Re: Recent trends in retroactive IME cut-offs

[Guest guest]

;

I have a

question for you. Are any of these IME reports deficient in any of the

references or specifications that are proposed in the Clinical Justification

rule? I’m just curious what your thoughts are from the standpoint

of an attorney who probably appreciates the significance and impact of these

reports more than most of us in the profession who have written IME reports.

ly, I’d be surprised if these IME reports didn’t have all the

required data that the Clinical Justification rule would require. Isn’t

the real issue with regard to unfair IME reports more a function of the

reasoning of the IME based on the attitudes and biases they bring into the

process? Maybe I’m wrong in my thinking on this, and open to being

corrected. Maybe the IME reports you opine are unfair could not have

produced an unfair result if the CJ rule were in place. What is your

opinion on this?

S.

Feinberg, D.C.

From:

[mailto: ] On Behalf Of

Sent: Wednesday, February 01, 2006

11:29 AM

Subject: Recent trends

in retroactive IME cut-offs

I've seen a lot of retroactive PIP cut-offs lately,

including several IME cut-offs based upon IME examinations conducted months

after a patient had finished treating. Not surprisingly, the most

shocking examples are Safeco claims. Suprisingly, however, it is the

identity of the IME doctors that kind of shocks me. They are none other

than Skip Throop, M.D. (evaluating a completed course of chiropractic

treatment that was deemed excessive because the treatment exceeded two times

per week for three weeks and once a week for an additional three

weeks). Dr. Throop states, " I believe the treatment was excessive in

terms of chiropractic. " I would think two treatments per week for

the first three weeks, and one treatment per week for three additional weeks

would have been normal and standard, combined with a home exercise

regimen. " Rearend damage exceeded $ 4,000, and target vehicle was

knocked at least ten feet into an intersection. Client continued to

experience improvement with care after the so-called six week cut-off and

actually experienced a near full recovery. Nowhere is that mentioned in

the report. Interestingly, an infant in the same car wreck was treated

chiropractically for several months after the same car wreck, and a different

IME doctor (Dr. Freedland, D.C., evaluating D.C. treatment) determined that the

care was reasonable and necessary. Safeco paid for all of that

care. The next is from Dr. Greg Albright, D.C. (evaluating treatment

provided by an M.D. PCP, a physical therapist, and an orthopedic

surgeon). Dr. Albright states: " As previously noted, I believe

Ms. ____ has reached a point of maximum medical improvement. " As of

today's examination, we are in excess of six months following a low to moderate

speed rear-impact motor vehicle crash. " She has undergone

conservative medical and physical therapy modalities. " In general,

one would expect simple musculoskeletal sprain/strains to significantly

improve, if not completely resolve, within a four to six week period.

" Ms. ___ is significantly past that initial window and, even assuming she

had sustained a more significant Grade III lumbosacral ligamentous sprain, one

would expect recovery within approximately six months. " Repair

estimate was $1,200 and car was knocked forward several feet.

Additionally, patient continued to experience slow but steady progress with

treatment. Nowhere is that mentioned or discussed in the report.

Both clients are Hispanics, which I find significant, although maybe no one

else does. Is the healthcare community ever going to require that

scientific opinions from scientific experts who are colleagues be based on

science??? Anyone care to comment????? Best, G. ,

Gatti et. al., Salem, Oregon.

[Guest guest]

IME STORY: A chiropractor did an IME on one of my current PIP patients, and said the patient was medically stationary, and that further chiropractic treatment would only be "palliative."

Patient has herniated disc, double crush syndrome, bilateral ulnar neuropathy, and emerging carpal tunnel syndrome. Nerve conduction/neurologist/orthopedist examinations AFTER the chiropractic IME declared the patient NOT medically stationary, recommended nerve blocks, possible disc surgery, possible ulnar nerve relocation, and possible carpal tunnel surgery! (the ortho actually used the phrase "double crush" in his report--astounding).

Despite the fact that my chart notes documented ALL OF THESE PROBLEMS (course without the M.D. behind the name), and the IME chiropractor had all my notes; the chiropractor IME made our entire profession look like incompetent idiots, willing to sell each other out for a buck, and undermined the clinical reputation of every Chiropractor out there (the insurance industry LOVES to use us against each other like this).

Needless to say, the patient IS NOT medically stationary, he now has a bad-faith legal claim filed against the insurance company, and we're still treating, using the medical documentation to justify our care!

So, who do I report this IME chiropractor to? DIF? OBCE? (:-)

M. s, D.C.

RE: Recent trends in retroactive IME cut-offs

;

I have a question for you. Are any of these IME reports deficient in any of the references or specifications that are proposed in the Clinical Justification rule? I’m just curious what your thoughts are from the standpoint of an attorney who probably appreciates the significance and impact of these reports more than most of us in the profession who have written IME reports. ly, I’d be surprised if these IME reports didn’t have all the required data that the Clinical Justification rule would require. Isn’t the real issue with regard to unfair IME reports more a function of the reasoning of the IME based on the attitudes and biases they bring into the process? Maybe I’m wrong in my thinking on this, and open to being corrected. Maybe the IME reports you opine are unfair could not have produced an unfair result if the CJ rule were in place. What is your opinion on this?

S. Feinberg, D.C.

From: [mailto: ] On Behalf Of Sent: Wednesday, February 01, 2006 11:29 AM Subject: Recent trends in retroactive IME cut-offs

I've seen a lot of retroactive PIP cut-offs lately, including several IME cut-offs based upon IME examinations conducted months after a patient had finished treating. Not surprisingly, the most shocking examples are Safeco claims. Suprisingly, however, it is the identity of the IME doctors that kind of shocks me. They are none other than Skip Throop, M.D. (evaluating a completed course of chiropractic treatment that was deemed excessive because the treatment exceeded two times per week for three weeks and once a week for an additional three weeks). Dr. Throop states, "I believe the treatment was excessive in terms of chiropractic. "I would think two treatments per week for the first three weeks, and one treatment per week for three additional weeks would have been normal and standard, combined with a home exercise regimen." Rearend damage exceeded $ 4,000, and target vehicle was knocked at least ten feet into an intersection. Client continued to experience improvement with care after the so-called six week cut-off and actually experienced a near full recovery. Nowhere is that mentioned in the report. Interestingly, an infant in the same car wreck was treated chiropractically for several months after the same car wreck, and a different IME doctor (Dr. Freedland, D.C., evaluating D.C. treatment) determined that the care was reasonable and necessary. Safeco paid for all of that care. The next is from Dr. Greg Albright, D.C. (evaluating treatment provided by an M.D. PCP, a physical therapist, and an orthopedic surgeon). Dr. Albright states: "As previously noted, I believe Ms. ____ has reached a point of maximum medical improvement. "As of today's examination, we are in excess of six months following a low to moderate speed rear-impact motor vehicle crash. "She has undergone conservative medical and physical therapy modalities. "In general, one would expect simple musculoskeletal sprain/strains to significantly improve, if not completely resolve, within a four to six week period. "Ms. ___ is significantly past that initial window and, even assuming she had sustained a more significant Grade III lumbosacral ligamentous sprain, one would expect recovery within approximately six months." Repair estimate was $1,200 and car was knocked forward several feet. Additionally, patient continued to experience slow but steady progress with treatment. Nowhere is that mentioned or discussed in the report. Both clients are Hispanics, which I find significant, although maybe no one else does. Is the healthcare community ever going to require that scientific opinions from scientific experts who are colleagues be based on science??? Anyone care to comment????? Best, G. , Gatti et. al., Salem, Oregon.

[Guest guest]

Any chiropractic treatment would only be reasonable if it were for 2 visits per week for three weeks, perhaps followed by at most one treatment per week for an additional three weeks. That is the "opinion" of the IME doctor that is made under the authority of his standing as a licensed doctor of science. I guess I don't see how the proposed clinical justification rule, if adopted, would change or prevent the result. Mike

From: [mailto: ] On Behalf Of s, D.C.Sent: Thursday, February 02, 2006 12:00 PM Subject: Re: Recent trends in retroactive IME cut-offs

IME STORY: A chiropractor did an IME on one of my current PIP patients, and said the patient was medically stationary, and that further chiropractic treatment would only be "palliative."

Patient has herniated disc, double crush syndrome, bilateral ulnar neuropathy, and emerging carpal tunnel syndrome. Nerve conduction/neurologist/orthopedist examinations AFTER the chiropractic IME declared the patient NOT medically stationary, recommended nerve blocks, possible disc surgery, possible ulnar nerve relocation, and possible carpal tunnel surgery! (the ortho actually used the phrase "double crush" in his report--astounding).

Despite the fact that my chart notes documented ALL OF THESE PROBLEMS (course without the M.D. behind the name), and the IME chiropractor had all my notes; the chiropractor IME made our entire profession look like incompetent idiots, willing to sell each other out for a buck, and undermined the clinical reputation of every Chiropractor out there (the insurance industry LOVES to use us against each other like this).

Needless to say, the patient IS NOT medically stationary, he now has a bad-faith legal claim filed against the insurance company, and we're still treating, using the medical documentation to justify our care!

