desire to help workers.

“(She is) caring for her constituency and her workers,” Baker said. “(She is) analytical, strong with a strong conviction to protect workers.”

Though the state is still moving through the process of implementing SB 863 in its entirety, Wei said she sees several victories.

“Putting schedules on (medical fees), giving more predictability on things is an upside. I think the permanent disability ratings are going up, putting more money in the workers’ pockets is an upside” she said.

However, Wei still sees work to be done.

“I think the utilization review still needs a big look,” she said. “Something’s not working, injured workers aren’t getting the treatment they deserve.”


California Workers’ Comp Law Gets Criticism, Praise at Senate Hearing
http://www.propublica.org/article/california-workers-comp-law-gets-criticism-praise-at-senate-hearing
Some hearing witnesses say the 2012 reform law had “unintended consequences,” prompting insurers to deny medical care and doctors to leave the system.
by Michael Grabell
ProPublica, March 26, 2015, 5:01 p.m.17 Comments Print Print
This is part of an ongoing investigation:

Angie Wei of the California Labor Federation said the state needs to eliminate some of the layers of medical review that give employers and insurers multiple chances to overrule workers’ doctors. Above, Wei listens to testimony from an injured worker in 2005. (Steve Yeater/AP Photo)
An architect of California’s recent workers’ comp reform testified Wednesday that the law was being misused by insurers and that the system may need to be streamlined to make it fairer for injured workers.

In remarks before a senate committee, Angie Wei of the California Labor Federation said the state needs to crack down on insurers using the law as an excuse to deny medical care and eliminate some of the layers of medical review that give employers and insurers multiple chances to overrule workers’ doctors.

Several reforms of the state’s workers’ comp system over the years have given insurers more control over workers’ medical treatments, she said.

Insurers can steer workers to certain doctors by setting up medical provider networks. But if they don’t agree with these doctors’ recommendations, they can pick outside doctors to review them, Wei said. Then, under a system set up by the new law, if injured workers challenge the decisions of the outside doctors, the disputes are sent for a final review by an anonymous doctor picked by a state contractor. These reviews have upheld nearly all the insurers’ medical care denials.

“Why should the employers and insurers get another bite at the apple that increases friction and drives up costs and delays for everybody?” asked Wei, who negotiated the law with business representatives.

Wei’s comments came as part of the California senate’s first oversight hearing on the contentious 2012 workers’ comp law. The legislation sought to restore some benefits that had been severely cut years before and to speed up the system by moving decisions over medical disputes from judges to doctors. Costs would be controlled by reducing infighting and waste.

But earlier this month, ProPublica and NPR reported that some insurers were using the new law to reassess medical care that had been approved years before. In one case, a paralyzed warehouse manager had his home health care terminated, leaving him for hours at a time with no one to help him.

The investigation by ProPublica and NPR found that California is one of more than 30 states since 2003 that have cut benefits, created hurdles to getting medical care, or made it harder to qualify for workers’ comp.

During the hearing before the Senate Labor and Industrial Relations Committee, testimony about the law’s impact fell largely along expected lines. Insurer representatives said the law is working as intended. Employers complained that administrative costs are still too high. Workers’ lawyers said the new medical reviews were denying injured workers vital care.

But some testimony highlighted unexpected ramifications of the law. Dr. Brendan Morley, a pain specialist who heads the California Society of Industrial Medicine and Surgery—an organization of physicians who treat injured workers—said doctors have become increasingly frustrated as their recommended treatments are rejected during the review process.

“Not all reform is good reform, and there can be unintended consequences,” he said, citing ProPublica and NPR’s investigation. “This is driving a lot of good physicians out of the workers’ comp system.”

State officials and other hearing witnesses defended the law as a necessary fix to a system that had become dysfunctional and expensive.

“It is not perfect, but it is certainly better than it was before,” said Christine Baker, director of the state’s Department of Industrial Relations, which oversees workers’ comp.

