Re: Actual fees in the SAIF system pre 1197

[Guest guest]

Doc,

you are so right. It was a horrible injustice. I hope more of us working together this time around, will stop that from happening again.

MInga Guerrero DC

In a message dated 5/20/2004 6:00:10 PM Pacific Standard Time, chirodoc1@... writes:

I did a bit of care for those injured workers in the pre-1197 days......and I did do a little study during the end times because so many of even the straight forward cases were contested mightily....

I don't think I have the primary document any longer, but I do recall a study over a random sample of about a dozen cases in the last 18 months before 1197.....

I found that no matter what my total fees were, the charges of the opposing attorney would amount to around 2-2 1/2 times whatever my case total was...where they spend a great deal of time telling the court how excessive MY fees were.....(I ALWAYS was well within then current guidelines).....

we ALWAYS won against those due to my extensive clinical skills and a well honed reportage` that their fumbling opposition in itself had engendered....and the skills of the injured workers attorney who was doing no more than tell the judge where the carrier was failing to follow the rules....and THEY were getting 3 1/2 TIMES what MY case total amounted to.....

so of the cost to SAIF for those cases, 1 unit of chiro care; often preceded by 2-4 units of ineffective 'other' care, then 2 or 2 1/2 units of attorney, then 3 1/2 units of another attorney....

who knows what administrative costs all this cost....but my little AVERAGE in those days amounted to something under $750/case (page 18 of the hit list).....

it always annoyed me that the DC who was getting the injured back to work faster for less cost, was in fact getting but a tiny portion of what SAIF was spending on each case....yet WE took the fall.....

J. Pedersen DCOregonDCs rules:1. Keep correspondence professional; the purpose of the listserve is to foster communication and collegiality. No personal attacks on listserve members will be tolerated.2. Always sign your e-mails with your first and last name.3. The listserve is not secure; your e-mail could end up anywhere. However, it is against the rules of the listserve to copy, print, forward, or otherwise distribute correspondence written by another member without his or her consent, unless all personal identifiers have been removed.

[Guest guest]

Well, IME fees within the PIP arena would be an EXCELLENT thing to know (particularly as a % of the overall claim).

I watched one claim representative send a patient to 2 IME's in order to justify denial of an $800.00 Chiropractic bill! Didn't make sense to me (and didn't work, either) but THAT'S how they inflate their "claims management" costs. They then turn around and use that figure in order to justify the need to raise premiums.

Any IME docs willing to share what a PIP carrier will pay for a one-time, knock-off exam? If so, you could privately forward that information to Dr. Minga Guerrero, I believe she is collecting such stats.

M. s, D.C.

Re: Actual fees in the SAIF system pre 1197

Now, let's not start bringing up what happened around SB1197 or we'll end up citing who in our current group of respected "players" were involved in horrible, incompetent, and insulting IME's. These people have changed and they do not need their reports shared and quoted to folks who weren't around back then. We must look ahead. E. Abrahamson, D.C.Chiropractic physicianLake Oswego Chiropractic ClinicPlease note "New address" 315 Second StreetLake Oswego, OR 97034503-635-6246drscott@...orinfo@...

From: AboWoman@...Date: Sun, 23 May 2004 02:19:34 EDT Subject: Re: Actual fees in the SAIF system pre 1197

Doc,you are so right. It was a horrible injustice. I hope more of us working together this time around, will stop that from happening again. MInga Guerrero DCIn a message dated 5/20/2004 6:00:10 PM Pacific Standard Time, chirodoc1@... writes:

I did a bit of care for those injured workers in the pre-1197 days......and I did do a little study during the end times because so many of even the straight forward cases were contested mightily....I don't think I have the primary document any longer, but I do recall a study over a random sample of about a dozen cases in the last 18 months before 1197.....I found that no matter what my total fees were, the charges of the opposing attorney would amount to around 2-2 1/2 times whatever my case total was...where they spend a great deal of time telling the court how excessive MY fees were.....(I ALWAYS was well within then current guidelines).....we ALWAYS won against those due to my extensive clinical skills and a well honed reportage` that their fumbling opposition in itself had engendered....and the skills of the injured workers attorney who was doing no more than tell the judge where the carrier was failing to follow the rules....and THEY were getting 3 1/2 TIMES what MY case total amounted to.....so of the cost to SAIF for those cases, 1 unit of chiro care; often preceded by 2-4 units of ineffective 'other' care, then 2 or 2 1/2 units of attorney, then 3 1/2 units of another attorney....who knows what administrative costs all this cost....but my little AVERAGE in those days amounted to something under $750/case (page 18 of the hit list).....it always annoyed me that the DC who was getting the injured back to work faster for less cost, was in fact getting but a tiny portion of what SAIF was spending on each case....yet WE took the fall.....J. Pedersen DCOregonDCs rules:1. Keep correspondence professional; the purpose of the listserve is to foster communication and collegiality. No personal attacks on listserve members will be tolerated.2. Always sign your e-mails with your first and last name.3. The listserve is not secure; your e-mail could end up anywhere. However, it is against the rules of the listserve to copy, print, forward, or otherwise distribute correspondence written by another member without his or her consent, unless all personal identifiers have been removed. OregonDCs rules:1. Keep correspondence professional; the purpose of the listserve is to foster communication and collegiality. No personal attacks on listserve members will be tolerated.2. Always sign your e-mails with your first and last name.3. The listserve is not secure; your e-mail could end up anywhere. However, it is against the rules of the listserve to copy, print, forward, or otherwise distribute correspondence written by another member without his or her consent, unless all personal identifiers have been removed.

[Guest guest]

: I am not an IME doctor, but have done some evaluations for insurance companies. They are not knock-offs. I spend an hour to hour and a half with the patient. I have to read their entire file, digest all the information and write a very long report requiring me to make difficult decisions. All told I spend at least 4 hours- sometimes as much as 8 hours. The last few I did I charged $350 (and got it).

Ann Goldeen, Astoria

Re: Actual fees in the SAIF system pre 1197

Now, let's not start bringing up what happened around SB1197 or we'll end up citing who in our current group of respected "players" were involved in horrible, incompetent, and insulting IME's. These people have changed and they do not need their reports shared and quoted to folks who weren't around back then. We must look ahead. E. Abrahamson, D.C.Chiropractic physicianLake Oswego Chiropractic ClinicPlease note "New address" 315 Second StreetLake Oswego, OR 97034503-635-6246drscott@...orinfo@...