So, who do I report this IME chiropractor to? DIF? OBCE? (:-)

M. s, D.C.

RE: Recent trends in retroactive IME cut-offs

;

I have a question for you. Are any of these IME reports deficient in any of the references or specifications that are proposed in the Clinical Justification rule? I’m just curious what your thoughts are from the standpoint of an attorney who probably appreciates the significance and impact of these reports more than most of us in the profession who have written IME reports. ly, I’d be surprised if these IME reports didn’t have all the required data that the Clinical Justification rule would require. Isn’t the real issue with regard to unfair IME reports more a function of the reasoning of the IME based on the attitudes and biases they bring into the process? Maybe I’m wrong in my thinking on this, and open to being corrected. Maybe the IME reports you opine are unfair could not have produced an unfair result if the CJ rule were in place. What is your opinion on this?

S. Feinberg, D.C.

From: [mailto: ] On Behalf Of Sent: Wednesday, February 01, 2006 11:29 AM Subject: Recent trends in retroactive IME cut-offs

I've seen a lot of retroactive PIP cut-offs lately, including several IME cut-offs based upon IME examinations conducted months after a patient had finished treating. Not surprisingly, the most shocking examples are Safeco claims. Suprisingly, however, it is the identity of the IME doctors that kind of shocks me. They are none other than Skip Throop, M.D. (evaluating a completed course of chiropractic treatment that was deemed excessive because the treatment exceeded two times per week for three weeks and once a week for an additional three weeks). Dr. Throop states, "I believe the treatment was excessive in terms of chiropractic. "I would think two treatments per week for the first three weeks, and one treatment per week for three additional weeks would have been normal and standard, combined with a home exercise regimen." Rearend damage exceeded $ 4,000, and target vehicle was knocked at least ten feet into an intersection. Client continued to experience improvement with care after the so-called six week cut-off and actually experienced a near full recovery. Nowhere is that mentioned in the report. Interestingly, an infant in the same car wreck was treated chiropractically for several months after the same car wreck, and a different IME doctor (Dr. Freedland, D.C., evaluating D.C. treatment) determined that the care was reasonable and necessary. Safeco paid for all of that care. The next is from Dr. Greg Albright, D.C. (evaluating treatment provided by an M.D. PCP, a physical therapist, and an orthopedic surgeon). Dr. Albright states: "As previously noted, I believe Ms. ____ has reached a point of maximum medical improvement. "As of today's examination, we are in excess of six months following a low to moderate speed rear-impact motor vehicle crash. "She has undergone conservative medical and physical therapy modalities. "In general, one would expect simple musculoskeletal sprain/strains to significantly improve, if not completely resolve, within a four to six week period. "Ms. ___ is significantly past that initial window and, even assuming she had sustained a more significant Grade III lumbosacral ligamentous sprain, one would expect recovery within approximately six months." Repair estimate was $1,200 and car was knocked forward several feet. Additionally, patient continued to experience slow but steady progress with treatment. Nowhere is that mentioned or discussed in the report. Both clients are Hispanics, which I find significant, although maybe no one else does. Is the healthcare community ever going to require that scientific opinions from scientific experts who are colleagues be based on science??? Anyone care to comment????? Best, G. , Gatti et. al., Salem, Oregon.

[Guest guest]

Anyone out there getting the opinion that care should reasonable for an additional 3 weeks at 2x per week and 3 weeks at 1 time per week as has intimated? This was strangely familiar to me and I would appreciate anyone who was also familiar with this scenario to contact me off list.

Thanks

Danno

RE: Recent trends in retroactive IME cut-offs

;

I have a question for you. Are any of these IME reports deficient in any of the references or specifications that are proposed in the Clinical Justification rule? I’m just curious what your thoughts are from the standpoint of an attorney who probably appreciates the significance and impact of these reports more than most of us in the profession who have written IME reports. ly, I’d be surprised if these IME reports didn’t have all the required data that the Clinical Justification rule would require. Isn’t the real issue with regard to unfair IME reports more a function of the reasoning of the IME based on the attitudes and biases they bring into the process? Maybe I’m wrong in my thinking on this, and open to being corrected. Maybe the IME reports you opine are unfair could not have produced an unfair result if the CJ rule were in place. What is your opinion on this?

S. Feinberg, D.C.

From: [mailto: ] On Behalf Of Sent: Wednesday, February 01, 2006 11:29 AM Subject: Recent trends in retroactive IME cut-offs

I've seen a lot of retroactive PIP cut-offs lately, including several IME cut-offs based upon IME examinations conducted months after a patient had finished treating. Not surprisingly, the most shocking examples are Safeco claims. Suprisingly, however, it is the identity of the IME doctors that kind of shocks me. They are none other than Skip Throop, M.D. (evaluating a completed course of chiropractic treatment that was deemed excessive because the treatment exceeded two times per week for three weeks and once a week for an additional three weeks). Dr. Throop states, "I believe the treatment was excessive in terms of chiropractic. "I would think two treatments per week for the first three weeks, and one treatment per week for three additional weeks would have been normal and standard, combined with a home exercise regimen." Rearend damage exceeded $ 4,000, and target vehicle was knocked at least ten feet into an intersection. Client continued to experience improvement with care after the so-called six week cut-off and actually experienced a near full recovery. Nowhere is that mentioned in the report. Interestingly, an infant in the same car wreck was treated chiropractically for several months after the same car wreck, and a different IME doctor (Dr. Freedland, D.C., evaluating D.C. treatment) determined that the care was reasonable and necessary. Safeco paid for all of that care. The next is from Dr. Greg Albright, D.C. (evaluating treatment provided by an M.D. PCP, a physical therapist, and an orthopedic surgeon). Dr. Albright states: "As previously noted, I believe Ms. ____ has reached a point of maximum medical improvement. "As of today's examination, we are in excess of six months following a low to moderate speed rear-impact motor vehicle crash. "She has undergone conservative medical and physical therapy modalities. "In general, one would expect simple musculoskeletal sprain/strains to significantly improve, if not completely resolve, within a four to six week period. "Ms. ___ is significantly past that initial window and, even assuming she had sustained a more significant Grade III lumbosacral ligamentous sprain, one would expect recovery within approximately six months." Repair estimate was $1,200 and car was knocked forward several feet. Additionally, patient continued to experience slow but steady progress with treatment. Nowhere is that mentioned or discussed in the report. Both clients are Hispanics, which I find significant, although maybe no one else does. Is the healthcare community ever going to require that scientific opinions from scientific experts who are colleagues be based on science??? Anyone care to comment????? Best, G. , Gatti et. al., Salem, Oregon.

No virus found in this incoming message.Checked by AVG Free Edition.Version: 7.1.375 / Virus Database: 267.15.0/248 - Release Date: 2/1/2006

[Guest guest]

Ok guys let me take a little crack at it,

In my humble opinion the current required Serial "Evidence Based Outcome Assessments" (which is part of the Clin. Justification Rule) performed minimally at four week intervals that then revealed a clear progression of care (improvement) would have tank this opinion completely and soundly and as such why many colleagues believe this rule is a very good one.

If in this trauma case the patient's Oswestry and Neck Disability self-reported scores showed a clear continued improvement and the same was shown with their self reported pain levels e.g., visual analog scales, numeric pain rating box scores, pain drawings etc. then this IME docs opinion would be invalid.

Additionally if the treating colleagues serial re-examination findings documented a continued improvement this combined with the above patient centered self reporting psychometrics would be more than enough to support the IME's opinion as being invalid....and if it is shown that this IME doc consistently does this in other cases, that is routinely disregards these mandated Outcomes, the OBCE I believe could finally act on this as unprofessional conduct and sanction that IME doctor.

Vern Saboe

RE: Recent trends in retroactive IME cut-offs

;

I have a question for you. Are any of these IME reports deficient in any of the references or specifications that are proposed in the Clinical Justification rule? I’m just curious what your thoughts are from the standpoint of an attorney who probably appreciates the significance and impact of these reports more than most of us in the profession who have written IME reports. ly, I’d be surprised if these IME reports didn’t have all the required data that the Clinical Justification rule would require. Isn’t the real issue with regard to unfair IME reports more a function of the reasoning of the IME based on the attitudes and biases they bring into the process? Maybe I’m wrong in my thinking on this, and open to being corrected. Maybe the IME reports you opine are unfair could not have produced an unfair result if the CJ rule were in place. What is your opinion on this?

S. Feinberg, D.C.

From: [mailto: ] On Behalf Of Sent: Wednesday, February 01, 2006 11:29 AM Subject: Recent trends in retroactive IME cut-offs

I've seen a lot of retroactive PIP cut-offs lately, including several IME cut-offs based upon IME examinations conducted months after a patient had finished treating. Not surprisingly, the most shocking examples are Safeco claims. Suprisingly, however, it is the identity of the IME doctors that kind of shocks me. They are none other than Skip Throop, M.D. (evaluating a completed course of chiropractic treatment that was deemed excessive because the treatment exceeded two times per week for three weeks and once a week for an additional three weeks). Dr. Throop states, "I believe the treatment was excessive in terms of chiropractic. "I would think two treatments per week for the first three weeks, and one treatment per week for three additional weeks would have been normal and standard, combined with a home exercise regimen." Rearend damage exceeded $ 4,000, and target vehicle was knocked at least ten feet into an intersection. Client continued to experience improvement with care after the so-called six week cut-off and actually experienced a near full recovery. Nowhere is that mentioned in the report. Interestingly, an infant in the same car wreck was treated chiropractically for several months after the same car wreck, and a different IME doctor (Dr. Freedland, D.C., evaluating D.C. treatment) determined that the care was reasonable and necessary. Safeco paid for all of that care. The next is from Dr. Greg Albright, D.C. (evaluating treatment provided by an M.D. PCP, a physical therapist, and an orthopedic surgeon). Dr. Albright states: "As previously noted, I believe Ms. ____ has reached a point of maximum medical improvement. "As of today's examination, we are in excess of six months following a low to moderate speed rear-impact motor vehicle crash. "She has undergone conservative medical and physical therapy modalities. "In general, one would expect simple musculoskeletal sprain/strains to significantly improve, if not completely resolve, within a four to six week period. "Ms. ___ is significantly past that initial window and, even assuming she had sustained a more significant Grade III lumbosacral ligamentous sprain, one would expect recovery within approximately six months." Repair estimate was $1,200 and car was knocked forward several feet. Additionally, patient continued to experience slow but steady progress with treatment. Nowhere is that mentioned or discussed in the report. Both clients are Hispanics, which I find significant, although maybe no one else does. Is the healthcare community ever going to require that scientific opinions from scientific experts who are colleagues be based on science??? Anyone care to comment????? Best, G. , Gatti et. al., Salem, Oregon.

