Report 2019-102 Recommendation 3 Responses

Report 2019-102: Department of Industrial Relations: Its Failure to Adequately Administer the Qualified Medical Evaluator Process May Delay Injured Workers' Access to Benefits (Release Date: November 2019)

Recommendation #3 To: Industrial Relations, Department of

To ensure that DWC appoints enough QMEs to keep up with the demand for QME services, it should, by April 2020, develop and implement a plan to increase the number of QMEs commensurate with demand. The plan should describe how DWC will actively recruit for and increase the pool of QMEs, prioritizing specialties with the greatest shortages relative to demand. It should also use QME data trends to project the necessary QME supply to meet demand. The plan should include continuing negotiation with medical groups to allow their physicians to become QMEs, as well as establishing goals for recruiting new QMEs in specific specialties.

1-Year Agency Response

The DWC has developed and implemented a strategic plan to recruit physicians and increase the pool of QMEs. The plan includes virtual QME examinations, outreach and recruitment strategies targeted at medical communities, and increased remuneration for QMEs.

Please see the full response submitted to the State Auditor on November 18, 2024 complete details.

California State Auditor's Assessment of 1-Year Status: Fully Implemented

DWC's response indicates that it will expand the availability of its QME examination and publicize the availability of the exam through sending letters to physicians who have previously failed the exam, using its social media accounts, and advertising in the newsletter of a professional organization of industrial physicians in California. DWC also provided an analysis of QMEs and demand for QMEs and identified specialties that require recruitment of additional QMEs to meet demand. DWC's response also indicates that it has begun the process of reaching out to institutional medical providers to begin recruitment of its members and plans to perform this outreach with other organizations. To the extent that DWC follows through with its plan and recruits the QMEs necessary to meet the demand it identified in its analysis, it will implement our recommendation.

6-Month Agency Response

DWC 180-Day Status on the Recommendation: Completed and Implementing.

The DWC's plan to recruit physicians as QMEs is as follows:

1. The DWC has identified physicians that passed the QME exam in 2017 and 2018 but never registered as a QME.

2. The DWC has identified physicians who failed the QME exam in 2017 and 2018.

3. The DWC has identified physicians who previously were active QMEs but have become inactive during the period of 2013 to October 2019.

Upon development of the final lists of physicians identified above, the DWC will reach out to these physicians via mail and email by July 1, 2020 to encourage them to complete the process to become or recertify themselves as QMEs. A follow-up communication will be sent again in January 2021 since, given the current crisis, doctors may miss advertisements and recruitment materials received during this time.

With

DWC is working to increase the fees for medical-legal evaluations.

The DWC has held numerous stakeholder meetings over the course of nine months, to work collaboratively to formulate a new medical-legal fee schedule. The DWC has drafted proposed regulations for a new fee schedule. Given the current State of Emergency, the DWC is assessing options for holding the required public hearing on these important proposed regulations. (See Exhibit A - Proposed Regulations regarding Medical-Legal Fee Schedule.)

DWC is assessing its data to better understand QME assignments and requested specialties.

The DWC's plan is to be able to bring in medical groups like the UC-system physicians as this would allow for a more diverse range of specialties being offered in the QME database. Again, we intend to pursue these discussions with medical groups in the fall of 2020.

See further detail in Letter response

California State Auditor's Assessment of 6-Month Status: Pending

Although DWC lists several ways it plans to recruit physicians, its letter response does not indicate that it will use data to identify the number of QMEs it needs to recruit or what specialties it should focus on. As we state in our report, it should ensure that it uses data to better manage the QME supply and recruit more QMEs. We recommended that DWC specifically prioritize specialties with the greatest shortages relative to demand.

60-Day Agency Response

The DWC has identified physicians that passed the QME exam in 2017 and 2018, but never registered as a QME. Additionally, the DWC has identified physicians who failed the QME exam in 2017 and 2018, and those who were QMEs but have become inactive from 2013 to October 2019. (Exhibit B.)

The DWC is currently working to identify the physicians in 2019 that passed the QME exam and have not registered as a QME, in addition to those who did not pass the exam in 2019.

With regard to the list of physicians who passed the exam and did not register as a QME, the DWC is currently checking the doctor's status with the California Medical Board to

confirm they are in good standing. Upon development of a final list, the DWC intends to reach out to these physicians and encourage them to complete the process to attain QME status. It will also be important to ascertain why the physicians decided not to become

QMEs so that the DWC can remove any perceived barriers to appointment in the future.

The DWC has an educational conference in the spring of every year, held in northern and southern California. We are developing a flyer to be distributed to the medical community at the upcoming conference. A working copy of the flyer is attached hereto as Exhibit D.

The DWC continues to actively work with stakeholders to formulate a new fee schedule. It is anticipated that the new fee schedule will include increased rates for medical-legal reporting, which the Auditor cited as a possible factor in attracting QMEs and increasing

QME availability.

The DWC is working with our Information Technology ("IT") Department to better understand the current process for panel assignments and determine if there is a problem with the current process resulting in some QMEs not getting panel assignments. The DWC is committed to developing a system that takes advantage of 100% of the current QME

population in panel assignments.

California State Auditor's Assessment of 60-Day Status: Pending

All Recommendations in 2019-102

Agency responses received are posted verbatim.