From: AboWoman@...Date: Sun, 23 May 2004 02:19:34 EDT Subject: Re: Actual fees in the SAIF system pre 1197

Doc,you are so right. It was a horrible injustice. I hope more of us working together this time around, will stop that from happening again. MInga Guerrero DCIn a message dated 5/20/2004 6:00:10 PM Pacific Standard Time, chirodoc1@... writes:

I did a bit of care for those injured workers in the pre-1197 days......and I did do a little study during the end times because so many of even the straight forward cases were contested mightily....I don't think I have the primary document any longer, but I do recall a study over a random sample of about a dozen cases in the last 18 months before 1197.....I found that no matter what my total fees were, the charges of the opposing attorney would amount to around 2-2 1/2 times whatever my case total was...where they spend a great deal of time telling the court how excessive MY fees were.....(I ALWAYS was well within then current guidelines).....we ALWAYS won against those due to my extensive clinical skills and a well honed reportage` that their fumbling opposition in itself had engendered....and the skills of the injured workers attorney who was doing no more than tell the judge where the carrier was failing to follow the rules....and THEY were getting 3 1/2 TIMES what MY case total amounted to.....so of the cost to SAIF for those cases, 1 unit of chiro care; often preceded by 2-4 units of ineffective 'other' care, then 2 or 2 1/2 units of attorney, then 3 1/2 units of another attorney....who knows what administrative costs all this cost....but my little AVERAGE in those days amounted to something under $750/case (page 18 of the hit list).....it always annoyed me that the DC who was getting the injured back to work faster for less cost, was in fact getting but a tiny portion of what SAIF was spending on each case....yet WE took the fall.....J. Pedersen DCOregonDCs rules:1. Keep correspondence professional; the purpose of the listserve is to foster communication and collegiality. No personal attacks on listserve members will be tolerated.2. Always sign your e-mails with your first and last name.3. The listserve is not secure; your e-mail could end up anywhere. However, it is against the rules of the listserve to copy, print, forward, or otherwise distribute correspondence written by another member without his or her consent, unless all personal identifiers have been removed. OregonDCs rules:1. Keep correspondence professional; the purpose of the listserve is to foster communication and collegiality. No personal attacks on listserve members will be tolerated.2. Always sign your e-mails with your first and last name.3. The listserve is not secure; your e-mail could end up anywhere. However, it is against the rules of the listserve to copy, print, forward, or otherwise distribute correspondence written by another member without his or her consent, unless all personal identifiers have been removed.

[Guest guest]

Dr. s - Somewhere between 250 and 450 is reasonable for the amount of work involved plus the risk of occasionally having to defend your opinion in court.

OK - I just have to ask. How does one define an "IME" doctor vs. one that perfoms an evaluation for an insurance company? Is it someone who has performed one evaluation / independant medical exam / insurance exam, (definition subject to the point of view of the definer), someone who performs ONLY these exams, or somewhere in between? What about a doc that performs an exam at the request of another doc, does the same exact exam and review and same report? What are they called? I have done both in the past, though I have not performed any, nor will I in the future perform any for insurance companies or defense attorneys. I think this is an important discussion if both "sides" of the issue can resist slinging arrows, mud and other soft mushy stuff at each other. Any comments?

P. Thille, D.C., FACORedmond, Oregon

Re: Actual fees in the SAIF system pre 1197

Now, let's not start bringing up what happened around SB1197 or we'll end up citing who in our current group of respected "players" were involved in horrible, incompetent, and insulting IME's. These people have changed and they do not need their reports shared and quoted to folks who weren't around back then. We must look ahead. E. Abrahamson, D.C.Chiropractic physicianLake Oswego Chiropractic ClinicPlease note "New address" 315 Second StreetLake Oswego, OR 97034503-635-6246drscott@...orinfo@...

From: AboWoman@...Date: Sun, 23 May 2004 02:19:34 EDT Subject: Re: Actual fees in the SAIF system pre 1197

Doc,you are so right. It was a horrible injustice. I hope more of us working together this time around, will stop that from happening again. MInga Guerrero DCIn a message dated 5/20/2004 6:00:10 PM Pacific Standard Time, chirodoc1@... writes:

I did a bit of care for those injured workers in the pre-1197 days......and I did do a little study during the end times because so many of even the straight forward cases were contested mightily....I don't think I have the primary document any longer, but I do recall a study over a random sample of about a dozen cases in the last 18 months before 1197.....I found that no matter what my total fees were, the charges of the opposing attorney would amount to around 2-2 1/2 times whatever my case total was...where they spend a great deal of time telling the court how excessive MY fees were.....(I ALWAYS was well within then current guidelines).....we ALWAYS won against those due to my extensive clinical skills and a well honed reportage` that their fumbling opposition in itself had engendered....and the skills of the injured workers attorney who was doing no more than tell the judge where the carrier was failing to follow the rules....and THEY were getting 3 1/2 TIMES what MY case total amounted to.....so of the cost to SAIF for those cases, 1 unit of chiro care; often preceded by 2-4 units of ineffective 'other' care, then 2 or 2 1/2 units of attorney, then 3 1/2 units of another attorney....who knows what administrative costs all this cost....but my little AVERAGE in those days amounted to something under $750/case (page 18 of the hit list).....it always annoyed me that the DC who was getting the injured back to work faster for less cost, was in fact getting but a tiny portion of what SAIF was spending on each case....yet WE took the fall.....J. Pedersen DCOregonDCs rules:1. Keep correspondence professional; the purpose of the listserve is to foster communication and collegiality. No personal attacks on listserve members will be tolerated.2. Always sign your e-mails with your first and last name.3. The listserve is not secure; your e-mail could end up anywhere. However, it is against the rules of the listserve to copy, print, forward, or otherwise distribute correspondence written by another member without his or her consent, unless all personal identifiers have been removed. OregonDCs rules:1. Keep correspondence professional; the purpose of the listserve is to foster communication and collegiality. No personal attacks on listserve members will be tolerated.2. Always sign your e-mails with your first and last name.3. The listserve is not secure; your e-mail could end up anywhere. However, it is against the rules of the listserve to copy, print, forward, or otherwise distribute correspondence written by another member without his or her consent, unless all personal identifiers have been removed.

[Guest guest]

Thank You !!!

 focus...focus...focus.. on the future

Dr. Charlie Caughlin DC 155 NW 1st Ave Day, Or 97845 off 541-575-1063 hm 541-575-1103 fax 541-575-5554

----- Re: Actual fees in the SAIF system pre 1197

> >

> Doc,

> you are so right. It was a horrible injustice. I hope more of us working together this time around, will stop that from happening again. > MInga Guerrero DC

> > In a message dated 5/20/2004 6:00:10 PM Pacific Standard Time, chirodoc1@... writes:

> I did a bit of care for those injured workers in the pre-1197 days......and I did do a little study during the end times because so many of even the straight forward cases were contested mightily....

>

> I don't think I have the primary document any longer, but I do recall a study over a random sample of about a dozen cases in the last 18 months before 1197.....

>

> I found that no matter what my total fees were, the charges of the opposing attorney would amount to around 2-2 1/2 times whatever my case total was...where they spend a great deal of time telling the  court how excessive MY fees were.....(I  ALWAYS was well within then current guidelines).....

>

> we ALWAYS won against those due to my extensive clinical skills and a well honed reportage` that their fumbling opposition in itself had engendered....and the skills of the injured workers attorney who was doing no more than tell the judge where the carrier was failing to follow the rules....and THEY were getting 3 1/2 TIMES what MY case total amounted to.....

>

> so of the cost to SAIF for those cases,  1 unit of chiro care; often preceded by 2-4 units of ineffective 'other' care,  then 2 or 2 1/2 units of attorney, then 3 1/2 units of another attorney....

>

> who knows what administrative costs all this cost....but my little AVERAGE in those days amounted to something under $750/case (page 18 of the hit list).....

>

> it always annoyed me that the DC who was getting the injured back to work faster for less cost, was in fact getting but a tiny portion of what SAIF was spending on each case....yet WE took the fall.....

>

> J. Pedersen DC

>

> > OregonDCs rules:

> 1. Keep correspondence professional; the purpose of the listserve is to foster communication and collegiality. No personal attacks on listserve members will be tolerated.

> 2. Always sign your e-mails with your first and last name.