[Guest guest]

And...the rest of the story!

In an effort to overturn the IME chiro opinion, the patient's attorney sent the IME chiro a letter asking if it was his "intention" to cut off Chiropractic care. He (the IME chiro) checked "no!"

In response, the insurance company (State Farm!) simply photocopied a paragraph from the first IME report, and restated it's position to deny payment of Chiropractic care (but is paying all the "medical" care). Thus, the bad faith claim filed by the patient's attorney against State Farm.

So, basically, insurance companies DON'T CARE if they have "clinical justification" to cut off care. Even if their own IME tanks...they just keep denying...

I guess in my last post I should have asked, who I report State Farm to! Oh yeah, I forgot, "they" already know THEY'RE READING THIS RIGHT NOW! (:-)

M. s, D.C.

RE: Recent trends in retroactive IME cut-offs

;

I have a question for you. Are any of these IME reports deficient in any of the references or specifications that are proposed in the Clinical Justification rule? I’m just curious what your thoughts are from the standpoint of an attorney who probably appreciates the significance and impact of these reports more than most of us in the profession who have written IME reports. ly, I’d be surprised if these IME reports didn’t have all the required data that the Clinical Justification rule would require. Isn’t the real issue with regard to unfair IME reports more a function of the reasoning of the IME based on the attitudes and biases they bring into the process? Maybe I’m wrong in my thinking on this, and open to being corrected. Maybe the IME reports you opine are unfair could not have produced an unfair result if the CJ rule were in place. What is your opinion on this?

S. Feinberg, D.C.

From: [mailto: ] On Behalf Of Sent: Wednesday, February 01, 2006 11:29 AM Subject: Recent trends in retroactive IME cut-offs

I've seen a lot of retroactive PIP cut-offs lately, including several IME cut-offs based upon IME examinations conducted months after a patient had finished treating. Not surprisingly, the most shocking examples are Safeco claims. Suprisingly, however, it is the identity of the IME doctors that kind of shocks me. They are none other than Skip Throop, M.D. (evaluating a completed course of chiropractic treatment that was deemed excessive because the treatment exceeded two times per week for three weeks and once a week for an additional three weeks). Dr. Throop states, "I believe the treatment was excessive in terms of chiropractic. "I would think two treatments per week for the first three weeks, and one treatment per week for three additional weeks would have been normal and standard, combined with a home exercise regimen." Rearend damage exceeded $ 4,000, and target vehicle was knocked at least ten feet into an intersection. Client continued to experience improvement with care after the so-called six week cut-off and actually experienced a near full recovery. Nowhere is that mentioned in the report. Interestingly, an infant in the same car wreck was treated chiropractically for several months after the same car wreck, and a different IME doctor (Dr. Freedland, D.C., evaluating D.C. treatment) determined that the care was reasonable and necessary. Safeco paid for all of that care. The next is from Dr. Greg Albright, D.C. (evaluating treatment provided by an M.D. PCP, a physical therapist, and an orthopedic surgeon). Dr. Albright states: "As previously noted, I believe Ms. ____ has reached a point of maximum medical improvement. "As of today's examination, we are in excess of six months following a low to moderate speed rear-impact motor vehicle crash. "She has undergone conservative medical and physical therapy modalities. "In general, one would expect simple musculoskeletal sprain/strains to significantly improve, if not completely resolve, within a four to six week period. "Ms. ___ is significantly past that initial window and, even assuming she had sustained a more significant Grade III lumbosacral ligamentous sprain, one would expect recovery within approximately six months." Repair estimate was $1,200 and car was knocked forward several feet. Additionally, patient continued to experience slow but steady progress with treatment. Nowhere is that mentioned or discussed in the report. Both clients are Hispanics, which I find significant, although maybe no one else does. Is the healthcare community ever going to require that scientific opinions from scientific experts who are colleagues be based on science??? Anyone care to comment????? Best, G. , Gatti et. al., Salem, Oregon.

[Guest guest]

Hi, Vern;

What I heard

you saying in previous posts about this CJ rule is that it would hold the

biased IMEs to a standard that would prevent them hurting chiropractors and

their patients. I took that to mean that the rule would directly affect

the IME in some way that was not clear to me. What I am hearing in this

post is that instead of directly affecting the IME, that the CJ rule would

instead protect the chiropractor and their patients by mandating that certain

material be part of their exam and documentation, and that by so mandating this

content that the IME would either have no choice by to give a supportive opinion.

Further, if the IME disregarded information in the treating DCs documentation

that they would be vulnerable to OBCE sanction for unprofessional

conduct.

You mention

the case in question was supported by the Owestry and Neck Disability

assessment tools. While this would be among the general references that

either the CJ or CR rule versions would support as appropriate documentation, neither

is mandated. So, it seems as if we are in the same situation with the

propose CJ rule as we are now. If you practice carefully, even

defensively, you may prevail if you and an IME come to crossed paths over care

you have provided to a particular patient. As far as the CJ rule actually

doing anything to protect the patient, I still don’t see it.

Ultimately, the IME will do as they will do and be fair or unfair. If they are

unfair, the weight of their IME report and the weight of the documentation of the

treating DC will be judged by OBCE, peer review, a court, or some other agency

of review, and that is where things will be set right.

Yes,

chiropractors should do the sort of exam and documentation that we are taught

and recommended to perform. Yes, if some conflict with an IME, insurer,

or regulatory agency happens over a particular case, good documentation is the

best protection. That has been and continues to be the case. The

idea that this supports the CJ rule over the CR rule is a false

syllogism. One is not connected to the other.

The truth

is that the CJ rule will have little impact on IMEs. They virtually always

do an examination, unless it is a paper review that would meet either CJ or CR

criteria. The damage they may do, justly or unjustly, to a case is based

on their opinion of the records of the case. That being the case, why not

just have a rule that says no paper IME reviews?

S.

Feinberg, D.C.

From:

[mailto: ] On Behalf Of Vern Saboe

Sent: Thursday, February 02, 2006

1:19 PM

Subject: Fw: Recent

trends in retroactive IME cut-offs

Recent trends

in retroactive IME cut-offs

I've seen a lot of retroactive PIP cut-offs lately,

including several IME cut-offs based upon IME examinations conducted months

after a patient had finished treating. Not surprisingly, the most

shocking examples are Safeco claims. Suprisingly, however, it is the

identity of the IME doctors that kind of shocks me. They are none other

than Skip Throop, M.D. (evaluating a completed course of chiropractic

treatment that was deemed excessive because the treatment exceeded two times

per week for three weeks and once a week for an additional three

weeks). Dr. Throop states, " I believe the treatment was excessive in

terms of chiropractic. " I would think two treatments per week for

the first three weeks, and one treatment per week for three additional weeks

would have been normal and standard, combined with a home exercise

regimen. " Rearend damage exceeded $ 4,000, and target vehicle was

knocked at least ten feet into an intersection. Client continued to

experience improvement with care after the so-called six week cut-off and

actually experienced a near full recovery. Nowhere is that mentioned in

the report. Interestingly, an infant in the same car wreck was treated

chiropractically for several months after the same car wreck, and a different

IME doctor (Dr. Freedland, D.C., evaluating D.C. treatment) determined that the

care was reasonable and necessary. Safeco paid for all of that

care. The next is from Dr. Greg Albright, D.C. (evaluating treatment

provided by an M.D. PCP, a physical therapist, and an orthopedic

surgeon). Dr. Albright states: " As previously noted, I believe

Ms. ____ has reached a point of maximum medical improvement. " As of

today's examination, we are in excess of six months following a low to moderate

speed rear-impact motor vehicle crash. " She has undergone

conservative medical and physical therapy modalities. " In general,

one would expect simple musculoskeletal sprain/strains to significantly

improve, if not completely resolve, within a four to six week period.

" Ms. ___ is significantly past that initial window and, even assuming she

had sustained a more significant Grade III lumbosacral ligamentous sprain, one

would expect recovery within approximately six months. " Repair

estimate was $1,200 and car was knocked forward several feet.

Additionally, patient continued to experience slow but steady progress with

treatment. Nowhere is that mentioned or discussed in the report.

Both clients are Hispanics, which I find significant, although maybe no one

else does. Is the healthcare community ever going to require that

scientific opinions from scientific experts who are colleagues be based on

science??? Anyone care to comment????? Best, G. ,

Gatti et. al., Salem, Oregon.

