The Commission on Health and Safety and Workers’ Compensation (CHSWC) has released its 197 page twenty-fourth Annual Report for 2018. The Report presents information about the health and safety and workers’ compensation systems in California and makes recommendations to improve their operations.
The Annual Report summarizes the state of all the relevant areas of the workers’ compensation and health and safety systems. The Annual Report includes several Special Studies of targeted areas of interest. One of the Special Studies involved the PQME process. Key findings in the study of the PQME system included the following.
— The number of providers registered as QMEs continues to decline (17% since 2007), but less rapidly than it did prior to 2007.
— The number of requests for QME panels has increased rapidly, 87 percent since 2007.
— The decline in QMEs and increase in panel requests means that the number of requests per QME has doubled (+101%).
— Coupled with a continuing increase in the average paid amount for QME reports, the average QME earns 240 percent more from panel reports now than in 2007.
— All the increase in panel requests is from represented track cases, up 400 percent despite the elimination of panels for most medical treatment issues (replaced by the IMR process). This increase was equally driven by requests from both applicants and defendants.
— Panel requests for unrepresented cases declined 55 percent, driven entirely by a decline in requests by injured workers. The number of requests by claims administrators in unrepresented cases changed little.
— The DWC began collecting the reasons for panel requests on represented cases in 2015. Those data show that the primary reasons for panels are: compensability (42.5%), permanent disability (21.4%), and Permanent & Stationary (P&S) status (11.4%).
In response to the earlier study, SB 863 placed limits on the number of locations (10) at which QMEs can be registered. This has had the effect of distributing QME panels more evenly and widely among registered providers.
— Very-high-volume QMEs (with 11-100+ registered locations) have been eliminated.
— However, a high proportion of panel assignments (55%-60%) are still assigned to the busiest 10 percent of QMEs, nearly all of whom have exactly 10 offices and are in orthopedic specialties.
— Unlike the very-high-volume QMEs studied earlier, the top 10 percent and 5 percent of QMEs by the number of panels in the current system produce reports that show less bias. Even the top 5 percent of QMEs by volume give ratings that are only slightly more conservatively than average.