> 3. The listserve is not secure; your e-mail could end up anywhere. However, it is against the rules of the listserve to copy, print, forward, or otherwise distribute correspondence written by another member without his or her consent, unless all personal identifiers have been removed. >

> > OregonDCs rules:

> 1. Keep correspondence professional; the purpose of the listserve is to foster communication and collegiality. No personal attacks on listserve members will be tolerated.

> 2. Always sign your e-mails with your first and last name.

> 3. The listserve is not secure; your e-mail could end up anywhere. However, it is against the rules of the listserve to copy, print, forward, or otherwise distribute correspondence written by another member without his or her consent, unless all personal identifiers have been removed. > >

[Guest guest]

Since 1197 the neurologists and most other specialty MD's in my region won't take PIP referrals. They want cash and will not bill the PIP carrier, they are not willing to accept the SAIF fees. I have my patients write our legislators and thank them for limiting the patients access to injury care.

Dr. Jim Siegel, DC

[Guest guest]

Dr. Jim: Are you confusing WC with MVA (PIP)??

- Seitz, DC

Re: Actual fees in the SAIF system pre 1197

Since 1197 the neurologists and most other specialty MD's in my region won't take PIP referrals. They want cash and will not bill the PIP carrier, they are not willing to accept the SAIF fees. I have my patients write our legislators and thank them for limiting the patients access to injury care.

Dr. Jim Siegel, DCOregonDCs rules:1. Keep correspondence professional; the purpose of the listserve is to foster communication and collegiality. No personal attacks on listserve members will be tolerated.2. Always sign your e-mails with your first and last name.3. The listserve is not secure; your e-mail could end up anywhere. However, it is against the rules of the listserve to copy, print, forward, or otherwise distribute correspondence written by another member without his or her consent, unless all personal identifiers have been removed.

[Guest guest]

,

I didn,t mean to confuse the issue. I was referring to House Bill 3668, 2003 which reduces all PIP fees in accordance the medical fee schedule per ORS 656.248 which I thought was the actual SAIF fees.--- Original Message -----

From: BRIAN SEITZ

oregon DCs

Sent: Tuesday, May 25, 2004 4:04 PM

Subject: Re: Actual fees in the SAIF system pre 1197

Dr. Jim: Are you confusing WC with MVA (PIP)??

- Seitz, DC

Re: Actual fees in the SAIF system pre 1197

Since 1197 the neurologists and most other specialty MD's in my region won't take PIP referrals. They want cash and will not bill the PIP carrier, they are not willing to accept the SAIF fees. I have my patients write our legislators and thank them for limiting the patients access to injury care.

Dr. Jim Siegel, DCOregonDCs rules:1. Keep correspondence professional; the purpose of the listserve is to foster communication and collegiality. No personal attacks on listserve members will be tolerated.2. Always sign your e-mails with your first and last name.3. The listserve is not secure; your e-mail could end up anywhere. However, it is against the rules of the listserve to copy, print, forward, or otherwise distribute correspondence written by another member without his or her consent, unless all personal identifiers have been removed. OregonDCs rules:1. Keep correspondence professional; the purpose of the listserve is to foster communication and collegiality. No personal attacks on listserve members will be tolerated.2. Always sign your e-mails with your first and last name.3. The listserve is not secure; your e-mail could end up anywhere. However, it is against the rules of the listserve to copy, print, forward, or otherwise distribute correspondence written by another member without his or her consent, unless all personal identifiers have been removed.

[Guest guest]

Mike - Don't get me started. Ok. You went and did it. An IME is - or should be -

exactly

what it says it is: an independent medical examination (includes chiropractors,

too).

Independent means that the examining doc is not otherwise involved with the

patient's

care. A " consulting exam " or " second opinion " examination is not an IME,

although when a

patient is referred by the treating doc to another for such an exam, one would

hope the

consulting examiner will also offer a fair an objective opinion, not one that

automatically concurs with the treating doctor or is intended to bolster the

treating doc's

opinions and treatment plan.

Whether or not such an IME is truly independent is debatable. Many chiropractors

seem to

believe that all IMEs are biased toward the party paying the freight. The term

" IME doctor "

seems to imply this. According to this point of view, if one is an IME doctor,

one is

therefore an insurance whore. Some even call IMEs " DMEs, " meaning that they are

intended

to support the defense's position. I will not speak for all chiropractors who do

IMEs, but

having done a few IMEs myself I understand how one gets that sort of reputation,

deserved

or not. A plaintiff's attorney once said he'd never seen an IME report from me

that did not

go against his client. He obviously based his statement on the relatively few

IMEs I'd done

that involved his clients. I could have just as accurately said that I'd never

seen a client of

his who had a legitimate claim. The fact is we would have both been describing

the

elephant from the perspective of ants.

IMEs are driven by docs who treat patients for injuries which -- at least to the

insurance

people -- appear relatively minor for lengthy periods without adequate

documentation

(i.e., legible records that reflect the doctor's clinical reasoning), who appear

to attempt to

drive up the cost of a claim by exaggerating the severity and extent of the

patient's

injuries, whose treatment does not change over time and in response to the

changing

needs of the injured patient, and who do not attempt to transfer responsibility

to the

patient by substituting active for passive care within a reasonable time frame.

If, as I often

hear, IME doctors are insurance whores, then there are some in the profession

who appear

to be insurance rapists.

My purpose here is to give some degree of perspective to this issue, not to be

inflammatory. I don't know what percentage of the profession falls into the

category of

overutilization or excessive treatment. Is it the proverbial " few " or more than

that? Again,

from the vantage point of an ant, how could any of us know?

There are plenty of folks I've examined in an IME who have had legitimate

injuries and

have required further care, and I've never hesitated to say so when that's the

case. I'm sure

I'm not the only chiropractor who has come to such an opinion in an IME. It's

time to hear

from some D.C.s who have had their patients go to an IME who have come back

with a

report favorable to the patient.

So much for my input on this, Mike. For now, anyway.

J. Burke, D.C.

J. Burke, D.C.

Tigard, Oregon

Sent by Medscape Mail: Free Portable E-mail for Professionals on the Move

http://www.medscape.com

[Guest guest]

Jim: Where are you? A big clinic here stopped seeing PI and work comp cases a couple years ago. This year they laid off most of their staff and lost several physicians. They appear to be drying up. As far as I can see, it is no great loss for the community. The care was marginal at best. Ann Goldeen, Astoria

Re: Actual fees in the SAIF system pre 1197

Since 1197 the neurologists and most other specialty MD's in my region won't take PIP referrals. They want cash and will not bill the PIP carrier, they are not willing to accept the SAIF fees. I have my patients write our legislators and thank them for limiting the patients access to injury care.

Dr. Jim Siegel, DCOregonDCs rules:1. Keep correspondence professional; the purpose of the listserve is to foster communication and collegiality. No personal attacks on listserve members will be tolerated.2. Always sign your e-mails with your first and last name.3. The listserve is not secure; your e-mail could end up anywhere. However, it is against the rules of the listserve to copy, print, forward, or otherwise distribute correspondence written by another member without his or her consent, unless all personal identifiers have been removed.

[Guest guest]

: I have seen several other situations where an IME was requested

and made sense. One was a long delay before active care was initiated.

Another is when there have been multiple accidents. I have several of those

now. Another and this is a biggy for some of us---lousy records of the

patient's history by the treating doctor. The insurance company wants more

facts to sort out the case. Because I do a few I feel a little defensive

about this. At least I can comfort myself in knowing whatever I write will

be the truth as I see it.