[Guest guest]

Hi, Les,

First before I respond to some of your points/comments etc. I must first point out to you and those on the list-serve that to many of us colleagues (the silent majority?) they're is a very fundamental issue that is currently hanging over the OBCE, it's recent action on the proposed "Clinical Rational Rule" of Drs. Boothby and Cafferty, and proper rule making process which is designed in hopes of gaining an acceptable level of professional consensus prior to adoption of any new Administrative Rule.

Currently that process is under attack by a small vocal minority who wish to circumvent this consensus building process in hopes of getting "their way." I nor any of the many colleagues in support of the existing "Clinical Justification Rule" believe it to be perfect and we are not against a continued dialog as it is in the profession's best interest to address and find resolution to the concerns that have been expressed about the current rule.

As an Executive Board member and it's lobbyist, I can tell you that the Chiropractic Association of Oregon is willing to be part of any reasonable discussion and effort to find a solution. But for any group large or small to attempt to circumvent a process which is in place to help insure that the greatest number of colleagues in the state are represented is fundamentally wrong.

The Chiropractic Association of Oregon's first surveyed it's membership to see if member colleagues would support the proposed "Evidence Based Outcome Assessments" language being added to the Clinical Justification Rule. The CAO Executive Board received a 99.9% consensus in favor of such a rule from it's membership. The CAO then surveyed the entire field and received an 89% consensus in favor of the rule. We then approached the OBCE who discussed and debated the rule and then voted to go into official "Rules Making." The OBCE then sent the proposed new Admin Rule language on Outcomes to the 15-20 colleague and lay member "Administrative Rules Advisory Committee." The rules advisory committee took public testimony, discussed, debated, and amended the proposed language (for the good btw) and voted the proposed "Clinical Justification Rule's" new language out of committee without a single no vote.

The rule was then sent back to the OBCE with a recommendation to adopt. More public testimony was given for and against, with the OBCE then forming a two member Sub-Committee (Migna G. & Kathleen G.) who then tweaked the proposed Outcomes language to be more in line with Admin Rule language (less jargon-type deal) and sent it back to the OBCE. There was more public testimony (e.g.,same concerns by Dr. Boothby etc.) for and against with the OBCE voting in favor of the proposed rule with Dr. Sigfried (ODOC) voting against the rule. This whole process took about one year and as I indicated this "process" is important to ensure an acceptable level of professional consensus.

The many colleagues around the state that support the current "Clinical Justification Rule" believe that an equal process must be followed to insure an acceptable level of profession consensus prior to any change or dismantling of the current CJ Rule.

Gotta go for now Les and colleagues, I'll attempt to respond to your other comments later today.

Vern Saboe

RE: Recent trends in retroactive IME cut-offs

;

I have a question for you. Are any of these IME reports deficient in any of the references or specifications that are proposed in the Clinical Justification rule? I’m just curious what your thoughts are from the standpoint of an attorney who probably appreciates the significance and impact of these reports more than most of us in the profession who have written IME reports. ly, I’d be surprised if these IME reports didn’t have all the required data that the Clinical Justification rule would require. Isn’t the real issue with regard to unfair IME reports more a function of the reasoning of the IME based on the attitudes and biases they bring into the process? Maybe I’m wrong in my thinking on this, and open to being corrected. Maybe the IME reports you opine are unfair could not have produced an unfair result if the CJ rule were in place. What is your opinion on this?

S. Feinberg, D.C.

From: [mailto: ] On Behalf Of Sent: Wednesday, February 01, 2006 11:29 AM Subject: Recent trends in retroactive IME cut-offs

I've seen a lot of retroactive PIP cut-offs lately, including several IME cut-offs based upon IME examinations conducted months after a patient had finished treating. Not surprisingly, the most shocking examples are Safeco claims. Suprisingly, however, it is the identity of the IME doctors that kind of shocks me. They are none other than Skip Throop, M.D. (evaluating a completed course of chiropractic treatment that was deemed excessive because the treatment exceeded two times per week for three weeks and once a week for an additional three weeks). Dr. Throop states, "I believe the treatment was excessive in terms of chiropractic. "I would think two treatments per week for the first three weeks, and one treatment per week for three additional weeks would have been normal and standard, combined with a home exercise regimen." Rearend damage exceeded $ 4,000, and target vehicle was knocked at least ten feet into an intersection. Client continued to experience improvement with care after the so-called six week cut-off and actually experienced a near full recovery. Nowhere is that mentioned in the report. Interestingly, an infant in the same car wreck was treated chiropractically for several months after the same car wreck, and a different IME doctor (Dr. Freedland, D.C., evaluating D.C. treatment) determined that the care was reasonable and necessary. Safeco paid for all of that care. The next is from Dr. Greg Albright, D.C. (evaluating treatment provided by an M.D. PCP, a physical therapist, and an orthopedic surgeon). Dr. Albright states: "As previously noted, I believe Ms. ____ has reached a point of maximum medical improvement. "As of today's examination, we are in excess of six months following a low to moderate speed rear-impact motor vehicle crash. "She has undergone conservative medical and physical therapy modalities. "In general, one would expect simple musculoskeletal sprain/strains to significantly improve, if not completely resolve, within a four to six week period. "Ms. ___ is significantly past that initial window and, even assuming she had sustained a more significant Grade III lumbosacral ligamentous sprain, one would expect recovery within approximately six months." Repair estimate was $1,200 and car was knocked forward several feet. Additionally, patient continued to experience slow but steady progress with treatment. Nowhere is that mentioned or discussed in the report. Both clients are Hispanics, which I find significant, although maybe no one else does. Is the healthcare community ever going to require that scientific opinions from scientific experts who are colleagues be based on science??? Anyone care to comment????? Best, G. , Gatti et. al., Salem, Oregon.

[Guest guest]

Hi Joyce,

I must agree with you Joyce as per the survey or simple the letter that was first send to the CAO membership and then ever DC in the state as not being unbiased nor scientific. The CAO's letter written by me was a heartfelt and urgent appeal to colleagues that we must be proactive and pre-emptive relative to the excessive treatment issue. I both gave the rational and urgent need to consider developing a rule that utilized "Evidence Based Outcome Assessments" as the determinate of when to end curative treatment. Again, when I say urgent I meant extremely urgent as in I believed that with the passage of House Bill 3668 during the 2003 legislative session and the simultaneous lobbying by a small out of state PPO group we as a profession were in very real danger of losing PIP to managed care, and we were.

The CAO also believed that if we were to have any chance of expanding chiropractic benefits or regaining Attending Physician status in Workers' Comp or to end up with the positive cost outcomes we hoped for in the CAO's first in the nation proposed prospective randomized cost comparison study in W/C, we had to address the problem of excessive treatment head-on prior to the start of the 2005 legislative session. We as a profession needed to be on the same page as per when to end curative care. Yes, it was an urgent message, not an un-biased message, and certainly not very scientific you are absolutely right. You asked how do we know that only one survey/letter response was sent in by each office? Because we saved the letterhead envelopes of the returned survey/letters and stapled the letter to them.

As per your other comment there was no proposed language to offer as we had not developed any language at that point we were only asking if colleagues agreed that we should pursue such a rule....and yes I was telling my colleagues that I believed the threat of losing PIP was real...(it was and still is) and that if the profession wanted any hope of regaining "Attending Physician" status in Workers' comp, or to gain the things we have always wanted for our patients and the profession (insurance equality/parity, any willing provider, mandated hospital privileges, etc.) or to counter the lingering perception at the state capitol we needed to consider developing such a rule. A rule that utilized "Evidence Based Outcome Assessments" (patient centered & doctor driven outcomes) to determine when to end curative care. As I've said prior several states are looking at doing something similar as per the "Outcomes" language.

The CAO's survey/letter flawed as it was, at least attempted to involve the greatest number of colleagues in both hopes educating doctors of the impending danger of losing PIP and of gaining an acceptable level of professional consensus to start developing such a rule, prior to the development of specific language.

The CAO then testified in front of the OBCE asking that it enter into Rule Making. The OBCE listened to public testimony, debated, discussed and then sent the proposal to the 15-18 colleague member "Administrative Rules Advisory Committee" which again listened to public testimony, discussed, debated, amended and improved on the language of the proposed "Outcomes" language. The OBCE listened to more public testimony and referred the proposal to a Sub-Committee of the OBCE which improved the language even more and returned the proposal to the OBCE which listened to more public testimony, discussed and further debated the new rule language. The Board adopted the rule with a sunset clause.

The premise for, or bases of, Drs. Boothby's and Cafferty's concerns with the recently adopted "Clinical Justification Rule" and that which they conveyed while the rule was being develop are simply not valid in our opinion.

Again, the main concerns we heard and continue to hear are that the CJ Rule would somehow effect adversely our scope of practice and/or that the procedures/treatments colleagues can use would somehow be restricted? Nonetheless we understood and respected those concerns and wrote in the Sunset Clause so that if indeed our scope of practice is somehow adversely affected or the procedures/treatments we use restricted we could then amend or eliminate the CJ rule completely. Neither of these anticipated adverse events have come to be (and they will not) not one example has been offered to date.

Yes Joyce, Will, colleagues, the CAO's letter/survey written by yours truly was not unbiased, nor very scientific but at least it alerted every DC in the state to our concerns and what we were suggesting.

