Compliance Corner: Calif. Disability Evaluation Report Writing Course

Sacramento, CA (WorkersCompensation.com) -- Did you know that in California, prior to appointment as a QME, a physician must complete a course of at least 16 hours of instruction in disability evaluation report writing? The course curriculum shall be specified by the Administrative Director. Only report writing courses which are offered by education providers as defined in the California Code of Regulations will meet this requirement.

What does an education provider applicant have to submit?

(1) A completed QME Form 118 (Application for Accreditation), which contains:
(A) The applicant's name; address; director of education with contact information; type of organization; length of time in business; nature of business; and past experience providing continuing education courses (including a list of other accrediting agencies that have approved such courses).
(B) A description of the proposed education program or course which includes the title; type (continuing education program or disability evaluation report writing course); location(s); date(s); length of training in clock hours; educational objectives; a complete description of the program or course content; faculty; and the names of other accrediting agencies that have approved the program.

(2) A curriculum vitae for each proposed instructor. A proposed instructor shall have education or training and recent work experience relevant to the subject of their presentation.

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(3) The application for accreditation as an education provider, along with all required supporting documents, shall be submitted to the Administrative Director, at least 60 calendar days before any public advertisement of the applicant's course.

What will the Administrative Director accredit?

An applicant that: meets the definition of an education provider; submits a completed, signed, and dated application that demonstrates past experience in providing continuing education programs; and proposes a program that meets the requirements of state law. The applicant must demonstrate that adequate time is allocated to the curriculum for the course to be approved by the Administrative Director. Proposed content for continuing education program credit must relate directly to disability evaluation or California workers' compensation-related medical dispute evaluation. No credit shall be recognized by the Administrative Director for material primarily discussing the business aspects of workers' compensation medical practice, like billing, coding, and marketing.

Are promotional materials regulated?

Each education provider that has been accredited by the Administrative Director will be given a number which must be displayed on course promotional material. Promotional materials for a course must state the education provider's educational objectives; the professional qualifications of course faculty (at the least, all relevant professional degrees); the content of course activities; and the intended audience.

When will the Administrative Director notify the applicant?

Within 20 calendar days after receipt of the application. The Administrative Director will share whether the education provider has been accredited for a two-year period and the proposed course has been approved. Incomplete applications will be returned to the applicant.

What must the Administrative Director know about the content of the course?

On or before the date the course is first presented, the education provider shall submit the program syllabus (all program handouts) to the Administrative Director.

An approved course may be offered for two years. An accredited education provider shall notify the Administrative Director in writing of any change to the faculty in an approved course. The provider shall send the Administrative Director the program outline, promotional material, and faculty for each offering of the program at least 45 days prior to the date of the presentation of the program. The Administrative Director may require submission of the program syllabi. The Administrative Director may require changes in the program based on its review of the program outline, program syllabi, promotional material or faculty if the Administrative Director finds that any aspect of the program is not in compliance with these regulations.

How does a provider apply for re-accreditation?

To apply for re-accreditation, the education provider applicant must submit a completed QME Form 118 (Application for Accreditation). The applicant may complete section 2 of the form using a new program or course or one which was given by the applicant during the recent accreditation period. The Administrative

Director shall give the provider 90 days' notice of the need to seek re-accreditation.

What must instruction cover?

The minimum of 16 hours of instruction in disability evaluation report writing shall include:

+ The Qualified Medical Evaluator's Role in the Disability Evaluation Process (minimum recommended 1 hour)
+ How disability evaluation reports are used
+The reasons why reports must be clear, complete and timely
+The QME's role as an expert witness
+ Impact of the QME's report on the injured worker
+ QME ethics and the Confidentiality of Medical Information Act
+ Elements of the Medical-Legal Report (minimum recommended 1 hour)
+The Labor Code and regulatory requirements for medical-legal reports
+ (3) The Language of Reports (minimum recommended 4 hours)
+ Evaluation of disability in California (impairment and disability)
+ The occupational history
+ The physician examination and the role of testing
+ The Medical Treatment Utilization Schedule (MTUS) adopted by the Administrative Director pursuant to Labor Code section 5307.27, found in section 9792.20 et seq of Title 8 of the California Code of Regulations
+ Providing opinions that resolve disputed medical treatment issues
+ Packard Thurber's Evaluation of Industrial Disability, section 43 through 47 and section 9725 through 9727 of Title 8 of the California Code of Regulations (for cases with dates of injury not subject to the AMA guide-based impairment rating system)
+ Factors of disability, including subjective and objective factors, loss of pre-injury capacity and work restrictions, for cases involving dates of injury not subject to the AMA guide-based impairment rating system
+Activities of Daily Living, for cases subject to the AMA Guides
+Work restrictions
+ Work Capabilities
+ American Medical Association, Guides to the Evaluation of Permanent Impairment, [Fifth Edition] (AMA Guides) and its use in determining permanent disability in accordance with the Schedule for Rating Permanent Disabilities [effective Jan. 1, 2005] (for all claims with dates of injury on or after Jan. 1, 2005, and for those compensable claims arising before Jan. 1, 2005, in which either there is no comprehensive medical-legal report or no report by a treating physician indicating the existence of permanent disability, or when the employer is not required to provide notice to the injured worker
+ Causation
+ Determination of permanent and stationary status
+ Apportionment
+ Future medical care
+ Review of records
+ Providing sufficient support for conclusions
+ Instruction in anti-bias training (mandatory minimum of at least 2 hours)
+ Instruction consisting of a review workers' compensation case law (minimum recommended 2 hours)
+ The Administrative Director's Disability Evaluation Protocols (minimum recommended 1 hour)
An overview of the Neuromusculoskeletal, Pulmonary, Cardiac, Immunologic, or Psychiatric protocols, and an in-depth discussion of measurement of impairment, calculations and rationale for rating under the AMA Guides, as relevant
+ The Third Party Perspective (minimum recommended 1 hour)
+The report from the perspective of those who read it: judges, attorneys, insurers, raters, employers, qualified rehabilitation representatives.
+ Anatomy of a Good Report (small group or other interactive sessions -- minimum recommended 3 hours)
+ Discussion of examples of good reports and identification of weaknesses in reports
+ Opportunities for the practitioner to critique and/or correct reports
+ If feasible, physician should have the opportunity to write a sample report
+ Review of results of Administrative Director's annual report review and identification of common problems with reports
+ Mechanics of Report Writing (minimum recommended 1 hour)
+ The QME Process
+ Face to face time
+ Timelines for submission of report
+ Completion of required forms
+Service of reports
+ Final questions and answers