Ann Goldeen, Astoria

Re: Re: Actual fees in the SAIF system pre 1197

> Mike - Don't get me started. Ok. You went and did it. An IME is - or

should be - exactly

> what it says it is: an independent medical examination (includes

chiropractors, too).

> Independent means that the examining doc is not otherwise involved with

the patient's

> care. A " consulting exam " or " second opinion " examination is not an IME,

although when a

> patient is referred by the treating doc to another for such an exam, one

would hope the

> consulting examiner will also offer a fair an objective opinion, not one

that

> automatically concurs with the treating doctor or is intended to bolster

the treating doc's

> opinions and treatment plan.

>

> Whether or not such an IME is truly independent is debatable. Many

chiropractors seem to

> believe that all IMEs are biased toward the party paying the freight. The

term " IME doctor "

> seems to imply this. According to this point of view, if one is an IME

doctor, one is

> therefore an insurance whore. Some even call IMEs " DMEs, " meaning that

they are intended

> to support the defense's position. I will not speak for all chiropractors

who do IMEs, but

> having done a few IMEs myself I understand how one gets that sort of

reputation, deserved

> or not. A plaintiff's attorney once said he'd never seen an IME report

from me that did not

> go against his client. He obviously based his statement on the relatively

few IMEs I'd done

> that involved his clients. I could have just as accurately said that I'd

never seen a client of

> his who had a legitimate claim. The fact is we would have both been

describing the

> elephant from the perspective of ants.

>

> IMEs are driven by docs who treat patients for injuries which -- at least

to the insurance

> people -- appear relatively minor for lengthy periods without adequate

documentation

> (i.e., legible records that reflect the doctor's clinical reasoning), who

appear to attempt to

> drive up the cost of a claim by exaggerating the severity and extent of

the patient's

> injuries, whose treatment does not change over time and in response to the

changing

> needs of the injured patient, and who do not attempt to transfer

responsibility to the

> patient by substituting active for passive care within a reasonable time

frame. If, as I often

> hear, IME doctors are insurance whores, then there are some in the

profession who appear

> to be insurance rapists.

>

> My purpose here is to give some degree of perspective to this issue, not

to be

> inflammatory. I don't know what percentage of the profession falls into

the category of

> overutilization or excessive treatment. Is it the proverbial " few " or more

than that? Again,

> from the vantage point of an ant, how could any of us know?

>

> There are plenty of folks I've examined in an IME who have had legitimate

injuries and

> have required further care, and I've never hesitated to say so when that's

the case. I'm sure

> I'm not the only chiropractor who has come to such an opinion in an IME.

It's time to hear

> from some D.C.s who have had their patients go to an IME who have come

back with a

> report favorable to the patient.

>

> So much for my input on this, Mike. For now, anyway.

>

> J. Burke, D.C.

>

>

>

> J. Burke, D.C.

> Tigard, Oregon

> Sent by Medscape Mail: Free Portable E-mail for Professionals on the Move

> http://www.medscape.com

>

>

> OregonDCs rules:

> 1. Keep correspondence professional; the purpose of the listserve is to

foster communication and collegiality. No personal attacks on listserve

members will be tolerated.

> 2. Always sign your e-mails with your first and last name.

> 3. The listserve is not secure; your e-mail could end up anywhere.

However, it is against the rules of the listserve to copy, print, forward,

or otherwise distribute correspondence written by another member without his

or her consent, unless all personal identifiers have been removed.

>

[Guest guest]

Dr. Burke,

Thanks for your insight from the perspective of the independent or defense medical examiner (I prefer the latter term because I believe that an insurer mandated examination is improper labeled "independendent"). I am exceedingly proud that Oregon chiropractors have a forum where such views and topics can be discussed in a collegial manner.

I have a simple rule by which I judge DME reports; if the conclusions are representative of what the patient presents with and explains the patient's complaints then it is more likely to be reasonable. On the other hand, the report that states that the patient has 8 out of 10 pain and multiple objective findings but dismisses them all by claiming that they can't be real because the injury should have resolved by a few weeks or month following a trauma lets me know that I am dealing with a dishonest opportunist. If a patient presents to a DME stating that they are not receiving any benefit from treatment and they are not sure why they are still getting adjustments then it is perfectly reasonable to recommend that treatment be stopped. If the patient states that treatment is the only thing that allows them to keep working yet the DME recommends cessation of all treatment because such injuries shouldn't last more than 12 weeks then I think the DME should undergo the same scrutiny as any other doctor who commits an act of intentional negligence.

Freeman Re: Re: Actual fees in the SAIF system pre 1197 Mike - Don't get me started. Ok. You went and did it. An IME is - or should be - exactly what it says it is: an independent medical examination (includes chiropractors, too). Independent means that the examining doc is not otherwise involved with the patient's care. A "consulting exam" or "second opinion" examination is not an IME, although when a patient is referred by the treating doc to another for such an exam, one would hope the consulting examiner will also offer a fair an objective opinion, not one that automatically concurs with the treating doctor or is intended to bolster the treating doc's opinions and treatment plan. Whether or not such an IME is truly independent is debatable. Many chiropractors seem to believe that all IMEs are biased toward the party paying the freight. The term "IME doctor" seems to imply this. According to this point of view, if one is an IME doctor, one is therefore an insurance whore. Some even call IMEs "DMEs," meaning that they are intended to support the defense's position. I will not speak for all chiropractors who do IMEs, but having done a few IMEs myself I understand how one gets that sort of reputation, deserved or not. A plaintiff's attorney once said he'd never seen an IME report from me that did not go against his client. He obviously based his statement on the relatively few IMEs I'd done that involved his clients. I could have just as accurately said that I'd never seen a client of his who had a legitimate claim. The fact is we would have both been describing the elephant from the perspective of ants. IMEs are driven by docs who treat patients for injuries which -- at least to the insurance people -- appear relatively minor for lengthy periods without adequate documentation (i.e., legible records that reflect the doctor's clinical reasoning), who appear to attempt to drive up the cost of a claim by exaggerating the severity and extent of the patient's injuries, whose treatment does not change over time and in response to the changing needs of the injured patient, and who do not attempt to transfer responsibility to the patient by substituting active for passive care within a reasonable time frame. If, as I often hear, IME doctors are insurance whores, then there are some in the profession who appear to be insurance rapists. My purpose here is to give some degree of perspective to this issue, not to be inflammatory. I don't know what percentage of the profession falls into the category of overutilization or excessive treatment. Is it the proverbial "few" or more than that? Again, from the vantage point of an ant, how could any of us know? There are plenty of folks I've examined in an IME who have had legitimate injuries and have required further care, and I've never hesitated to say so when that's the case. I'm sure I'm not the only chiropractor who has come to such an opinion in an IME. It's time to hear from some D.C.s who have had their patients go to an IME who have come back with a report favorable to the patient. So much for my input on this, Mike. For now, anyway.J. Burke, D.C.J. Burke, D.C.Tigard, OregonSent by Medscape Mail: Free Portable E-mail for Professionals on the Move http://www.medscape.com OregonDCs rules:1. Keep correspondence professional; the purpose of the listserve is to foster communication and collegiality. No personal attacks on listserve members will be tolerated.2. Always sign your e-mails with your first and last name.3. The listserve is not secure; your e-mail could end up anywhere. However, it is against the rules of the listserve to copy, print, forward, or otherwise distribute correspondence written by another member without his or her consent, unless all personal identifiers have been removed.