Alternatively we now have Drs. Boothby & Cafferty's "Clinical Rational Rule" proposal in which there has been no such attempt at a statewide mailing which removes 90% of the existing CJ rule language. In our opinion due process is further being circumvented by the OBCE's failure to refer the "Boothby/Cafferty" proposal to the 15-18 colleague member "Administrative Rules Advisory Committee." As you must recall a OBCE member moved that the proposed rule by Boothby and Cafferty be properly referred to the "Administrative Rules Advisory Committee" for further discussion, debate etc., but the motion failed? Another Board member subsequently asked Dr. Cafferty and myself if we would be willing to enter into mediation over the CJ & CR Rule language in hopes of facilitating unity in the profession, as you recall I said yes, Dr. Cafferty's repeated response was both predictable and telling, he of course refused.

I, the CAO, and the many colleagues who work for nearly a year on the "Clinical Justification Rule's" "Evidence Based Outcome Assessments" language believe it to be an excellent rule that will once and for all be able to address the age old problems of excessive treatment and biased IME opinions that disrupt curative care. We realize that the CJ rule is not perfect which is why there is a "Sunset Clause," we ask that concerned colleagues give the thing a chance but with that said the CAO and those who support the CJ rule are not against a continued dialog. We believe that to circumvent proper Administrative Rule making process which was created in hopes of both involving the greatest number of colleagues and gaining an acceptable level of professional consensus is fundamentally wrong. At the very least the proposed rule by Drs. Boothby & Cafferty should be referred to the Administrative Rules Advisory Committee for further discussion/debate, failure to do so will not serve the profession well, it certainly will not facilitate professional unity.

Vern

RE: Recent trends in retroactive IME cut-offs

;

I have a question for you. Are any of these IME reports deficient in any of the references or specifications that are proposed in the Clinical Justification rule? I’m just curious what your thoughts are from the standpoint of an attorney who probably appreciates the significance and impact of these reports more than most of us in the profession who have written IME reports. ly, I’d be surprised if these IME reports didn’t have all the required data that the Clinical Justification rule would require. Isn’t the real issue with regard to unfair IME reports more a function of the reasoning of the IME based on the attitudes and biases they bring into the process? Maybe I’m wrong in my thinking on this, and open to being corrected. Maybe the IME reports you opine are unfair could not have produced an unfair result if the CJ rule were in place. What is your opinion on this?

S. Feinberg, D.C.

From: [mailto: ] On Behalf Of Sent: Wednesday, February 01, 2006 11:29 AM Subject: Recent trends in retroactive IME cut-offs

I've seen a lot of retroactive PIP cut-offs lately, including several IME cut-offs based upon IME examinations conducted months after a patient had finished treating. Not surprisingly, the most shocking examples are Safeco claims. Suprisingly, however, it is the identity of the IME doctors that kind of shocks me. They are none other than Skip Throop, M.D. (evaluating a completed course of chiropractic treatment that was deemed excessive because the treatment exceeded two times per week for three weeks and once a week for an additional three weeks). Dr. Throop states, "I believe the treatment was excessive in terms of chiropractic. "I would think two treatments per week for the first three weeks, and one treatment per week for three additional weeks would have been normal and standard, combined with a home exercise regimen." Rearend damage exceeded $ 4,000, and target vehicle was knocked at least ten feet into an intersection. Client continued to experience improvement with care after the so-called six week cut-off and actually experienced a near full recovery. Nowhere is that mentioned in the report. Interestingly, an infant in the same car wreck was treated chiropractically for several months after the same car wreck, and a different IME doctor (Dr. Freedland, D.C., evaluating D.C. treatment) determined that the care was reasonable and necessary. Safeco paid for all of that care. The next is from Dr. Greg Albright, D.C. (evaluating treatment provided by an M.D. PCP, a physical therapist, and an orthopedic surgeon). Dr. Albright states: "As previously noted, I believe Ms. ____ has reached a point of maximum medical improvement. "As of today's examination, we are in excess of six months following a low to moderate speed rear-impact motor vehicle crash. "She has undergone conservative medical and physical therapy modalities. "In general, one would expect simple musculoskeletal sprain/strains to significantly improve, if not completely resolve, within a four to six week period. "Ms. ___ is significantly past that initial window and, even assuming she had sustained a more significant Grade III lumbosacral ligamentous sprain, one would expect recovery within approximately six months." Repair estimate was $1,200 and car was knocked forward several feet. Additionally, patient continued to experience slow but steady progress with treatment. Nowhere is that mentioned or discussed in the report. Both clients are Hispanics, which I find significant, although maybe no one else does. Is the healthcare community ever going to require that scientific opinions from scientific experts who are colleagues be based on science??? Anyone care to comment????? Best, G. , Gatti et. al., Salem, Oregon.

[Guest guest]

Mr. , Given a system by which one has to justify ones opinion will in and of itself correct some of the problems of which you speak. I enjoyed reading your example but I really think you should have left the doctor's name off the commentary. This certainly provoked an angry retort but in fairness it must have been very upsetting for the doctor.

I had two IME's in my own cases and I was cut off of PIP 6 months prior to the IME ! If not for having my own health insurance and the ability to pay out of pocket I would have been totally squeezed out of the system with final insurance commentary.....'see she must have been cured, stabilized or at MMI because she didn't see any doctors after we cut her off'. I ,for one ,have motivation to see fairnees brought back into the IME issues.

sharron fuchs dc

From: [mailto: ] On Behalf Of Sent: Thursday, February 02, 2006 12:06 PM s, D.C.; Subject: RE: Recent trends in retroactive IME cut-offs

Any chiropractic treatment would only be reasonable if it were for 2 visits per week for three weeks, perhaps followed by at most one treatment per week for an additional three weeks. That is the "opinion" of the IME doctor that is made under the authority of his standing as a licensed doctor of science. I guess I don't see how the proposed clinical justification rule, if adopted, would change or prevent the result. Mike

From: [mailto: ] On Behalf Of s, D.C.Sent: Thursday, February 02, 2006 12:00 PM Subject: Re: Recent trends in retroactive IME cut-offs

IME STORY: A chiropractor did an IME on one of my current PIP patients, and said the patient was medically stationary, and that further chiropractic treatment would only be "palliative."

Patient has herniated disc, double crush syndrome, bilateral ulnar neuropathy, and emerging carpal tunnel syndrome. Nerve conduction/neurologist/orthopedist examinations AFTER the chiropractic IME declared the patient NOT medically stationary, recommended nerve blocks, possible disc surgery, possible ulnar nerve relocation, and possible carpal tunnel surgery! (the ortho actually used the phrase "double crush" in his report--astounding).

Despite the fact that my chart notes documented ALL OF THESE PROBLEMS (course without the M.D. behind the name), and the IME chiropractor had all my notes; the chiropractor IME made our entire profession look like incompetent idiots, willing to sell each other out for a buck, and undermined the clinical reputation of every Chiropractor out there (the insurance industry LOVES to use us against each other like this).

Needless to say, the patient IS NOT medically stationary, he now has a bad-faith legal claim filed against the insurance company, and we're still treating, using the medical documentation to justify our care!

So, who do I report this IME chiropractor to? DIF? OBCE? (:-)

M. s, D.C.

RE: Recent trends in retroactive IME cut-offs

;

I have a question for you. Are any of these IME reports deficient in any of the references or specifications that are proposed in the Clinical Justification rule? I’m just curious what your thoughts are from the standpoint of an attorney who probably appreciates the significance and impact of these reports more than most of us in the profession who have written IME reports. ly, I’d be surprised if these IME reports didn’t have all the required data that the Clinical Justification rule would require. Isn’t the real issue with regard to unfair IME reports more a function of the reasoning of the IME based on the attitudes and biases they bring into the process? Maybe I’m wrong in my thinking on this, and open to being corrected. Maybe the IME reports you opine are unfair could not have produced an unfair result if the CJ rule were in place. What is your opinion on this?

S. Feinberg, D.C.

From: [mailto: ] On Behalf Of Sent: Wednesday, February 01, 2006 11:29 AM Subject: Recent trends in retroactive IME cut-offs

I've seen a lot of retroactive PIP cut-offs lately, including several IME cut-offs based upon IME examinations conducted months after a patient had finished treating. Not surprisingly, the most shocking examples are Safeco claims. Suprisingly, however, it is the identity of the IME doctors that kind of shocks me. They are none other than Skip Throop, M.D. (evaluating a completed course of chiropractic treatment that was deemed excessive because the treatment exceeded two times per week for three weeks and once a week for an additional three weeks). Dr. Throop states, "I believe the treatment was excessive in terms of chiropractic. "I would think two treatments per week for the first three weeks, and one treatment per week for three additional weeks would have been normal and standard, combined with a home exercise regimen." Rearend damage exceeded $ 4,000, and target vehicle was knocked at least ten feet into an intersection. Client continued to experience improvement with care after the so-called six week cut-off and actually experienced a near full recovery. Nowhere is that mentioned in the report. Interestingly, an infant in the same car wreck was treated chiropractically for several months after the same car wreck, and a different IME doctor (Dr. Freedland, D.C., evaluating D.C. treatment) determined that the care was reasonable and necessary. Safeco paid for all of that care. The next is from Dr. Greg Albright, D.C. (evaluating treatment provided by an M.D. PCP, a physical therapist, and an orthopedic surgeon). Dr. Albright states: "As previously noted, I believe Ms. ____ has reached a point of maximum medical improvement. "As of today's examination, we are in excess of six months following a low to moderate speed rear-impact motor vehicle crash. "She has undergone conservative medical and physical therapy modalities. "In general, one would expect simple musculoskeletal sprain/strains to significantly improve, if not completely resolve, within a four to six week period. "Ms. ___ is significantly past that initial window and, even assuming she had sustained a more significant Grade III lumbosacral ligamentous sprain, one would expect recovery within approximately six months." Repair estimate was $1,200 and car was knocked forward several feet. Additionally, patient continued to experience slow but steady progress with treatment. Nowhere is that mentioned or discussed in the report. Both clients are Hispanics, which I find significant, although maybe no one else does. Is the healthcare community ever going to require that scientific opinions from scientific experts who are colleagues be based on science??? Anyone care to comment????? Best, G. , Gatti et. al., Salem, Oregon.

