Guest guest Posted February 9, 2006 Report Share Posted February 9, 2006 1. No MD should be allowed to offer opinion on chiro care, duration, frequency, etc. Hello, that's practicing chiropractic without a lic. At the same time, a DC should not offer opinions about surgery, medical treatment, etc. 2. IME should only be done within one's own scope of pracatice. Therefore, if a MD and and DC are co-treating, two IMEs need to be performed. 3. Does a MD who does a IME have to adhere to the ORS noted by Dr. DeShaw? I don't think the OBCE will get involved in this fight, does anyone else? 4. In the past year, how many of your patient's IMEs been done by a DC vs. a MD? I've had two DC IMEs in four years and the rest were all by a MD. , DC Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 9, 2006 Report Share Posted February 9, 2006 I agree with you there! Not many MD's have a clue as to what we do... it is so far outside of their box. Another problem is the incredible diversity among DC's as to what type of treatment is provided and how that can play into a DC IME decision. Say I specialize in a treatment which not only has a clinical goal of restoring a patient to pre-accident status as far as symptoms and function goes, but can also help improve potential risk factors to the patient's long-term prognosis like correcting a cervical kyphosis in a whiplash case. Many times this involves treating a patient beyond the resolution of symptoms. A DC IME who has a different opinion of what should be done is not going to see eye to eye and will recommend a denial of services every time. If we are talking about comparing apples to apples, with IME's, then it they should be done by a DC who has knowledge in my particular technique and treatment method. If I did an IME on a case and saw that the DC was only treating one time per week initially with a 20 mph rear-impact MVC, based on my experience and training in treating these cases, I would be recommending an increase in treatment! Doing that, I probably wouldn't get many IME's sent my way, though. Here is an interesting question... has anyone ever had an IME which came to the conclusion that the treating DC was undertreating and recommended an increase in frequency and duration? Jamey IME, statue, DC vs MD 1. No MD should be allowed to offer opinion on chiro care, duration, frequency, etc. Hello, that's practicing chiropractic without a lic.At the same time, a DC should not offer opinions about surgery, medical treatment, etc.2. IME should only be done within one's own scope of pracatice. Therefore, if a MD and and DC are co-treating, two IMEs need to be performed.3. Does a MD who does a IME have to adhere to the ORS noted by Dr. DeShaw? I don't think the OBCE will get involved in this fight, does anyone else?4. In the past year, how many of your patient's IMEs been done by a DC vs. a MD? I've had two DC IMEs in four years and the rest were all by a MD. , DC Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 9, 2006 Report Share Posted February 9, 2006 Hi Jamey, Colleagues, You would need look no further than our new (1-year old) "Clinical Justification Administrative Rule" which mandates serial "Evidence Based Outcomes" as the determinate of when a chiropractic patient has reached maximal chiropractic improvement. These outcomes are divided into patient driven outcomes (pain & disability/function) and provider driven outcomes (exam findings). Though the patient's, for example, pain drawings and neck disability index scores may have leveled out, in you can show that their functional radiographic findings continue to show measurable improved, in this case the quality of the cervical lordosis (Gore's Angle, 's Angle "which Don Harrionson of Biophysicis uses) that's enough to continue "curative care." At trial time your expert testimony utilizing large story board showing these outcomes and with the OBCE's "Clinical Justification Rule" projected over head and you lay explanation what it means....you will kick the MD DME/IME booty ever single time! Vern Saboe IME, statue, DC vs MD 1. No MD should be allowed to offer opinion on chiro care, duration, frequency, etc. Hello, that's practicing chiropractic without a lic.At the same time, a DC should not offer opinions about surgery, medical treatment, etc.2. IME should only be done within one's own scope of pracatice. Therefore, if a MD and and DC are co-treating, two IMEs need to be performed.3. Does a MD who does a IME have to adhere to the ORS noted by Dr. DeShaw? I don't think the OBCE will get involved in this fight, does anyone else?4. In the past year, how many of your patient's IMEs been done by a DC vs. a MD? I've had two DC IMEs in four years and the rest were all by a MD. , DC Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 9, 2006 Report Share Posted February 9, 2006 Jamey, OR DCs, Not to put too fine a point on it, but when you as a treating DC, “specialize in a treatment which not only has a clinical goal of restoring a patient to pre-accident status as far as symptoms and function goes, but can also help improve potential risk factors to the patient's long-term prognosis like correcting a cervical kyphosis in a whiplash case. Many times this involves treating a patient beyond the resolution of symptoms…” watch out. It’s not that your goal is bad, it’s just that it may well reach beyond the insurer’s obligation to provider “reasonable and necessary” treatment. Medical necessity in the context of most acute injuries such as those encountered in MVCs is generally (as you have said) “…has a clinical goal of restoring a patient to pre-accident status as far as symptoms and