[Guest guest]

Dear colleagues:

What has always been needed is the application of a measuring stick that we all agree to use to determine reasonable and necessary frequency and duration of chiropractic treatment.

Outcomes management can do this for us, combining patient driven outcomes assessment tools such as the pain drawing, VAS, and numerical pain rating box as measures of our patient current level of pain. Combined also with quantitative measures of their current level of activity intolerance or disabilities tools such as the Revised Oswestry, Rolland-, Neck Disability Index.

These patient driven outcomes assessment tools are then combined with provider driven outcomes assessment, motion palpation, static palpation, functional radiology, ROM etc. Lastly physical performance measurements.

These are universal tools in the health industry and as such all the stakeholders can use them to determine a progression of care, when the patient is at maximal chiropractic/medical improvement and evidence of impairment etc., etc.

Even a lay claims rep., looking at the patient driven outcomes assessment tools and a scan of the objective doctor driven exam findings could get a sense of where the patient is at.

This is what the CAO is suggesting with it's first draft of the "Excessive Treatment" Admin. Rule, outcomes management can provide that measuring stick that can be the referent for over and under treatment.

Vern Saboe

Re: Re: Actual fees in the SAIF system pre 1197 Mike - Don't get me started. Ok. You went and did it. An IME is - or should be - exactly what it says it is: an independent medical examination (includes chiropractors, too). Independent means that the examining doc is not otherwise involved with the patient's care. A "consulting exam" or "second opinion" examination is not an IME, although when a patient is referred by the treating doc to another for such an exam, one would hope the consulting examiner will also offer a fair an objective opinion, not one that automatically concurs with the treating doctor or is intended to bolster the treating doc's opinions and treatment plan. Whether or not such an IME is truly independent is debatable. Many chiropractors seem to believe that all IMEs are biased toward the party paying the freight. The term "IME doctor" seems to imply this. According to this point of view, if one is an IME doctor, one is therefore an insurance whore. Some even call IMEs "DMEs," meaning that they are intended to support the defense's position. I will not speak for all chiropractors who do IMEs, but having done a few IMEs myself I understand how one gets that sort of reputation, deserved or not. A plaintiff's attorney once said he'd never seen an IME report from me that did not go against his client. He obviously based his statement on the relatively few IMEs I'd done that involved his clients. I could have just as accurately said that I'd never seen a client of his who had a legitimate claim. The fact is we would have both been describing the elephant from the perspective of ants. IMEs are driven by docs who treat patients for injuries which -- at least to the insurance people -- appear relatively minor for lengthy periods without adequate documentation (i.e., legible records that reflect the doctor's clinical reasoning), who appear to attempt to drive up the cost of a claim by exaggerating the severity and extent of the patient's injuries, whose treatment does not change over time and in response to the changing needs of the injured patient, and who do not attempt to transfer responsibility to the patient by substituting active for passive care within a reasonable time frame. If, as I often hear, IME doctors are insurance whores, then there are some in the profession who appear to be insurance rapists. My purpose here is to give some degree of perspective to this issue, not to be inflammatory. I don't know what percentage of the profession falls into the category of overutilization or excessive treatment. Is it the proverbial "few" or more than that? Again, from the vantage point of an ant, how could any of us know? There are plenty of folks I've examined in an IME who have had legitimate injuries and have required further care, and I've never hesitated to say so when that's the case. I'm sure I'm not the only chiropractor who has come to such an opinion in an IME. It's time to hear from some D.C.s who have had their patients go to an IME who have come back with a report favorable to the patient. So much for my input on this, Mike. For now, anyway.J. Burke, D.C.J. Burke, D.C.Tigard, OregonSent by Medscape Mail: Free Portable E-mail for Professionals on the Move http://www.medscape.com OregonDCs rules:1. Keep correspondence professional; the purpose of the listserve is to foster communication and collegiality. No personal attacks on listserve members will be tolerated.2. Always sign your e-mails with your first and last name.3. The listserve is not secure; your e-mail could end up anywhere. However, it is against the rules of the listserve to copy, print, forward, or otherwise distribute correspondence written by another member without his or her consent, unless all personal identifiers have been removed.

[Guest guest]

Listmates,

This situation is naturally not confined to Oregon. A few basic thoughts that may assist your patients, when there is a complex, lengthy or contested course of care and you are the attending:

Send the patient for a second opinion to an experienced DC (or DO/MD if that is available), who can write a report, and can testify on the patient’s behalf should that become necessary. When a clearly biased DME is performed, be sure you obtain a copy of the report, and go through it for inconsistencies in the history, the reported symptoms, the exam findings, the diagnostic conclusion, and the treatment recommendations. I have prepared these items in tabular form as response reports to insurers, with copies, of course to the legal representatives.

If it looks like there is going to be a mediation/arbitration/trial, be sure the plaintiff’s lawyer has a pre-conference with you (not just before testimony), and is familiar with the case and how to use you. This avoids unpleasant surprises and gaps in legal knowledge, as in “ It was just a soft tissue injury, and the defense expert said [inset global negative commentary or meaningless dazzle BS].”

This reader group seems pretty sophisticated, and you are all probably pretty familiar with this. There is a separate set of items pertaining to Colossus, perhaps that subject would bear some posting.

--

Roy Steinberg DC DABCO

Steinberg Consulting Services Inc.

14136 NE 32nd Place

Bellevue WA 98007

425-883-8783: voice

425-556-0616: fax

Dr. Burke,

Thanks for your insight from the perspective of the independent or defense medical examiner (I prefer the latter term because I believe that an insurer mandated examination is improper labeled " independendent " ). I am exceedingly proud that Oregon chiropractors have a forum where such views and topics can be discussed in a collegial manner.

I have a simple rule by which I judge DME reports; if the conclusions are representative of what the patient presents with and explains the patient's complaints then it is more likely to be reasonable. On the other hand, the report that states that the patient has 8 out of 10 pain and multiple objective findings but dismisses them all by claiming that they can't be real because the injury should have resolved by a few weeks or month following a trauma lets me know that I am dealing with a dishonest opportunist. If a patient presents to a DME stating that they are not receiving any benefit from treatment and they are not sure why they are still getting adjustments then it is perfectly reasonable to recommend that treatment be stopped. If the patient states that treatment is the only thing that allows them to keep working yet the DME recommends cessation of all treatment because such injuries shouldn't last more than 12 weeks then I think the DME should undergo the same scrutiny as any other doctor who commits an act of intentional negligence.

Freeman

Re: Re: Actual fees in the SAIF system pre 1197

Mike - Don't get me started. Ok. You went and did it. An IME is - or should be - exactly

what it says it is: an independent medical examination (includes chiropractors, too).

Independent means that the examining doc is not otherwise involved with the patient's

care. A " consulting exam " or " second opinion " examination is not an IME, although when a

patient is referred by the treating doc to another for such an exam, one would hope the

consulting examiner will also offer a fair an objective opinion, not one that

automatically concurs with the treating doctor or is intended to bolster the treating doc's

opinions and treatment plan.

Whether or not such an IME is truly independent is debatable. Many chiropractors seem to

believe that all IMEs are biased toward the party paying the freight. The term " IME doctor "

seems to imply this. According to this point of view, if one is an IME doctor, one is

therefore an insurance whore. Some even call IMEs " DMEs, " meaning that they are intended

to support the defense's position. I will not speak for all chiropractors who do IMEs, but

having done a few IMEs myself I understand how one gets that sort of reputation, deserved

or not. A plaintiff's attorney once said he'd never seen an IME report from me that did not

go against his client. He obviously based his statement on the relatively few IMEs I'd done

that involved his clients. I could have just as accurately said that I'd never seen a client of

his who had a legitimate claim. The fact is we would have both been describing the

elephant from the perspective of ants.