Submission and Critique of Written Medical/legal Report

As a condition of completion of the course taken to satisfy the requirements of this section, each physician enrollee shall draft at least one practice written medical/legal report, based on a sample case library of materials, and this written report must be critiqued with notations by the course education provider.

All audio or video tapes, computer programs and printed educational material used in the course must be submitted to the Administrative Director on or before the date the course is first given. Six hours of instruction shall consist of in person or onsite lecture, didactic sessions, and group discussion. Up to 10 hours of instruction may be completed by distance learning whenever the Administrative Director has approved the submitted course prior to the first day the course is given. All distance learning materials shall bear a date of release and shall be updated yearly. The education provider shall notify the Administrative Director in writing of the revision.

Marketing Opportunities

No one shall recruit members or promote commercial products or services in the instruction room immediately before, during, or immediately after the presentation of a course. Education providers or vendors may display or sell educational materials related to workers' compensation or applications for membership in an area adjoining a course. A course provider or faculty member shall disclose on QME Form 119 (Faculty Disclosure of Commercial Interest) any significant financial interest held by faculty in or affiliation with any commercial product or service which is discussed in a course and that interest or affiliation must be disclosed to all attendees. An education provider shall file every Form 119 in its possession with the Administrator Director.

How is attendance taken?

The provider shall maintain attendance records for each disability evaluation report writing course for a period of no less than three years after the course is given. A physician attending the course must be identified by signature. The provider must submit a copy of the signature list to the Administrative Director within 60 days of completion of the course.

Evaluation Form, Completion Certificate

The provider is required to give the QME Evaluation Form 117 (Qualified Medical Evaluator Continuing Education Response Form) to course attendees and request they submit the form to the Administrative Director. This information shall not be used in lieu of a certification of completion given by the provider. Destruction by a provider or its employee of a QME's Evaluation Form or failure by such provider or its employee to distribute Form 117 as part of its course shall constitute grounds for revocation of a provider's accredited status. The Administrative Director shall tabulate the responses and return a summary to the provider within 90 days of completion of the course.

The provider shall issue a certificate of completion to the physician that states the name of the provider, the provider's number, the dates and location and title of the course. To be eligible for appointment as a QME, a physician must complete no less than 16 hours of the curriculum and must submit a copy of that certificate to the Administrative Director.

Joint Sponsorship

Joint sponsorship of courses (as between an accredited and an unaccredited provider) must be approved by the Administrative Director prior to presentation of the course.

Audits

The Administrative Director may audit a provider's courses at the request of the medical director to determine if the provider meets the criteria for accreditation. The Administrative Director may audit courses given by providers randomly, when a complaint is received, or on the basis of responses on QME Form 117 (Qualified Medical Evaluator Continuing Education Response Form). An auditor shall not receive QME credit for auditing a course. The Administrative Director shall make written results of the audit available to the provider no more than 30 days after the audit is completed.

Ending Accrediation

Accredited providers that cease to offer disability evaluation report writing courses shall notify the Administrative Director in writing no later than 60 days prior to the discontinuing an approved course.

The Administrative Director may withdraw accreditation of a provider or deny such a provider's application for accreditation on the following grounds:

(1) Conviction of a felony or any offense substantially related to the activities of the provider.
(2) Any material misrepresentation of fact made by the provider.
(3) Failure to comply with Administrative Director regulations.
(4) False or misleading advertising.
(5) Failure to comply with Administrative Director's recommendations following an audit.
(6) Failure to distribute QME Form 117 (Qualified Medical Evaluator Continuing Education Response Form) cards to course attendees.

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