[Guest guest]

Personally I would like to see several things

with regard to IME/DME’s:

1. I would like to see everyone post

the names of the Doc’s that are currently doing DME’s after one is

performed on their patient.

2. Just how relevant and fair the Doc who

had this claims management procedure performed on his patient found that exam

to be.

3. Did the claims management /

insurance company even send the report to the Chiropractic PCP in charge of the

case?

4. Lets shine some light on this

issue and by doing so take a poll of our own Doc’s to see just who is

doing what and what venues are being used to make conclusions of appropriate

care.

Just make sure that you couch your post as

just your opinion and avoid including the patient name.

L. C.

Lubcke, DC, DABCO

Re: Recent

trends in retroactive IME cut-offs

IME STORY: A chiropractor did an IME on one of my

current PIP patients, and said the patient was medically stationary, and

that further chiropractic treatment would only be " palliative. "

Patient has herniated disc, double crush syndrome,

bilateral ulnar neuropathy, and emerging carpal tunnel syndrome.

Nerve conduction/neurologist/orthopedist examinations AFTER

the chiropractic IME declared the patient NOT

medically stationary, recommended nerve blocks, possible disc surgery,

possible ulnar nerve relocation, and possible carpal tunnel surgery! (the ortho

actually used the phrase " double crush " in his report--astounding).

Despite the fact that my chart notes

documented ALL OF THESE PROBLEMS (course without the M.D. behind the

name), and the IME chiropractor had all my notes; the chiropractor

IME made our entire profession look like incompetent idiots, willing

to sell each other out for a buck, and undermined the clinical reputation

of every Chiropractor out there (the insurance industry LOVES to use us against

each other like this).

Needless to say, the patient IS NOT medically

stationary, he now has a bad-faith legal claim filed against the insurance

company, and we're still treating, using the medical documentation to justify

our care!

So, who do I report this

IME chiropractor to? DIF? OBCE? (:-)

M. s, D.C.

Recent trends

in retroactive IME cut-offs

I've seen a lot of retroactive PIP

cut-offs lately, including several IME cut-offs based upon IME examinations

conducted months after a patient had finished treating. Not surprisingly,

the most shocking examples are Safeco claims. Surprisingly, however, it

is the identity of the IME doctors that kind of shocks me. They are none

other than Skip Throop, M.D. (evaluating a completed course of

chiropractic treatment that was deemed excessive because the treatment exceeded

two times per week for three weeks and once a week for an additional three

weeks). Dr. Throop states, " I believe the treatment was excessive in

terms of chiropractic. " I would think two treatments per week for

the first three weeks, and one treatment per week for three additional weeks

would have been normal and standard, combined with a home exercise

regimen. " Rearend damage exceeded $ 4,000, and target vehicle was

knocked at least ten feet into an intersection. Client continued to

experience improvement with care after the so-called six week cut-off and

actually experienced a near full recovery. Nowhere is that mentioned in

the report. Interestingly, an infant in the same car wreck was treated

chiropractically for several months after the same car wreck, and a different

IME doctor (Dr. Freedland, D.C., evaluating D.C. treatment) determined that the

care was reasonable and necessary. Safeco paid for all of that

care. The next is from Dr. Greg Albright, D.C. (evaluating treatment

provided by an M.D. PCP, a physical therapist, and an orthopedic

surgeon). Dr. Albright states: " As previously noted, I believe

Ms. ____ has reached a point of maximum medical improvement. " As of

today's examination, we are in excess of six months following a low to moderate

speed rear-impact motor vehicle crash. " She has undergone

conservative medical and physical therapy modalities. " In general,

one would expect simple musculoskeletal sprain/strains to significantly

improve, if not completely resolve, within a four to six week period.

" Ms. ___ is significantly past that initial window and, even assuming she

had sustained a more significant Grade III lumbosacral ligamentous sprain, one

would expect recovery within approximately six months. " Repair

estimate was $1,200 and car was knocked forward several feet.

Additionally, patient continued to experience slow but steady progress with

treatment. Nowhere is that mentioned or discussed in the report.

Both clients are Hispanics, which I find significant, although maybe no one

else does. Is the healthcare community ever going to require that

scientific opinions from scientific experts who are colleagues be based on

science??? Anyone care to comment????? Best, G. , Gatti

et. al., Salem, Oregon.

[Guest guest]

Larry,

I think your idea is a great one. I believe just bringing this matter out into

the open might encourage some of the IME docs to be a bit more careful in there

assesments of our patients.

Schneider

Portland

----- Recent trends in retroactive IME cut-offs

>

>

>

>I've seen a lot of retroactive PIP cut-offs lately, including several IME

>cut-offs based upon IME examinations conducted months after a patient had

>finished treating. Not surprisingly, the most shocking examples are Safeco

>claims. Surprisingly, however, it is the identity of the IME doctors that

>kind of shocks me. They are none other than Skip Throop, M.D. (evaluating a

>completed course of chiropractic treatment that was deemed excessive

>because the treatment exceeded two times per week for three weeks and once a

>week for an additional three weeks). Dr. Throop states, " I believe the

>treatment was excessive in terms of chiropractic. " I would think two

>treatments per week for the first three weeks, and one treatment per week

>for three additional weeks would have been normal and standard, combined

>with a home exercise regimen. " Rearend damage exceeded $ 4,000, and target

>vehicle was knocked at least ten feet into an intersection. Client

>continued to experience improvement with care after the so-called six week

>cut-off and actually experienced a near full recovery. Nowhere is that

>mentioned in the report. Interestingly, an infant in the same car wreck was

>treated chiropractically for several months after the same car wreck, and a

>different IME doctor (Dr. Freedland, D.C., evaluating D.C. treatment)

>determined that the care was reasonable and necessary. Safeco paid for all

>of that care. The next is from Dr. Greg Albright, D.C. (evaluating

>treatment provided by an M.D. PCP, a physical therapist, and an orthopedic

>surgeon). Dr. Albright states: " As previously noted, I believe Ms. ____

>has reached a point of maximum medical improvement. " As of today's

>examination, we are in excess of six months following a low to moderate

>speed rear-impact motor vehicle crash. " She has undergone conservative

>medical and physical therapy modalities. " In general, one would expect

>simple musculoskeletal sprain/strains to significantly improve, if not

>completely resolve, within a four to six week period. " Ms. ___ is

>significantly past that initial window and, even assuming she had sustained

>a more significant Grade III lumbosacral ligamentous sprain, one would

>expect recovery within approximately six months. " Repair estimate was

>$1,200 and car was knocked forward several feet. Additionally, patient

>continued to experience slow but steady progress with treatment. Nowhere is

>that mentioned or discussed in the report. Both clients are Hispanics,

>which I find significant, although maybe no one else does. Is the

>healthcare community ever going to require that scientific opinions from

>scientific experts who are colleagues be based on science??? Anyone care to

>comment????? Best, G. , Gatti et. al., Salem, Oregon.

>

>

>

>

>

>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]

Larry, OR DCs,

I would add a comment or two…

Who

determines “how relevant and fair” the I/DME is…the

treating DC? Or some neutral 3rd party? The CAO set

up an ethics committee many years ago and set some standards for a “fair”

IME. (I think your were involved Larry, right?)

Did

the I/DME make any treatment recommendations? Did the treating DC

implement them?

Was

the exam a “PIP” IME or an attorney referred DME? There

is quite a difference.

A. Simpson, DC

From:

[mailto: ] On Behalf

Of Dr. Lubcke

Sent: Tuesday, February 07, 2006

9:17 PM

'Chiro ListServe'

Subject: RE: Recent

trends in retroactive IME cut-offs

Personally I would like to see several

things with regard to IME/DME’s:

1. I would like to see everyone post

the names of the Doc’s that are currently doing DME’s after one is

performed on their patient.

2. Just how relevant and fair the Doc who

had this claims management procedure performed on his patient found that exam

to be.

3. Did the claims management /

insurance company even send the report to the Chiropractic PCP in charge of the

case?

4. Lets shine some light on this

issue and by doing so take a poll of our own Doc’s to see just who is

doing what and what venues are being used to make conclusions of appropriate

care.

Just make sure that you couch your post as

just your opinion and avoid including the patient name.

L. C.

Lubcke, DC, DABCO

Re: Recent

trends in retroactive IME cut-offs

IME STORY: A chiropractor did an IME on one of my

current PIP patients, and said the patient was medically stationary, and

that further chiropractic treatment would only be " palliative. "

Patient has herniated disc, double crush syndrome,

bilateral ulnar neuropathy, and emerging carpal tunnel syndrome.