IMEs are driven by docs who treat patients for injuries which -- at least to the insurance

people -- appear relatively minor for lengthy periods without adequate documentation

(i.e., legible records that reflect the doctor's clinical reasoning), who appear to attempt to

drive up the cost of a claim by exaggerating the severity and extent of the patient's

injuries, whose treatment does not change over time and in response to the changing

needs of the injured patient, and who do not attempt to transfer responsibility to the

patient by substituting active for passive care within a reasonable time frame. If, as I often

hear, IME doctors are insurance whores, then there are some in the profession who appear

to be insurance rapists.

My purpose here is to give some degree of perspective to this issue, not to be

inflammatory. I don't know what percentage of the profession falls into the category of

overutilization or excessive treatment. Is it the proverbial " few " or more than that? Again,

from the vantage point of an ant, how could any of us know?

There are plenty of folks I've examined in an IME who have had legitimate injuries and

have required further care, and I've never hesitated to say so when that's the case. I'm sure

I'm not the only chiropractor who has come to such an opinion in an IME. It's time to hear

from some D.C.s who have had their patients go to an IME who have come back with a

report favorable to the patient.

So much for my input on this, Mike. For now, anyway.

J. Burke, D.C.

J. Burke, D.C.

Tigard, Oregon

Sent by Medscape Mail: Free Portable E-mail for Professionals on the Move

http://www.medscape.com

OregonDCs rules:

1. Keep correspondence professional; the purpose of the listserve is to foster communication and collegiality. No personal attacks on listserve members will be tolerated.

2. Always sign your e-mails with your first and last name.

3. The listserve is not secure; your e-mail could end up anywhere. However, it is against the rules of the listserve to copy, print, forward, or otherwise distribute correspondence written by another member without his or her consent, unless all personal identifiers have been removed.

[Guest guest]

I'm back from a few days out of town, so this may not be timely.....

one of the last WC cases I did these long years ago, I had treated all of 2 or 3 TIMES!!! when I was informed and IME had been scheduled!!!

I called the carrier and told them the patient had already been released recovered, but if they wanted to throw their money around that was up to them......the case manager said something about 'long term care' and I pointed out the chart notes accompanying the intake forms, etc....and they couldn't believe how organized and useful that had been...."in THIS case"....still they were hostile and rude in spite of everything going by the book.....

J. Pedersen DC

[Guest guest]

Charlie,

Thanks. Yeah good idea. I thought of your post last night as I watched the news. Many others are reviewing Goldschmidt's notes. I have absolutely no time with board activity and running my business to say nothing of trying to have a life! But...what do you think of calling willamette week reporters and giving them some history of our profession and turn them loose on it? I am not a fan of that newspaper because they promote sexual ads that I find distateful. But, maybe using them for research will work for us? I don't have all the facts about things leading up to the 1990 loss of WC for our profession. Someone on the listserv will if this is an appropriate course of action. What do others think? Opinions please.

Minga Guerrero DC

a message dated 6/8/2004 9:26:08 AM Pacific Daylight Time, caughlindrc@... writes:

Sorry thoght my signature was attached. Just started with a new IP adn

still working out the bugs

Charlie Caughlin DC

>In a message dated 6/7/2004 11:10:10 AM Pacific Standard Time,

>caughlindrc@... writes:

>Now that Goldschmidts private records are now public I wonder if it

>might behove us to paruse them to try and esatblish in writing what WE

>all know about the plot and false accuastions about DC's btw

>Neil-Stan-Ted and the rest of the gang

>Name please.

>thanks.

>Minga Guerrero

[Guest guest]

Wasn't it just last summer (or the summer before) when the ette Weekly did a negative piece on Chiropractic? Your idea about publicity is good but that rag might backfire in our face. Sunny

Sunny Kierstyn, RN DCFibromyalgia Care Center of Oregon59 Santa Clara St.,Eugene, Oregon, 97404541-689-0935

Re: Actual fees in the SAIF system pre 1197

Charlie,Thanks. Yeah good idea. I thought of your post last night as I watched the news. Many others are reviewing Goldschmidt's notes. I have absolutely no time with board activity and running my business to say nothing of trying to have a life! But...what do you think of calling willamette week reporters and giving them some history of our profession and turn them loose on it? I am not a fan of that newspaper because they promote sexual ads that I find distateful. But, maybe using them for research will work for us? I don't have all the facts about things leading up to the 1990 loss of WC for our profession. Someone on the listserv will if this is an appropriate course of action. What do others think? Opinions please.Minga Guerrero DCa message dated 6/8/2004 9:26:08 AM Pacific Daylight Time, caughlindrc@... writes:

Sorry thoght my signature was attached. Just started with a new IP adnstill working out the bugsCharlie Caughlin DC>In a message dated 6/7/2004 11:10:10 AM Pacific Standard Time,>caughlindrc@... writes:>Now that Goldschmidts private records are now public I wonder if it>might behove us to paruse them to try and esatblish in writing what WE>all know about the plot and false accuastions about DC's btw>Neil-Stan-Ted and the rest of the gang>Name please.>thanks.>Minga GuerreroOregonDCs rules:1. Keep correspondence professional; the purpose of the listserve is to foster communication and collegiality. No personal attacks on listserve members will be tolerated.2. Always sign your e-mails with your first and last name.3. The listserve is not secure; your e-mail could end up anywhere. However, it is against the rules of the listserve to copy, print, forward, or otherwise distribute correspondence written by another member without his or her consent, unless all personal identifiers have been removed.

[Guest guest]

The Portland Tribune might be better.

s.fuchs dc

-----Original Message-----From: Sunny Kierstyn [mailto:skrndc1@...]Sent: Tuesday, June 08, 2004 2:19 PM ; AboWoman@...Subject: Re: Actual fees in the SAIF system pre 1197

Wasn't it just last summer (or the summer before) when the ette Weekly did a negative piece on Chiropractic? Your idea about publicity is good but that rag might backfire in our face. Sunny

Sunny Kierstyn, RN DCFibromyalgia Care Center of Oregon59 Santa Clara St.,Eugene, Oregon, 97404541-689-0935

Re: Actual fees in the SAIF system pre 1197

Charlie,Thanks. Yeah good idea. I thought of your post last night as I watched the news. Many others are reviewing Goldschmidt's notes. I have absolutely no time with board activity and running my business to say nothing of trying to have a life! But...what do you think of calling willamette week reporters and giving them some history of our profession and turn them loose on it? I am not a fan of that newspaper because they promote sexual ads that I find distateful. But, maybe using them for research will work for us? I don't have all the facts about things leading up to the 1990 loss of WC for our profession. Someone on the listserv will if this is an appropriate course of action. What do others think? Opinions please.Minga Guerrero DCa message dated 6/8/2004 9:26:08 AM Pacific Daylight Time, caughlindrc@... writes:

Sorry thoght my signature was attached. Just started with a new IP adnstill working out the bugsCharlie Caughlin DC>In a message dated 6/7/2004 11:10:10 AM Pacific Standard Time,>caughlindrc@... writes:>Now that Goldschmidts private records are now public I wonder if it>might behove us to paruse them to try and esatblish in writing what WE>all know about the plot and false accuastions about DC's btw>Neil-Stan-Ted and the rest of the gang>Name please.>thanks.>Minga GuerreroOregonDCs rules:1. Keep correspondence professional; the purpose of the listserve is to foster communication and collegiality. No personal attacks on listserve members will be tolerated.2. Always sign your e-mails with your first and last name.3. The listserve is not secure; your e-mail could end up anywhere. However, it is against the rules of the listserve to copy, print, forward, or otherwise distribute correspondence written by another member without his or her consent, unless all personal identifiers have been removed. OregonDCs rules:1. Keep correspondence professional; the purpose of the listserve is to foster communication and collegiality. No personal attacks on listserve members will be tolerated.2. Always sign your e-mails with your first and last name.3. The listserve is not secure; your e-mail could end up anywhere. However, it is against the rules of the listserve to copy, print, forward, or otherwise distribute correspondence written by another member without his or her consent, unless all personal identifiers have been removed.

