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.

Friday, April 17, 2015

WHEN DOES A $681,000 SALARY REQUIRE "ADDITIONAL INCENTIVE COMPENSATION?" Is there a reasonable argument that ABMS and other board salaries are tied into MOC (Maintenance of Certification)?

According to Form 990 from the IRS for 2013 for the American Board of Medical Specialties (ABMS), Lois Margaret Nora, MD, JD, MBA, president & CEO of the ABMS,  got base compensation of $681,188 plus "bonus and incentive compensation" of $12,500 plus "deferred compensation" of $71,000 plus "nontaxable benefits" of $14,799 for a total of $779,487.

Net assets by contrast, pages 1 and 12 of Form 990 are listed as minus $1,238,805.

Of interest is that Dr. Huntoon in AAPS reported $330,000 in remuneration for Dr. Nora for 2012 (see references below) whereas our copy of Form 990 shows remuneration for 2013 of $779,000 -- if we have actually documented a raise, kudos for Dr. Nora.  All ABMS specialists should look over their organizations' Form 990s as a matter of ordinary due diligence. 

According to Form 990 for the American Board of Pyschiatry and Neurology (ABPN) for 2012, Larry R. Faulkner, MD, president and CEO, was compensated at $560,522 for base compensation plus $260,713 for "retirement and other deferred compensation," $22,356 for "nontaxable benefits" for a total of $ 843,591.

Total revenue for 2012 is listed on page 4 of the form in the amount of $17,122,985 (expenses were $12,389,987). Page 10 of the ABPN document, under "Statement of Functional Expenses," shows "assessments of ABMS" in the amount of $687,884. Page 11 shows end-of-year net assets of $65,083,864.


MOC has become one of the most controversial programs within medical practice with a myriad of organizations willing to take it on and offer their own Continued Medical Education (CME) at prices ranging from bargain-level to exorbitant. The point is that the selling of education has become its own business with ABMS boards devouring their own members as fast as greed allows digestion.

When the American Academy of Neurology (AAN) filed a timid letter in protest to ABPN and asked that MOC Part IV be repealed, that organization got the response of feckless organizations everywhere. Doctor Lois Nora, quoted in NEUROLOGY TODAY, 04/02/15, said with pithy candor, "I don't see us moving on that."

Current AAN president, Tim Pedley, MD, is quoted on page one of AAN News, April 2015, as stating that the MOC Part IV "process is unnecessarily cumbersome" as though a less cumbersome inconvenience would not distress AAN. Meanwhile, in NEUROLOGY TODAY, 04/02/15, Pedley practically apologizes for his support of several hundred disgruntled AAN members and seeks to dissociate AAN from ABPN ("AAN is an independent association with no control over ABPN, the American Board of Medical Specialties, or the MOC rationale and process"). It may eventually turn out that the members no longer need AAN and reconsider paying dues.

Meanwhile,  ABPN's $843,591 salaried president and CEO, Larry Faulkner, MD,  timorously stated in NEUROLOGY TODAY, " ... wiping out part of the requirements (he means MOC Part IV) is not something we at ABPN believe we have the authority to do. The American Board of Medical Specialties sets the standards, and unless they decide to change them, we don't have a choice but to follow them." We disagree. ABPN is not supposed to be anybody's subject or hand-maiden.


As we pointed out above, the ABPN form 990 IRS document from 2012 lists $687,884 as "assessments of ABMS" which itself showed negative net assets for 2013 in the amount of $1,238,805. Under these circumstances it is reasonable to inquire further to what extent fiscal issues between the specialty boards and ABMS may be inextricably intertwined.


"Money and Medicine," The Weinmann Report (, 7/21/12

"How Physicians Eat their Young," The Weinmann Report (, 2/12/14

"AAN Calls for Elimination of MOC Part IV," AAN News

"Do Doctors Expire in 10 Years?" Workcompcentral, Robert Weinmann, MD, 5/15/14 (In the original AAPS article Larry Huntoon, MD, PhD, pointed out that AAN had scheduled an MOC symposium and that Dr. Nora was to be a speaker but did not feel obliged at the time to disclose as a possible conflict of interest that her 2012 salary at ABMS was about $330,000. AAN then is reported to have told AAPS that no such disclaimer was needed since AAN wasn't giving CME credits to participants)

"Do Doctors Expire in 10 Years?" American Association of Physicians and Surgeons (AAPS News), May 2014 (V. 70, #5)