The Silent Killer in the Independent Medical Examination (IME) Industry
by Dr. Luke Boudreau BSc, DC, MHA
Issue at Hand: Poor use of Medical Records
The organization and preparation of medical records into a medical brief is a necessary, labor-intensive activity that is costly, prone to error, and with information often shared insecurely. The quality of the medical brief used by healthcare professionals when conducting an independent medical exam can have a profound effect on the quality of the report, leading to increased costs and dire outcomes for all involved. Re-thinking the methods of preparing the medical brief and improving the effectiveness of its use during the assessment process is the key to solving these serious issues in the Independent Medical Examination industry.
Tags: Medical Briefs, Independent Medical Examination, Medical Records, Document Organization, Medical Assessments, Third Party Assessment Company, IME Vendor.
The Issue: Poor use of Medical Records
Medical records continue to be siloed in clinical charts and electronic medical record systems that do not communicate. This has resulted in a long-standing, burdensome, system of manual labor to amalgamate medical records for use in independent medical examinations. The process is high cost, extremely time consuming, fractious, and at high risk for error, affecting the ability of case managers and healthcare providers to effectively navigate the medical information used to perform medical assessments.
The Independent Medical Examination (IME) is a form of assessment that is a vital tool in settling disputes regarding benefit entitlement and the degree of bodily injury. During the 1990’s and early 2000’s, downward financial pressure on North American insurers and worker’s compensation boards resulted in a higher degree of offloading medical records handling and organization of medical briefs to third party assessment companies, law firms, and healthcare providers performing IMEs. Although millions of medical assessments are performed in North America and abroad each year, medical records are still received by fax, by courier or delivered electronically by download email links that can get lost in junk mail folders. Not only are there serious security risks with this form of data sharing, but medical records are often fraught with duplications, fax coversheets and irrelevant documents intermixed in the medical brief, which significantly slows the assessment process. With no standardization of how to index the records or what information should be focused on by the examiners, the state of the medical brief can have a seriously adverse effect on the quality of the IME report as well as the assessor opinions or conclusions, resulting in unwarranted benefit payouts or an unjust denial of benefits.
The costs of document handling for the purpose of organizing and preparing a medical brief for IMEs weighs heavy as third-party assessment companies, government agencies, law firms and healthcare providers spend hundreds of millions of dollars yearly on a manual process that has not significantly changed in decades, despite technology advancements. The direct and indirect costs staff dedicated to preparing medical briefs are escalating and can range from a few hundred thousand dollars to millions per company. The mundane task of organizing documents often falls upon junior employees with no healthcare experience, resulting in a high risk of error, a high turnover rate in the job position, and a bottleneck on the ability to handle a large volume of assessment referrals.
Another rising cost that is of concern is the quality assurance process required to ensure the IME report produced meets a high standard of defensibility in a court of law. With compensation for IMEs often fixed for healthcare providers, the quality of the reports produced by some assessors has suffered over the years, forcing third-party assessment companies to ‘repair the report to meet a quality standard’, which has resulted in several court challenges on ghostwriting of reports. This has hurt the integrity of the industry and has a great potential to inflict long-term damage.
“This has hurt the integrity of the industry and has a great potential to inflict long-term damage.”
The use of medical briefs from the healthcare provider prospective is problematic from two angles. The first issue is that the navigation of the medical brief prior to the actual assessment can take 2-10 times longer than the assessment itself, with little to no ability to receive adequate compensation for the extra time needed preparing. The risk with this situation is that some providers may spend less time and miss pertinent details in the medical documents for purely financial reasons or due to time constraints. The second issue is the fact that medical briefs are not usable in real-time during the actual assessment (meaning, there is not enough time to flip through countless pages or scroll through PDF documents to effectively find pertinent information in the brief to guide the history exam and aid in the assessment process with the evaluee present). Healthcare providers often perform several IMEs in the same day, which compounds the risk of error when trying to remember details of the numerous medical briefs which may have been reviewed the week prior to the assessments, which can force the examiner to rely more on the evaluee (who may be a questionable historian) to try to fill in the blanks during the assessment.
The keys to success in the IME industry is to continue to provide value to the referral source through:
Maintaining quality of the assessment report;
Providing breath of assessor choice in performing the work by easing the medical brief burden for assessors;
Securing health data effectively;
Certification of valid and complete reports from the authors; and
Finding cost efficiencies to enable competitiveness.
What if there was a way to help solve all these challenges with a single tech platform that requires no software upgrades, no on-site servers and no changes in legacy systems? BEAR (Biomedical Evaluation Assessment Resource) has the solutions and is the tech engine that will drive the industry forward.
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About BEAR Health Technologies
BEAR Health Technologies is the smartest way to perform medical assessments in the independent medical examination industry. We empower our clients to focus on work that increases the quality of their assessments and reports. It is our mission to rethink the way medical assessments are performed in the IME industry to become the technological and standard reference.
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