[Guest guest]

Dr. Ray,

You invited my opinion, so I’m responding to your post of June 7. Sorry to take

so long

getting back to you. Before I knew it there were nearly 250 posts in my e-mail

box which

took some time to sort through. This listserve is a good forum, but it can be a

bit

overwhelming sometimes.

Were you suggesting that I put the statement “I could be wrong” at the end of

IME reports?

I presume you were joking, but the comment is nonetheless inappropriate for the

listserve.

It’s one thing to end an e-mail message with this statement, but would you

conclude your

own narrative reports this way? How about a SOAP note? Maybe put it in the

Assessment:

“Cervical sprain/strain and intersegmental dysfunction, but I could be wrong.”

The truth is, any healthcare provider can be wrong; every one of our clinical

impressions

and treatment decisions is subject to outside review, as it should be. When a

patient is not

responding to a given treatment we change it or refer the patient. That’s an

admission of

error in a way, one that is not only acceptable but desired: “Based on my

clinical

judgement, I thought this would be the best treatment for you, but in your case

I was

wrong.” There is also review by our peers which can occur in various formats:

medical

record review, 2nd opinion, IME, or board-sanctioned peer review, to name a few.

Then

there’s malpractice, in which case your chiropractic expert and theirs will duke

it out in

court. None of us practices in a vacuum (that would suck); the privilege of

having a license

means that we all are looking over each other’s shoulder. This notion is still

relatively new

to chiropractors, but medical physicians, most of whom have hospital privileges,

are more

accustomed to this concept of peer review.

Since you appear to take particular exception to my IME reports (I’m not

speaking for the

other doctors you named), I’ll briefly address that issue. I’m quite willing to

reconsider my

opinion in any particular case if I’m presented with credible evidence contrary

to my

position, but rarely have I seen a rebuttal that does not either attack me

personally (the

killing-the-messenger approach, he gave you the opinion you paid him for, etc.)

or offer

specious reasoning to justify the treatment, or both. If you have a problem with

any

particular chiropractor about IMEs, then take it up with that doctor or with the

insurer, an

attorney, or the OBCE. The Oregon DC listserve is not the place for it, in my

opinion, but I

could be wrong.

To quote another recent post, “Always take the high road in any debate. Do not

take what

an insurance examiner says as a personal insult, but rather, use their our

arrogance

against them. You can throw their BS right back in their face, but it must be

done with

grace and with at least an air of seeming respect for the dumbkoff that said all

those nasty

things about you in the first place.”

I’ve been in practice for a long time, as have you, and I’m not shy about

standing up for

my professional opinions. If you still have a problem with this, then do what

anyone worth

his or her salt would do: let’s go to lunch and talk it out. Seriously. My

office number is

503-245-7181. Call me. I’m buying.

J. Burke, D.C.

J. Burke, D.C.

Tigard, Oregon

Sent by Medscape Mail: Free Portable E-mail for Professionals on the Move

http://www.medscape.com

[Guest guest]

Thank you Dr. Burke for reminding all of us that collegiality is an important part of what we do as chiropractors. Personal attacks have no place on this listserve or in the way we critique the professional work of others.

D Freeman Mailing address: 1165 Union Street NE, Suite 300Salem, Oregon 97301ph 503 586-0127 fax 503 763-3581cell 503 871-0715 drmfreeman@...

-----Original Message-----From: J. Burke, D.C. [mailto:jmburkedc@...]Sent: Wednesday, June 23, 2004 10:59 AMmottray@...Cc: Subject: Re: Re: Actual fees in the SAIF system pre 1197Dr. Ray,You invited my opinion, so I'm responding to your post of June 7. Sorry to take so long getting back to you. Before I knew it there were nearly 250 posts in my e-mail box which took some time to sort through. This listserve is a good forum, but it can be a bit overwhelming sometimes.Were you suggesting that I put the statement "I could be wrong" at the end of IME reports? I presume you were joking, but the comment is nonetheless inappropriate for the listserve. It's one thing to end an e-mail message with this statement, but would you conclude your own narrative reports this way? How about a SOAP note? Maybe put it in the Assessment: "Cervical sprain/strain and intersegmental dysfunction, but I could be wrong."The truth is, any healthcare provider can be wrong; every one of our clinical impressions and treatment decisions is subject to outside review, as it should be. When a patient is not responding to a given treatment we change it or refer the patient. That's an admission of error in a way, one that is not only acceptable but desired: "Based on my clinical judgement, I thought this would be the best treatment for you, but in your case I was wrong." There is also review by our peers which can occur in various formats: medical record review, 2nd opinion, IME, or board-sanctioned peer review, to name a few. Then there's malpractice, in which case your chiropractic expert and theirs will duke it out in court. None of us practices in a vacuum (that would suck); the privilege of having a license means that we all are looking over each other's shoulder. This notion is still relatively new to chiropractors, but medical physicians, most of whom have hospital privileges, are more accustomed to this concept of peer review.Since you appear to take particular exception to my IME reports (I'm not speaking for the other doctors you named), I'll briefly address that issue. I'm quite willing to reconsider my opinion in any particular case if I'm presented with credible evidence contrary to my position, but rarely have I seen a rebuttal that does not either attack me personally (the killing-the-messenger approach, he gave you the opinion you paid him for, etc.) or offer specious reasoning to justify the treatment, or both. If you have a problem with any particular chiropractor about IMEs, then take it up with that doctor or with the insurer, an attorney, or the OBCE. The Oregon DC listserve is not the place for it, in my opinion, but I could be wrong.To quote another recent post, "Always take the high road in any debate. Do not take what an insurance examiner says as a personal insult, but rather, use their our arrogance against them. You can throw their BS right back in their face, but it must be done with grace and with at least an air of seeming respect for the dumbkoff that said all those nasty things about you in the first place."I've been in practice for a long time, as have you, and I'm not shy about standing up for my professional opinions. If you still have a problem with this, then do what anyone worth his or her salt would do: let's go to lunch and talk it out. Seriously. My office number is 503-245-7181. Call me. I'm buying.J. Burke, D.C.J. Burke, D.C.Tigard, OregonSent by Medscape Mail: Free Portable E-mail for Professionals on the Move http://www.medscape.com OregonDCs rules:1. Keep correspondence professional; the purpose of the listserve is to foster communication and collegiality. No personal attacks on listserve members will be tolerated.2. Always sign your e-mails with your first and last name.3. The listserve is not secure; your e-mail could end up anywhere. However, it is against the rules of the listserve to copy, print, forward, or otherwise distribute correspondence written by another member without his or her consent, unless all personal identifiers have been removed.