Last week, in response to our story, the workers’ comp agency warned insurance companies not to use the new law to deny approved home health care. It has also launched an audit of the insurer that removed the paralyzed worker’s aide.

Data presented at the hearing by the state and by the California Workers’ Compensation Institute, an insurance research group, showed that most medical care is getting approved. But when disputes reach the final stage, the new medical reviewers are upholding insurance company denials about 90 percent of the time.

Alex Swedlow of the research institute said that means doctors hired by the insurers “got it right.” He added that most of the review requests are coming from a small number of physicians.

But Bernardo de la Torre, an attorney for injured workers, said the data distorts the picture because the overwhelming majority of claims involve minor injuries, which involve routine, inexpensive treatment. He said the claims that often end up in disputes involve the most serious—and typically more costly—injuries.

The data, he said, proves the new review process is merely a “rubber stamp” for insurer decisions.

Wei said that while nearly every other player in workers’ comp took a hit during the recent reform, insurers were left unscathed.

“I think it’s time,” she said, “to really zone in on the insurance company industry and to understand what it is that they’re doing to affect the plight of injured workers."

NPR correspondent Howard Berkes contributed to this report.

Clarification, March 27, 2015: An earlier version of this story may have implied that Alex Swedlow of the California Workers’ Compensation Institute said insurers were making medical decisions. Those decisions were made by doctors hired by the insurers.

Related coverage: Read about the demolition of workers' compensation and how what your limbs are worth depends on where you work. For more, see the full investigation.



Utilizaton Review (UR) and Independent Medical Review (IMR)


Of these two programs the more perfidious one is Independent Medical Review (IMR) into which the legislature carelessly linked secrecy and finality of decision making.
http://politicsofhealthcare.blogspot.com/2014_12_01_archive.html


saturday, december 27, 2014
Utilizaton Review (UR) and Independent Medical Review (IMR)


Of these two programs the more perfidious one is Independent Medical Review (IMR) into which the legislature carelessly linked secrecy and finality of decision making.
http://politicsofhealthcare.blogspot.com/2014_12_01_archive.html

The IMR decision is supposedly a final medical decision no matter how incorrect and harmful that decision may be. It cannot be appealed to WCAB since that otherwise constitutional pathway has been precluded by SB 863. The idea in this situation is that doctors, not lawyers or judges, should make medical decisions. The concept sounds good in theory. Nonetheless, the legislature felt it necessary to protect the IMR doctors from outside scrutiny by keeping IMR doctors' names secret just as in France in the days of the Bastille when secret letters enabled throwing French citizens, including nobility, into prison without trial.

IMR is justly under fire at this time. On 12/03/14 the California Court of Appeal First Appellate District, Division One, granted the petition for writ of review filed by Attorney Joseph Waxman in the case of Frances Stevens, Petitioner, v. WCAB and Outspoken Enterprises/State Compensation Insurance Fund (ADJ 1526353). In a workcompcentral report from 12/18/14 we're told that Stevens had been found 100% disabled. Stevens needed a high level of assistance even for ordinary activities of daily living including personal hygiene. State Comp (SCIF) submitted the request to Utilization Review (UR) which denied the requested home health aide and four medications. An IMR review request was submitted. After a lengthy delay, seven months, actually, Maximus upheld the UR denial. That is when an appeal was filed with the Workers Compensation Appeals Board (WCAB). Part of the legal appeal revolves about jurisdiction, i.e., the constitutionality of Labor Codes 4610.5 and 4610.6. This writer understands IMR is governed in part by LC 4610.6 (h) which says WCAB can only set Maximus IMR decisions aside on what workcompcentral's piece called "very limited grounds" such as fraud, material conflict of interest, racial bias, and other matters such as ethnic or sexual orientation.

