CWCI Says New Doc Fee Schedule is Costly

CWCI has released a July 2022 study of costs under the California Medical-Legal Fee Schedule (MLFS), which was revised in 2021.

Although costs were expected to rise under the MLFS, they appear to be rising much more than anticipated.

According to the CWCI, a higher flat fee rate led to a 222% cost increase in basic evaluations. CWCI claims that the average payment for a face to face exam jumped by 52.9% (compared to 2019). The average payment for a supplemental increased by 39.1%.

Also, the numbers of supplemental reports increased.

Contributing to the cost rise was the $3 per page review payment for records over 200 pages. CWCI claims that those added “an average of $1,917 to the base fee for comprehensive evaluations, $1,410 to the base fee for follow-up evaluations and $1,437 to the base fee for supplemental evaluations.”

CWCI also notes that:

“One goal of the new fee structure was to attract and retain more Qualified Medical Evaluators (QMEs). A review of DWC data show that 211 new physicians joined the pool of certified QMEs in 2021, while only 18 became inactive, resulting in 2,554 active evaluators, a 3% increase from 2020 yet a 1% decrease from 2019.”

Notably, the California DWC struggled to find a better solution to compensate QMEs for their work evaluating California injured workers. Background stakeholder talks went on for years about this (I know firsthand: I sat in on a number of the meetings), and multiple proposals surfaced only to be criticized and withdrawn.

And against the backdrop of fee schedule revisions was concern that examiners would leave the California comp system if not adequately compensated for their work. If there are insufficient numbers of QMEs, it takes longer to resolve cases. It is in the interest of all comp stakeholders that there be adequate numbers of QMEs.

So here we are. Where does this go now? Clearly, some major stakeholders are not happy with he deal that was struck.

If a future amendment of the MFLS tries to make cuts in payments to evaluators, will that encourage QMEs to exit the system? Although the DWC has generally looked at employers and labor as the key comp stakeholders, the system does depend on the willing participation of doctors.

Are some of the costs within the control of carriers and employers? Clearly yes. Timing matters. Getting records to QMEs before the exams eliminates the need for many supplementals.

Are excessive amounts of medical records being sent to QMEs? In many cases, yes. Some of this is just driven by habit or by a quixotic effort to show apportionment. When an adjuster or a defense attorney sends decades of employment records or Kaiser records to a QME, how likely is it that this is going to be meaningful? Yet, it happens in case after case. 

It’s almost expected. Deposition is taken. There are questions about decades of employment or group health treaters. Those records are subpoenaed. Then the adjuster or the defense attorney ships them off to the QME, who generally finds little of interest.

It has become a sort of pathetic dance, but at $3 per page can be an expensive dance.

Here is a link to the CWCI study:

https://www.cwci.org/press_release.html?id=905

Stay tuned.

Within the next week I’ll be doing a post recapping some of the key events in California Workers’ Comp during the first half of 2022.

By Julius Young

Courtesy of Workers Comp ZONE

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