Nerve conduction/neurologist/orthopedist examinations AFTER

the chiropractic IME declared the patient NOT

medically stationary, recommended nerve blocks, possible disc surgery,

possible ulnar nerve relocation, and possible carpal tunnel surgery! (the ortho

actually used the phrase " double crush " in his report--astounding).

Despite the fact that my chart notes

documented ALL OF THESE PROBLEMS (course without the M.D. behind the

name), and the IME chiropractor had all my notes; the chiropractor

IME made our entire profession look like incompetent idiots, willing

to sell each other out for a buck, and undermined the clinical reputation

of every Chiropractor out there (the insurance industry LOVES to use us against

each other like this).

Needless to say, the patient IS NOT medically

stationary, he now has a bad-faith legal claim filed against the insurance

company, and we're still treating, using the medical documentation to justify

our care!

So, who do I report this

IME chiropractor to? DIF? OBCE? (:-)

M. s, D.C.

Recent trends

in retroactive IME cut-offs

I've seen a lot of retroactive PIP

cut-offs lately, including several IME cut-offs based upon IME examinations

conducted months after a patient had finished treating. Not surprisingly,

the most shocking examples are Safeco claims. Surprisingly, however, it

is the identity of the IME doctors that kind of shocks me. They are none

other than Skip Throop, M.D. (evaluating a completed course of

chiropractic treatment that was deemed excessive because the treatment exceeded

two times per week for three weeks and once a week for an additional three

weeks). Dr. Throop states, " I believe the treatment was excessive in

terms of chiropractic. " I would think two treatments per week for

the first three weeks, and one treatment per week for three additional weeks

would have been normal and standard, combined with a home exercise

regimen. " Rearend damage exceeded $ 4,000, and target vehicle was

knocked at least ten feet into an intersection. Client continued to

experience improvement with care after the so-called six week cut-off and

actually experienced a near full recovery. Nowhere is that mentioned in

the report. Interestingly, an infant in the same car wreck was treated

chiropractically for several months after the same car wreck, and a different

IME doctor (Dr. Freedland, D.C., evaluating D.C. treatment) determined that the

care was reasonable and necessary. Safeco paid for all of that

care. The next is from Dr. Greg Albright, D.C. (evaluating treatment

provided by an M.D. PCP, a physical therapist, and an orthopedic

surgeon). Dr. Albright states: " As previously noted, I believe

Ms. ____ has reached a point of maximum medical improvement. " As of

today's examination, we are in excess of six months following a low to moderate

speed rear-impact motor vehicle crash. " She has undergone

conservative medical and physical therapy modalities. " In general,

one would expect simple musculoskeletal sprain/strains to significantly

improve, if not completely resolve, within a four to six week period.

" Ms. ___ is significantly past that initial window and, even assuming she

had sustained a more significant Grade III lumbosacral ligamentous sprain, one

would expect recovery within approximately six months. " Repair

estimate was $1,200 and car was knocked forward several feet.

Additionally, patient continued to experience slow but steady progress with

treatment. Nowhere is that mentioned or discussed in the report.

Both clients are Hispanics, which I find significant, although maybe no one else

does. Is the healthcare community ever going to require that scientific

opinions from scientific experts who are colleagues be based on

science??? Anyone care to comment????? Best, G. ,

Gatti et. al., Salem, Oregon.

[Guest guest]

I agree I should have probably not named the Insurance Medical Examiners who performed the exams. My point was not to attack the particular doctors, but rather the system as a whole. I mentioned the doctors in the post, because they are both generally considered two very good treating physicians (by me and everyone I know), and are even physicians to whom I have referred patients in the past. And I will continue to do so. I myself have been a patient at Dr. Albright's clinic, and I have also been a patient of his. I have walked (crouched) into his office crooked and walked out straight. He's an awesome doctor, as is retired neurologist Skip Throop. Dr. Albright was correct in his criticism of my post: that I simply took a snippet of his eight page report and held it up to scrutiny. That is exactly what I did. I did the same with Dr. Throops IME report. Why??? Because that's exactly what the insurance company did to my patient. In the letter retroactively denying the last two months or so of curative care, Safeco quoted from Dr. Throops report: "I believe the treatment was excessive in terms of chiropractic. I would think two treatments per week for the first three weeks, and one treatment per week for three additional weeks would have been normal and standard, combined with a home exercise regimen." It was the insurance company that did the dissection, not me. With regards to Dr. Albright's report, he stated in his report that one would normally expect a grade II sprain/strain to heal within six to eight weeks. That doesn't mean that it did. However, that statement regarding what some regard as "normal" healing rates forms the cornerstone of the insurance company's denial of further treatment. Now the patient is treating with Dr. Rand (another IME'r) and he wants the patient to have an MRI to rule out disc involvement in ongoing radicular type complaints. I've had to tell both Rand's office and the MRI facility that I will do my scout's best to get both paid by the PIP carrier. But due to the IME, unless the MRI is positive, it will be deemed unreasonable by the insurance company (they have told me as much), because Dr. Albright has already opined that no further treatment would be reasonable or necessary, according to them, based upon usual and customary healing rates. My criticism is to question why the statement is even included in the report. It's certainly not relevant to whether this particular patient healed within six weeks. After all, "the vast majority of children don't have brain tumors." But that statement shouldn't scientifically be in an IME report to determine whether a particular child has a brain tumor and whether brain surgery is indicated. I also don't feel comfortable having an insurance company use a chiropractor to evaluate the reasonableness and necessity of M.D., orthopedic M.D., and P.T. treatment. I am just as troubled when I see a Board Certified Neurologist criticize chiropractic treatment because it exceeded twice a week for two treatments per week for three weeks followed by one additional treatment per week for three additional weeks. How is either physician really qualified to opine in either case? Now before you answer that, please remember that chiropractic treatment is routinely critiqued by M.D. IME'rs when the reverse scenario is quite rare. I don't blame the IME doctors, really, it is the insurance companies. However, I just wish more IME doctors would look, see, and follow-up with just how their reports are used to deny further care. With regard to racial, ethnic, and cultural bias, I certainly didn't mean to point the finger at either doctor. What I meant was that I have suspicions that minorities are targeted by insurance companies for IME's and disparate treatment in the processing of their claims. They seem to get IME'd with a remarkably high frequency. You folks need to wake up and realize that the insurance adjusters who pay your bills (a greatly percentage of them) are trained to believe and actually do believe that chiropractic treatment does nothing whatsoever to effectively treat connective tissue injuries. Chiropractic just makes someone feel better for a little while, then they are back to where they were in a day or so, which is why they need to treat three+ times per week. Once or twice a month an adjustor will actually ask me "aren't you concerned that your client is seeing a chiropractor???" I'm invariably always asked that when the patient is a child. Doctors who do IME's need to be cognizant of the fact that their contracting insurance companies have already decided to cut the patient off (if they can) and are going to read your report to dissect anything and everything in it that even remotely can be read to limit or terminate reimbursement of care. I know that, because I used to be an adjustor. "IME him!" was our way of saying, "Cut him off." We used to do a little arithmetic and figure whether we'd save more money by paying the IME doctor or just paying the additional treatment. Let's face it, when most patient's are IME'd, they've reached a point in their recovery (usually) where the strong objective signs of injury have abated. There's not a lot of spasm, bruises are gone, and their subjective complaints are consistent with the history of the injury and the treatment, but they are, after all, just subjective complaints, and those can easily be lied about, so therefore they are. And what patient over 40 doesn't have some preexisting ddd or djd?? So the 'ol cut'em off and blame it on age or obesity really can't be affirmatively disproved. It cannot be proven, either, but the PIP carrier's don't care. I am also guilty of posting something in the heat of anger, as both IME reports I wrote about arrived on my desk on the same morning, and my feeling was actually one of "Geez, we're really in trouble now, if the insurance companies can take opinions from doctors like Albright and Throop and stuff them down the patients' throats. And as regards to minorities, let's face it, a higher percentage of Hispanic individuals do not have personal health insurance to fall back on. They are also physically demonstrative when they communicate their complaints, and even especially so if they know they're communicating with a doctor who does not speak their language. It invariably is described in many reports I read as "pain behavior" and "profound symptom magnification." BUT I DO DEEPLY AND REPEATEDLY APOLOGIZE TO DR. ALBRIGHT AND THROOP IF MY WORDS WERE TAKEN AS A STATEMENT THAT I BELIEVED THEY HAD ANY RACIAL ANIMUS OR BIAS. I DO NOT BELIEVE THAT AT ALL, AND WHEN I REREAD MY RATHER SHORT POST, I HAVE TO ADMIT THAT I CAN CERTAINLY SEE HOW AND WHY MY WORDS WERE TAKEN THAT WAY. AGAIN I AM SORRY ABOUT THAT.

From: [mailto: ] On Behalf Of Sharron FuchsSent: Tuesday, February 07, 2006 4:32 PM Subject: RE: Recent trends in retroactive IME cut-offs

Mr. , Given a system by which one has to justify ones opinion will in and of itself correct some of the problems of which you speak. I enjoyed reading your example but I really think you should have left the doctor's name off the commentary. This certainly provoked an angry retort but in fairness it must have been very upsetting for the doctor.