Under these circumstances, that a UR decision might have been flat-out wrong, stupid, and harmful, and that IMR approval might also have been wrong, stupid, and harmful, simply doesn't matter under the law. Welcome to "1984" in medical-legal jurisprudence.

Organizations with a stake or interest in the outcome should file amicus briefs as soon as possible, especially medical organizations that purport to have patients' interests at heart.

References (some items listed more than once under separate headings when more than one site used the editorial and if one of the sites is not readily accessible)

From Workcompcentral:

1) "Malpractice by Utilization Review," 12/19/14;

2) "Utilization Review: Hypocrisy in Velvet Gloves," 3/16/14;

3) "Stevens Writ Granted," 12/18/14;

4) "Applicants' Attorneys Pan DWC's Rosy View of Independent Medical Review," 12/19/14;

5) "Maximus Upheld Denial of Treatment Four-Fifths of the Time," 12/10/14.

From California Applicants Attorneys' Association:

1) Under Eclips Daily News, 12/19/14, "Malpractice by Utilization Review."

From Politicsofhealthcare.com:

1) "Is SB 863 an Example of Legislative Malpractice?, " 12/22,14;

2) "Malpractice by Utilization Review, " 12/13/14;

3) "Is Utilization Review in the Cards for 2015?, " 12/01/14;

4) "How Utilization Review and Independent Medical Review ... Deprive Injured Workers," 8/11/14;

5) "Utilization Review: Hypocrisy in Velvet Gloves," 3/18/14.


posted by robert weinmann at 8:56 am no comments:
labels: attorney josepj waxman, frances stevens v. wcab, independent medical review (imr), maximus, stevens writ, utilization review (ur)

monday, december 22, 2014
Is SB 863 an Example of Legislative Malpractice?


In our previous op-ed we discussed malpractice by Utilization Review doctors, namely, which ones were eligible for discipline from the Medical Board of California (MBC) and which ones were able to skedaddle from underneath this potentially onerous obligation. In a nutshell, UR doctors not licensed in California are allowed substantially more leeway than their properly licensed counterparts -- they can deny, modify, or approve care to California's injured workers without being subject to sanctions for unprofessional conduct from the MBC when their incorrect decisions are harmful to injured workers.

We then discussed the special relief that's granted to Independent Medical Review (IMR) doctors such as those used by Maximus. While many of these IMR doctors may be licensed in California, many are not. Physicians do not need to be licensed in California to do IMR thanks to SB 863 which grants at least two levels of protection to this favored class. First, the IMR doctor does not have to be licensed in California. Second, the IMR doctor gets to be anonymous, not unlike the situation in pre-revolutionary France where nobles were allowed to file secret complaints called "lettres de cachet" -- these accusations put hapless defendants into prison. The unlucky defendant was not told the name of his accuser.

Our editorial entitled "Malpractice by Utilization Review?" has been reprinted on other websites, e.g., workcompcentral, California Neurology Society, and has come to the attention of the California Applicants' Attorneys Association (CAAA). We call your attention to comments that have been submitted to workcompcentral, in particular, one from an orthopedic patient who said "I too am thinking about going to the CA medical board on a UR doctor."

This patient said he was made to "suffer for close to 5 weeks with the headaches that comes with spinal fluid leaks." These situations point out why SB 863 needs to be substantially modified or repealed.

Physicians know that utilization review occurs in diverse forms and isn't limited to workers comp or injured workers -- it's used for managed care of all kinds and for Medicare and Medicaid.

It appears that SB 863 has provided a safe-haven for malpractice protection for UR doctors and their 80% supportive IMR colleagues. It appears that one can argue with reasonable medical probability that SB 863 itself reflects legislative malpractice and has earned the right to be repealed.