function…” and no more. Treatment beyond this point is most often not the obligation of the insurance company and it usually falls to us as attending physicians to help our patients understand that even though this treatment may be helpful to “improve potential risk factors to the patient's long-term prognosis like correcting a cervical kyphosis in a whiplash case” it the patient’s own financial responsibility in most cases. A. Simpson, DC From: [mailto: ] On Behalf Of jcaadyson Sent: Thursday, February 09, 2006 10:12 AM Subject: Re: IME, statue, DC vs MD I agree with you there! Not many MD's have a clue as to what we do... it is so far outside of their box. Another problem is the incredible diversity among DC's as to what type of treatment is provided and how that can play into a DC IME decision. Say I specialize in a treatment which not only has a clinical goal of restoring a patient to pre-accident status as far as symptoms and function goes, but can also help improve potential risk factors to the patient's long-term prognosis like correcting a cervical kyphosis in a whiplash case. Many times this involves treating a patient beyond the resolution of symptoms. A DC IME who has a different opinion of what should be done is not going to see eye to eye and will recommend a denial of services every time. If we are talking about comparing apples to apples, with IME's, then it they should be done by a DC who has knowledge in my particular technique and treatment method. If I did an IME on a case and saw that the DC was only treating one time per week initially with a 20 mph rear-impact MVC, based on my experience and training in treating these cases, I would be recommending an increase in treatment! Doing that, I probably wouldn't get many IME's sent my way, though. Here is an interesting question... has anyone ever had an IME which came to the conclusion that the treating DC was undertreating and recommended an increase in frequency and duration? Jamey IME, statue, DC vs MD 1. No MD should be allowed to offer opinion on chiro care, duration, frequency, etc. Hello, that's practicing chiropractic without a lic. At the same time, a DC should not offer opinions about surgery, medical treatment, etc. 2. IME should only be done within one's own scope of pracatice. Therefore, if a MD and and DC are co-treating, two IMEs need to be performed. 3. Does a MD who does a IME have to adhere to the ORS noted by Dr. DeShaw? I don't think the OBCE will get involved in this fight, does anyone else? 4. In the past year, how many of your patient's IMEs been done by a DC vs. a MD? I've had two DC IMEs in four years and the rest were all by a MD. , DC Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 9, 2006 Report Share Posted February 9, 2006 If there is reasonable medical probability that the injured consumer's cervical lordosis was reversed secondary to a class I or II ligamentous sprain caused by the auto crash then.... it would not be the consumers financial responsibility but the insurance company's. Alternatively if pre-existing films clearly show a reversed cervical lordosis it's on the consumer's dime. Vern Saboe IME, statue, DC vs MD 1. No MD should be allowed to offer opinion on chiro care, duration, frequency, etc. Hello, that's practicing chiropractic without a lic.At the same time, a DC should not offer opinions about surgery, medical treatment, etc.2. IME should only be done within one's own scope of pracatice. Therefore, if a MD and and DC are co-treating, two IMEs need to be performed.3. Does a MD who does a IME have to adhere to the ORS noted by Dr. DeShaw? I don't think the OBCE will get involved in this fight, does anyone else?4. In the past year, how many of your patient's IMEs been done by a DC vs. a MD? I've had two DC IMEs in four years and the rest were all by a MD. , DC Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 9, 2006 Report Share Posted February 9, 2006 But what if the person can't get better from injuries due to the accident because the reversed curve is preventing healing ? The insurance company gets the insured as they are - pre-existing problems are par for the course and so the treatment for them to allow healing of accident related injuries are covered. This is why the person pays for PIP, to be covered. True or not ? sharron fuchs dc From: [mailto: ] On Behalf Of Vern SaboeSent: Thursday, February 09, 2006 12:55 PMjcaadyson; ; Chuck Simpson, DCSubject: Re: IME, statue, DC vs MD If there is reasonable medical probability that the injured consumer's cervical lordosis was reversed secondary to a class I or II ligamentous sprain caused by the auto crash then.... it would not be the consumers financial responsibility but the insurance company's. Alternatively if pre-existing films clearly show a reversed cervical lordosis it's on the consumer's dime. Vern Saboe IME, statue, DC vs MD 1. No MD should be allowed to offer opinion on chiro care, duration, frequency, etc. Hello, that's practicing chiropractic without a lic.At the same time, a DC should not offer opinions about surgery, medical treatment, etc.2. IME should only be done within one's own scope of pracatice. Therefore, if a MD and and DC are co-treating, two IMEs need to be performed.3. Does a MD who does a IME have to adhere to the ORS noted by Dr. DeShaw? I don't think the OBCE will get involved in this fight, does anyone else?4. In the past year, how many of your patient's IMEs been done by a DC vs. a MD? I've had two DC IMEs in four years and the rest were all by a MD. , DC Quote Link to comment Share on other sites More sharing options...
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