[Guest guest]

I must respond to what appears to be a misinterpretation of my comments at the

end of one of my posts that I made regarding IME's.

It seems some of us have forgotten that we can take ourselves too seriously. I

wrote personally to Dr. Burke, and I do not intend to share that post with the

entire listserve, other than to say that I respect Dr. Burke. At least he

actually performs an examination of the patient, and his opinions are usually

well reasoned. I don't always agree with him, but we have agreed to disagree at

times. Such is life in the world of treating the injured.

Enough said in that I was trying to make a light hearted dig at those whose

opinions more often than not lead to a discontinuation of what the treating DC

feels is " reasonable and necessary " care.

Everyone take a deep breath, relax and enjoy the rest of your evening.

Dr. Ray

Thank you Dr. Burke for reminding all of us that collegiality is an important part of what we do as chiropractors. Personal attacks have no place on this listserve or in the way we critique the professional work of others.

D Freeman Mailing address: 1165 Union Street NE, Suite 300Salem, Oregon 97301ph 503 586-0127 fax 503 763-3581cell 503 871-0715 drmfreeman@...

-----Original Message-----From: J. Burke, D.C. [mailto:jmburkedc@...]Sent: Wednesday, June 23, 2004 10:59 AMmottray@...Cc: Subject: Re: Re: Actual fees in the SAIF system pre 1197Dr. Ray,You invited my opinion, so I'm responding to your post of June 7. Sorry to take so long getting back to you. Before I knew it there were nearly 250 posts in my e-mail box which took some time to sort through. This listserve is a good forum, but it can be a bit overwhelming sometimes.Were you suggesting that I put the statement "I could be wrong" at the end of IME reports? I presume you were joking, but the comment is nonetheless inappropriate for the listserve. It's one thing to end an e-mail message with this statement, but would you conclude your own narrative reports this way? How about a SOAP note? Maybe put it in the Assessment: "Cervical sprain/strain and intersegmental dysfunction, but I could be wrong."The truth is, any healthcare provider can be wrong; every one of our clinical impressions and treatment decisions is subject to outside review, as it should be. When a patient is not responding to a given treatment we change it or refer the patient. That's an admission of error in a way, one that is not only acceptable but desired: "Based on my clinical judgement, I thought this would be the best treatment for you, but in your case I was wrong." There is also review by our peers which can occur in various formats: medical record review, 2nd opinion, IME, or board-sanctioned peer review, to name a few. Then there's malpractice, in which case your chiropractic expert and theirs will duke it out in court. None of us practices in a vacuum (that would suck); the privilege of having a license means that we all are looking over each other's shoulder. This notion is still relatively new to chiropractors, but medical physicians, most of whom have hospital privileges, are more accustomed to this concept of peer review.Since you appear to take particular exception to my IME reports (I'm not speaking for the other doctors you named), I'll briefly address that issue. I'm quite willing to reconsider my opinion in any particular case if I'm presented with credible evidence contrary to my position, but rarely have I seen a rebuttal that does not either attack me personally (the killing-the-messenger approach, he gave you the opinion you paid him for, etc.) or offer specious reasoning to justify the treatment, or both. If you have a problem with any particular chiropractor about IMEs, then take it up with that doctor or with the insurer, an attorney, or the OBCE. The Oregon DC listserve is not the place for it, in my opinion, but I could be wrong.To quote another recent post, "Always take the high road in any debate. Do not take what an insurance examiner says as a personal insult, but rather, use their our arrogance against them. You can throw their BS right back in their face, but it must be done with grace and with at least an air of seeming respect for the dumbkoff that said all those nasty things about you in the first place."I've been in practice for a long time, as have you, and I'm not shy about standing up for my professional opinions. If you still have a problem with this, then do what anyone worth his or her salt would do: let's go to lunch and talk it out. Seriously. My office number is 503-245-7181. Call me. I'm buying.J. Burke, D.C.J. Burke, D.C.Tigard, OregonSent by Medscape Mail: Free Portable E-mail for Professionals on the Move http://www.medscape.com OregonDCs rules:1. Keep correspondence professional; the purpose of the listserve is to foster communication and collegiality. No personal attacks on listserve members will be tolerated.2. Always sign your e-mails with your first and last name.3. The listserve is not secure; your e-mail could end up anywhere. However, it is against the rules of the listserve to copy, print, forward, or otherwise distribute correspondence written by another member without his or her consent, unless all personal identifiers have been removed.

OregonDCs rules:

1. Keep correspondence professional; the purpose of the listserve is to foster communication and collegiality. No personal attacks on listserve members will be tolerated.

2. Always sign your e-mails with your first and last name.

3. The listserve is not secure; your e-mail could end up anywhere. However, it is against the rules of the listserve to copy, print, forward, or otherwise distribute correspondence written by another member without his or her consent, unless all personal identifiers have been removed.

[Guest guest]

Just to clarify, my comments were general and not addressed to any problems

that I have observed on the listserve recently.

D Freeman

Mailing address: 1165 Union Street NE, Suite 300

Salem, Oregon 97301

ph 503 586-0127

fax 503 763-3581

cell 503 871-0715

drmfreeman@...

RE: Re: Actual fees in the SAIF system pre 1197

I must respond to what appears to be a misinterpretation of my comments at

the end of one of my posts that I made regarding IME's.

It seems some of us have forgotten that we can take ourselves too seriously.

I wrote personally to Dr. Burke, and I do not intend to share that post with

the entire listserve, other than to say that I respect Dr. Burke. At least

he actually performs an examination of the patient, and his opinions are

usually well reasoned. I don't always agree with him, but we have agreed to

disagree at times. Such is life in the world of treating the injured.

Enough said in that I was trying to make a light hearted dig at those whose

opinions more often than not lead to a discontinuation of what the treating

DC feels is " reasonable and necessary " care.

Everyone take a deep breath, relax and enjoy the rest of your evening.

Dr. Ray

[Guest guest]

How about everybody place their right ear lobe between their right thumb

and right index finger apply a light sqeeze and with light circular motion

and repeat several times in a low monotone

whooooooosaaaaa.....whooooosssaaaaaaa......whooooosssaaaa

> I must respond to what appears to be a misinterpretation of my comments

> at the end of one of my posts that I made regarding IME's.

>

> It seems some of us have forgotten that we can take ourselves too

> seriously. I wrote personally to Dr. Burke, and I do not intend to

> share that post with the entire listserve, other than to say that I

> respect Dr. Burke. At least he actually performs an examination of the

> patient, and his opinions are usually well reasoned. I don't always

> agree with him, but we have agreed to disagree at times. Such is life

> in the world of treating the injured.

>

> Enough said in that I was trying to make a light hearted dig at those

> whose opinions more often than not lead to a discontinuation of what the

> treating DC feels is " reasonable and necessary " care.

>

> Everyone take a deep breath, relax and enjoy the rest of your evening.

>

> Dr. Ray

>

>

>

>

>

>

>

> OregonDCs rules:

> 1. Keep correspondence professional; the purpose of the listserve is to

> foster communication and collegiality. No personal attacks on listserve

> members will be tolerated. 2. Always sign your e-mails with your first

> and last name.

> 3. The listserve is not secure; your e-mail could end up anywhere.

> However, it is against the rules of the listserve to copy, print,

> forward, or otherwise distribute correspondence written by another

> member without his or her consent, unless all personal identifiers have

> been removed.