Interested parties are referred to additional specific references (see below):

"Applicants' Attorneys Pan DWC's Rosy View of Independent Medical Review," by Greg Jones, Workcompcentral, 12/19/14;

"Maximus Upheld Denial of Treatment Four-Fifths of the Time," by Greg Jones, Workcompcentral, 12/16/14;

"Labor's Comp Expert Stepped on Toes to Make Reform," Workcompcentral, 12/10/14;

"Continuing Hope for Reinstatement of the Lien Activation Fee," Melissa LeBlanc, Workcompcental, 12/22/14.


posted by robert weinmann at 11:40 am 2 comments:
labels: caaa, california neurology society, independent medical review (imr), malpractice, maximus, mbc (medical board of california), sb 863, utilization review (ur)

saturday, december 13, 2014
MALPRACTICE BY UTILIZATION REVIEW?

MALPRACTICE CASE STORY IN PROGRESS

Here's the story we're working on right now: a Utilization Review physician with a California license is being challenged for a decision that is reported to have resulted in harm to a patient. As we go to press, here's what we know:

1) Patient X sustained brain and spinal cord injury in 2001;
2) Patient X had a three-level cervical fusion;
3) Patient X had been on lyrica since 2008;
4) Patient X reported relief of symptoms;
5) Patient X did not report adverse effects;
6) UR Doctor Y was referred the case for review;
7) As is the custom in these cases, UR Doctor Y did not interview or examine the patient since so doing is not required by California law covering utilization review;
8) As is the custom in these cases, UR Doctor Y reviewed the documents forwarded by the insurance company, three medical reports that purportedly covered the injured worker's 12-year medical and surgical history;
9) At this point one of the allegations against the UR doctor that could also be directed against the insurance company is that a paucity of medical records was reviewed by the doctor and/or submitted by the insurance company;
10) UR Doctor Y submitted a report advising that the dosage of lyrica which had been prescribed for about 6 years be cut in half;
11) This recommended reduction in medication was accepted by the insurance company which then reportedly declined to authorize the next request for medication refill (we do not know at this time if the actual primary treating physician or PTP agreed, acquiesced, or rewrote the prescription in accordance with the UR recommendation). We also do not know if the PTP filed an appeal;
12) Patient X did poorly with the reduced medication and experienced adverse effects;
13) In due course, a California licensed physician got the original dosage restored;
14) Patient X sustained adverse effects that were short-lived and reversed once the original dosage was restored;
15) Patient X now has a lawyer who has instituted proceedings to report UR Doctor Y to the Medical Board of California and to initiate a malpractice complaint.

In summary, although we believe we know more, the facts as stated above can safely be stated with reasonable medical probability. In previous op-eds, see also my reprints in workcompcentral, we've pointed out that Dr. Frantozzi as president of the MBC submitted a letter stating that UR was part of the practice of medicine and required a California medical license -- in this case, the offending UR doctor does in fact have a California medical license which is why the MBC retains jurisdiction in this case. In other cases where the UR doctor does not have a California medical license, there would be no sense in even submitting this complaint to the MBC. Malpractice litigation would be the only choice. In this case, it appears that both options are open. We'll follow up when we know more, Stay tuned.

MORE, A LITTLE MORE, IS HEREWITH REPORTED: repeal of SB 863 is indicated.

If you stayed tuned as requested, here's the next bits of information we've gleaned about this patient's plight. The PTP in this case reportedly filed an updated RFA which dutifully got referred back to Utilization Review. A different UR doctor than the one who nixed the original prescription then opined in favor of the original lyrica prescription. The medication was then re-authorized. We're also advised that the Medical Board has now been advised about this case and has been asked to comment on it. This method of medical practice owes its existence to SB 863. The solution is repeal of SB 863. Stay tuned, this fight has just begun.

