Saturday, April 25, 2015

NEUROPSYCHOLOGY MEDICAL-LEGAL EVALUATIONS (Neuropsyche QMEs): Does someone want to sabotage neuropsychological evaluations?


Assembly Bill 1542 (Mathis and Cooley)

Seemingly erudite and arcane, the question of when to use Neuropsychological QMEs as opposed to Psychology QMEs is not only crucial to industrial medicine and workers compensation, but also  to Medical Provider Networks (MPNs) and Managed Care everywhere (especially to Health Maintenance Organizations or HMOs). We'll tell our readers up front that this publication supports AB 1542. The rest of this article explains why and states some likely consequences of non-support.

Neurospsyche QMEs evaluate brain-injured patients with discrete neurocognitive techniques to make decisions about future medical needs and eligibility for employment. These techniques are separate and distinct from neurological tools such as EEG, EMG, or MRI scanning. The tests neuropsyches use are different from the techniques used by general psychologists who, although well versed in general psychology, are not as highly versed in the evaluation of specific traumatic brain injury as are the neuropsychologists who assess whetheoor not particular brain-damaged workers will be able to return to their usual and customary jobs, or, for that matter, to any job at all.

These evaluations are also critical for employers and for insurance companies. The insurance companies are obliged to cover future medical costs. Wrongful evaluations can result in incorrect job assignments, worsening impairment or disability, generation of useless medical expense, and, for employers, to further impairment of production and additional on-site work injuries.

The fact is that Clinical Neuropsychologists as a sub-specialty within the general framework of psychology has been accepted as such for over 20 years. All the same, the Division of Workers' Compensation (DWC) wants to drop the Neuropsyche QME sub-specialty category and treat all psychologists as a single group. Here's the rub: so doing would mean that brain-injured workers could be assessed by general psychologists who would not have had the specialized education and training that their Neuropsyche colleagues have obtained. By analogy, it might be said that so doing would be akin to putting all the MDs into the same group without consideration of specialty so that an injured worker with a broken leg might be evaluated by an obstetrician.

A further fact is that according to DWC in 2013 there were over 2,000 cases of concussion and that in 2014 there were 633 neuropsyche QME panels as opposed to 8,436 general psychology panels.  The reason for this divergence is clear: the general psychology panels focus on general psychological issues, not on the specific issues of traumatic brain injury, rehabilitation, and cognitive retraining.

If the Neuropsyche QME is eliminated, the brain-injured worker will not get the assessment he needs. From the industry perspective, neither will the employer or the insurance company. The likely outcome under this scenario would be wrongful return-to-work work assignments, or no return-to-work assignment when one such could have been made, wrongful deployment of insurance company resources for unindicated services, and, most sadly of all, failure to dispense indicated future medical treatment that could have been properly recommended by the Neuropsyche QME


For these reasons, we advise favorable consideration of AB 1542.

For private doctors not involved in workers comp, we have a warning: elimination of neuropsyche in workers comp could easily be taken up as model by managed care plans everywhere and by government covered entities eager to cut costs even if it means disenfranchising plan participants.

6 comments:

  1. Whatever you have provided for us in these posts really appreciative.John Franklin

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  2. Thank you for the kudos. We have recently been informed about a form letter from one of the insurance companies that threatens doctors with being fired from their MPNs if they protest UR denials too vigorously, Watch for our post on this unfortunate matter! Watch also Workcompcentral for any story they may publish. Watch also for which legislators dodge the issue. -- Robert L. Weinmann, MD, Editor

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  5. Another way for the payors to deny patient needed medical care which HMOs and insurance companies (including Medicare/Medicaid) will also soon implement.

    Not only will generalists be making medical decisions, but probably those with no background or training will be given authority to direct patient care.

    Cheap labor results in shoddy medical care.

    Gene Uzawa Dorio, M.D.
    Santa Clarita, CA

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