Independent Med Exams Study In Wash. State

Independent medical examiners perform exams for workers' compensation to clarify, causes, diagnoses, types and degrees of injury impairment and efficacy of treatment, effectiveness of potential surgical procedures, extent of pre-existing conditions, a spokesperson for ECB explained.

According to Helen Knight, the spokesperson for King of Prussia, Pa.-based ECB, Washington spends about $14 million a year for 30,000 independent medical exams.

She said ECB, a subsidiary of the MedRisk specialty managed care services firm, would receive about $400,000 for performing the work to develop a quality assurance pilot program.

ECB said it will develop and test a system to efficiently, consistently and reliably assess the quality of IMEs. This will include a mechanism for providing credible and useful feedback to examiners about the quality of their reports.

"Proven tools and systems for this type of IME program are not available in spite of their obvious potential value," said Ruth E. Estrich, assistant project manager for the pilot. "The Department of Labor and Industries is breaking new ground in this critical area."

Nationally the average cost of an independent exam is about $500.

ECB said it will determine the current prevailing quality of Washington State IME Reports by establishing a baseline profile of observed IME quality using a representative sample of IMEs. IT will also develop and test an IME audit tool and process, and test the effect of various levels of communication, feedback, and peer coaching on IME quality.

Based on the results, ECB said it will assist the Department of Labor and Industries in determining whether an ongoing IME quality assurance program is feasible–both logistically and financially–and transfer the technology it develops to the state.

David J. Overby, senior health policy analyst with Washington State Department of Labor and Industries said ECB had assembled "an impressive team of senior professionals who have extensive expertise in the core competencies the project demands. They share a profound commitment to quality improvement, and we're looking forward to working with this elite group of medical and workers' compensation specialists."

ECB said the team project manager and medical director is Dr. Jennifer Christian, a medical consultant to ECB and president and chief medical officer for Webility Corp., a company focused on physician training and performance improvement.

Project assistant and medical director of peer review is Dr. Elizabeth Genovese, who is also the medical director for IMX Medical Management Services, an IME medical review services company.

Assistant Project Manager Ms. Estrich, is the director of networks for ECB and MedRisk.

Jerry D. Poole, also with ECB and MedRisk, is the team's chief information officer and chief operations officer.

ECB said Dr. John E. Nimlos, Eastside clinic chief at the Occupational Medicine Clinic in Washington and the chair of the Washington State Medical Advisory Committee will guide auditor training from the perspective of the state and attending physicians.

Dr. Nimlos will also lead the Washington-based physician appeals process for IME examiners.

Ms. Knight said the exams under study are generally performed by a physician with specialty training that equals that of the treating doctor.