References

"Medical Board Asserts Jurisdiction Over Utilization Review," workcompcentral.com, by Greg Jones, 2013-06-12;

"Utilization Review Hypocrisy in Velvet Gloves," workcompcentral.com, by Robert Weinmann, MD, 2014-03-26;

"Is Utilization Review in the Cards for 2015?" workcompcentral.com, by Robert Weinmann, MD, 2014-12-03.



posted by robert weinmann at 11:38 am no comments:
labels: licensing of utilization review doctors in california, malpractice, mbc (medical board of california), sb 863 (deleon), utilization review data analysis

wednesday, december 3, 2014
PROPOSITION 45 MAY RIDE AGAIN (Regulating Insurance Companies That Sell Healthcare Policies)


Like a reliable bucking bronco used to rodeo participation, Proposition 45 may be down, not out, and capable of rising again if supportive organizations adopt it, revise it, and promote it.

Among the physicians who were supportive of Prop. 45 we can probably still count on Paul Song and Robyn Young to maintain interest and put up a fight. Doctor Song is reported to have an eye on running for insurance commissioner once Dave Jones has finished his tenure. Young is president of the California Neurology Society and maintains hands-on interest in medical- political issues in Sacramento and Washington, DC.

What killed Proposition 45 in the November, 2014 voting in California was the widespread perception that regulation of the insurance companies was largely smoke and mirrors. The idea was to allow the insurance commissioner as much authority over the sellers of healthcare insurance as is now allowed with reference to automobile liability insurance.

That meant that the insurance commissioner would be enabled to role back an insurance company's increase in premium it it were judged by the insurance commissioner to be arbitrary, not substantiated by demonstrable need. The insurance commissioner would be judge and jury.

Careful readers of the proposition quickly realized that what was deemed "arbitrary" might itself be arbitrary and that insurance commissioners might yield to political persuasion. The insurance companies countered with an ad that said doctors, not politicians, should decide medical matters. The obvious riposte was that insurance companies currently readily find ways to deny authorization of care, restricting access to diagnostic studies, specialists, and expensive procedures, sometimes even medicines. The proponents of 45 were caught flat-footed, or when not flat-footed, too penurious to afford proper rebuttal ads.

The Californnia Medical Association and the Union of American Physicians and Dentists found common ground in opposing 45 -- they agreed that a likely scenario for an insurance company whose increased premium got rebuked would simply be to reduce remuneration to providers such as hospitals, clinics, and physicians. That being so, they opted to oppose the proposition since its obvious effect would be to reduce access to care. The likely next step would be for MPNs (Medical Provider Networks) to fire physicians as fast as possible -- the longer the waiting line for access to care, the lower monthly expenses would be, the higher profits and executive compensation would be, never mind that overall serious illness would go up. The obvious fly-trap was "insurance for everybody, medical care for nobody"

As a result these and other medical organizations opposed the proposition even though in their collective guts they may have favored the concept. Prop. 45 did not cover providers or provider groups because it did not give the insurance commissioner authority to regulate provider reimbursement by the insurance companies.

Now it's up to the proponents to write a proper legislative bill that takes these concepts into account and puts them into legislative language in time for the 2015 legislative session. Since there's a long history on this concept, AB 52 from previous failed legislation, and now Prop. 45 itself, it should be possible to construct a new bill that will tie up these loose ends. The next step will be to get a legislative author and to be available as an articulate sponsor at committee hearings and the like.

Indeed, since the concept already has traction, my advice is to seek out an appropriate legislator to carry the bill with the understanding that when he looks over his shoulder he'll see troops in support, not defectors fleeing the political scene.



IS UTILIZATION REVIEW IN THE CARDS FOR 2015?



monday, december 1, 2014
IS UTILIZATION REVIEW IN THE CARDS FOR 2015?

Utilization Review (UR) is the process in Workers Comp whereby outside physicians decide whether or not to authorize care prescribed by a PTP (Primary Treating Physician) or consultant called upon by the PTP to advise about the next diagnostic or therapeutic steps that should be taken for an industrial patient or injured worker. Under current California law the UR physician does not have to be licensed to practice medicine in California -- any state license suffices. Proponents of the current system argue in support of the position that where a physician is licensed is beside the point and should not be made an issue. What matters, they say, is that he is knowledgeable in the specialty in which he opines and on this basis should be allowed to approve or disallow authorization for treatment based on accepted peer review guidelines. Opponents point out that the UR physician is actually practicing medicine and should be just as responsible to the state medical board as the PTP.