I had two IME's in my own cases and I was cut off of PIP 6 months prior to the IME ! If not for having my own health insurance and the ability to pay out of pocket I would have been totally squeezed out of the system with final insurance commentary.....'see she must have been cured, stabilized or at MMI because she didn't see any doctors after we cut her off'. I ,for one ,have motivation to see fairnees brought back into the IME issues.

sharron fuchs dc

From: [mailto: ] On Behalf Of Sent: Thursday, February 02, 2006 12:06 PM s, D.C.; Subject: RE: Recent trends in retroactive IME cut-offs

Any chiropractic treatment would only be reasonable if it were for 2 visits per week for three weeks, perhaps followed by at most one treatment per week for an additional three weeks. That is the "opinion" of the IME doctor that is made under the authority of his standing as a licensed doctor of science. I guess I don't see how the proposed clinical justification rule, if adopted, would change or prevent the result. Mike

From: [mailto: ] On Behalf Of s, D.C.Sent: Thursday, February 02, 2006 12:00 PM Subject: Re: Recent trends in retroactive IME cut-offs

IME STORY: A chiropractor did an IME on one of my current PIP patients, and said the patient was medically stationary, and that further chiropractic treatment would only be "palliative."

Patient has herniated disc, double crush syndrome, bilateral ulnar neuropathy, and emerging carpal tunnel syndrome. Nerve conduction/neurologist/orthopedist examinations AFTER the chiropractic IME declared the patient NOT medically stationary, recommended nerve blocks, possible disc surgery, possible ulnar nerve relocation, and possible carpal tunnel surgery! (the ortho actually used the phrase "double crush" in his report--astounding).

Despite the fact that my chart notes documented ALL OF THESE PROBLEMS (course without the M.D. behind the name), and the IME chiropractor had all my notes; the chiropractor IME made our entire profession look like incompetent idiots, willing to sell each other out for a buck, and undermined the clinical reputation of every Chiropractor out there (the insurance industry LOVES to use us against each other like this).

Needless to say, the patient IS NOT medically stationary, he now has a bad-faith legal claim filed against the insurance company, and we're still treating, using the medical documentation to justify our care!

So, who do I report this IME chiropractor to? DIF? OBCE? (:-)

M. s, D.C.

RE: Recent trends in retroactive IME cut-offs

;

I have a question for you. Are any of these IME reports deficient in any of the references or specifications that are proposed in the Clinical Justification rule? I’m just curious what your thoughts are from the standpoint of an attorney who probably appreciates the significance and impact of these reports more than most of us in the profession who have written IME reports. ly, I’d be surprised if these IME reports didn’t have all the required data that the Clinical Justification rule would require. Isn’t the real issue with regard to unfair IME reports more a function of the reasoning of the IME based on the attitudes and biases they bring into the process? Maybe I’m wrong in my thinking on this, and open to being corrected. Maybe the IME reports you opine are unfair could not have produced an unfair result if the CJ rule were in place. What is your opinion on this?

S. Feinberg, D.C.

From: [mailto: ] On Behalf Of Sent: Wednesday, February 01, 2006 11:29 AM Subject: Recent trends in retroactive IME cut-offs

I've seen a lot of retroactive PIP cut-offs lately, including several IME cut-offs based upon IME examinations conducted months after a patient had finished treating. Not surprisingly, the most shocking examples are Safeco claims. Suprisingly, however, it is the identity of the IME doctors that kind of shocks me. They are none other than Skip Throop, M.D. (evaluating a completed course of chiropractic treatment that was deemed excessive because the treatment exceeded two times per week for three weeks and once a week for an additional three weeks). Dr. Throop states, "I believe the treatment was excessive in terms of chiropractic. "I would think two treatments per week for the first three weeks, and one treatment per week for three additional weeks would have been normal and standard, combined with a home exercise regimen." Rearend damage exceeded $ 4,000, and target vehicle was knocked at least ten feet into an intersection. Client continued to experience improvement with care after the so-called six week cut-off and actually experienced a near full recovery. Nowhere is that mentioned in the report. Interestingly, an infant in the same car wreck was treated chiropractically for several months after the same car wreck, and a different IME doctor (Dr. Freedland, D.C., evaluating D.C. treatment) determined that the care was reasonable and necessary. Safeco paid for all of that care. The next is from Dr. Greg Albright, D.C. (evaluating treatment provided by an M.D. PCP, a physical therapist, and an orthopedic surgeon). Dr. Albright states: "As previously noted, I believe Ms. ____ has reached a point of maximum medical improvement. "As of today's examination, we are in excess of six months following a low to moderate speed rear-impact motor vehicle crash. "She has undergone conservative medical and physical therapy modalities. "In general, one would expect simple musculoskeletal sprain/strains to significantly improve, if not completely resolve, within a four to six week period. "Ms. ___ is significantly past that initial window and, even assuming she had sustained a more significant Grade III lumbosacral ligamentous sprain, one would expect recovery within approximately six months." Repair estimate was $1,200 and car was knocked forward several feet. Additionally, patient continued to experience slow but steady progress with treatment. Nowhere is that mentioned or discussed in the report. Both clients are Hispanics, which I find significant, although maybe no one else does. Is the healthcare community ever going to require that scientific opinions from scientific experts who are colleagues be based on science??? Anyone care to comment????? Best, G. , Gatti et. al., Salem, Oregon.

[Guest guest]

Chuck & OR DC’s

You pose good questions but, I am not

attempting to create something that is as complex as you suggest. I want

to shine some light on the specifics of a topic every one but

talks around. I would simply like to know who is doing these DME’s

and how the Doc’s in the field perceive the effect of this DME is on

their patients care. Who is perceived as doing a good job and who is not.

I have personally seen some hatchet jobs on my patients. When this

happens to my patients I take it personally and I do my best to write a

rebuttal that humiliates the individuals engaging in the DME to the extent that

they fear cross examination in court. I would like to know what other

Doc’s are doing, how it is working and if it does; how does its injury

their patients, their patients family and of course their patients

recovery. The tragedy in these cases is that these hack job DME’s

destroy lives in many ways. I have seen it precipitate divorces, break up

families, cause people to lose jobs and homes.

L. C.

Lubcke, DC, DABCO

Re: Recent

trends in retroactive IME cut-offs

IME STORY: A chiropractor did an IME on one of my

current PIP patients, and said the patient was medically stationary, and

that further chiropractic treatment would only be " palliative. "

Patient has herniated disc, double crush syndrome,

bilateral ulnar neuropathy, and emerging carpal tunnel syndrome.

Nerve conduction/neurologist/orthopedist examinations AFTER

the chiropractic IME declared the patient NOT medically stationary,

recommended nerve blocks, possible disc surgery, possible ulnar nerve

relocation, and possible carpal tunnel surgery! (the ortho actually used the

phrase " double crush " in his report--astounding).

Despite the fact that my chart notes

documented ALL OF THESE PROBLEMS (course without the M.D. behind the

name), and the IME chiropractor had all my notes; the chiropractor

IME made our entire profession look like incompetent idiots, willing

to sell each other out for a buck, and undermined the clinical reputation

of every Chiropractor out there (the insurance industry LOVES to use us against

each other like this).

Needless to say, the patient IS NOT medically

stationary, he now has a bad-faith legal claim filed against the insurance

company, and we're still treating, using the medical documentation to justify

our care!

So, who do I report this

IME chiropractor to? DIF? OBCE? (:-)

M. s, D.C.

Recent trends

in retroactive IME cut-offs

I've seen a lot of retroactive PIP

cut-offs lately, including several IME cut-offs based upon IME examinations

conducted months after a patient had finished treating. Not surprisingly,

the most shocking examples are Safeco claims. Surprisingly, however, it

is the identity of the IME doctors that kind of shocks me. They are none

other than Skip Throop, M.D. (evaluating a completed course of

chiropractic treatment that was deemed excessive because the treatment exceeded

two times per week for three weeks and once a week for an additional three

weeks). Dr. Throop states, " I believe the treatment was excessive in

terms of chiropractic. " I would think two treatments per week for

the first three weeks, and one treatment per week for three additional weeks

would have been normal and standard, combined with a home exercise

regimen. " Rearend damage exceeded $ 4,000, and target vehicle was

knocked at least ten feet into an intersection. Client continued to

experience improvement with care after the so-called six week cut-off and

actually experienced a near full recovery. Nowhere is that mentioned in

the report. Interestingly, an infant in the same car wreck was treated

chiropractically for several months after the same car wreck, and a different

IME doctor (Dr. Freedland, D.C., evaluating D.C. treatment) determined that the

care was reasonable and necessary. Safeco paid for all of that

care. The next is from Dr. Greg Albright, D.C. (evaluating treatment

provided by an M.D. PCP, a physical therapist, and an orthopedic

surgeon). Dr. Albright states: " As previously noted, I believe

Ms. ____ has reached a point of maximum medical improvement. " As of

today's examination, we are in excess of six months following a low to moderate

speed rear-impact motor vehicle crash. " She has undergone

conservative medical and physical therapy modalities. " In general,

one would expect simple musculoskeletal sprain/strains to significantly

improve, if not completely resolve, within a four to six week period.

" Ms. ___ is significantly past that initial window and, even assuming she

had sustained a more significant Grade III lumbosacral ligamentous sprain, one

would expect recovery within approximately six months. " Repair

estimate was $1,200 and car was knocked forward several feet.

Additionally, patient continued to experience slow but steady progress with

treatment. Nowhere is that mentioned or discussed in the report.

Both clients are Hispanics, which I find significant, although maybe no one

else does. Is the healthcare community ever going to require that

scientific opinions from scientific experts who are colleagues be based on

science??? Anyone care to comment????? Best, G. , Gatti

et. al., Salem, Oregon.