Opponents assert that some insurance companies go out of there way to find physicians who are more likely than others to be nay-sayers who deny more diagnostic services and treatment than their colleagues. California's state medical board has recognized this awkward situation and is on record saying that UR is part of the practice of medicine and that UR physicians on California cases should be licensed in this state. This writer agrees, but it will take fresh legislation to get this change into law. In fact, three times such legislation actually cleared the California legislature, and three times it was vetoed, twice by Gov. Schwarzenegger, once by Gov. Brown, at the heavy handed persuasion of the insurance lobby. However, the tax circumstances that applied then no longer apply, reason enough to try again and give Gov. Brown a chance to redeem himself.

This topic has previously been discussed in these pages, e.g., "Utilization Review: Hypocrisy in Velvet Gloves," and reprinted in toto in workcompcentral, 2014-03-26.

See also for reference "How to practice medicine without a license," San Francisco Chronicle, 8/29/08.

Willful or wrongful denial of care may constitute "unprofessional conduct." If a doctor with a California license willfully or wrongfully denies care, that doctor may be asked to appear before the state medical board for "unprofessional conduct." No such threat awaits the non-California licensed physician. The non-California licensed physician may not be hauled before his own state board, either -- that board would not have jurisdiction in a California case. As matters stand now, the doctors whose decisions invariably favor cost-cutting by denying care need not worry about professional discipline for wrongful denials of care. This situation begs to be changed. It'll require legislation akin to Texas law which requires doctors who do UR in Texas to be licensed in Texas.

At the moment, doctors licensed in California cannot do UR on Texas patients without first getting licensed in Texas. By contrast, Texas doctors who aren't licensed in California may deny authorization for diagnostic studies or treatment ordered by doctors licensed in California who are trying to take care of patients injured in California. The California doctor ends up carrying the proverbial malpractice bag through no fault of his own. The non-California doctor who actually denied the diagnostic study or treatment skedaddles away paid and unscathed.

One major lobbyist told me he's all for revising Utilization Review law but would need to be assured that the Governor would not veto it this time. As anyone knows who has dealt with Gov. Brown, we do not offer guarantees on what he'll do or won't do. Our job is to persuade.

UR in California is often buttressed by a yes-man mentality from IMR physicians, that is, from Independent Medical Review doctors who also don't need to be licensed in California and, who, to make matters worse, are actually protected by anonymity endowed by recently passed California legislation which also cries out for adjustment, better yet, outright repeal (we refer here to SB 863, DeLeon). The Medical Board of California (under then President Richard Fanozzi, MD) stated in a letter dated 8/25/08 that the MBC supported legislation that "would require a physician who is conducting utilization review to be licensed in California " because that "would provide increased consumer protection over decisions that do not have patients as its primary concern."

Instead, what has happened with IMR is that "consumer protections over decisions that do not have patients as its primary concern" has been weakened.

Organizations that have previously expressed concern with current standards re UR include the California Society of Industrial Medicine and Surgery (CSIMS), California Physical Medicine and Rehab (CPM&R), California Medical Association (CMA), California Applicants' Attorneys Association (CAAA), Union of American Physicians and Dentists (UAPD), Voters Injured at Work (VIAW), LatinoComp, and California Neurology Society (CNS).

We're now obliged to wait to see which one takes the lead on UR and IMR reform in the 2015 legislative year. Our recommendation is that it be a consortium that pools its resources.

posted by robert weinmann at 8:21 pm no comments:
labels: independent medical review (imr), licensing of utilization review doctors in california, medical board of california (mbc), sb 863 (deleon), utilization review (ur)