Academy of Chiropractic Personal Injury & Primary Spine Care Program

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Build Your Infrastructure 118 I

From the Desk of Dr. Mark Studin
Academy of Chiropractic
Preamble: Many of the issues I bring to you are very small, yet each issue is just that, an issue. If you take care of the small issues, then you will be able to build and more importantly, focus on the bigger issues...a larger practice and more family time.

“How Peer Reviews Destroy Your Practice”

The end result… The carriers and peer reviewers are richer, you are poorer and the peer review doctor continues to be “Teflon”
… Nothing sticks.
 
…because you allow it and it makes you part of the problem.
 
I received a call last week from a doctor who stated that the carriers in their region use a few peer review doctors to determine the necessity of his care to determine reimbursement. In many of the cases (all personal injury) the peer review doctor is recommending ZERO care based upon his experience and courses he has taken as a direct result of the doctor’s notes he reviewed. I saw this in Massachusetts 3 years ago helping to defend a fraud case and the carrier’s hired peer reviewer took so many liberties because NO ONE challenged them.
 
For the current situation, the doctor has chosen to take a pro-active role in helping to reverse this trend, as it is initially hurting his income and reputation. In the long-run, the local lawyers read these opinions and bull crap or not, it severely hampers the all chiropractor in the region credibility and ability to manage and treat trauma cases.
 
When I shared this with Dr. Owens, he wrote:
 
Remember one very important point...All responses and litigation should be directed to creating a path to an end result.  The end result in all of these cases is to NOT necessarily make the carrier change their minds at all, or even pay the bill for that matter.  The course is to put pressure on the Peer Reviewers to such a level that the income they derive from providing an opinion based report is NOT worth the stress imposed on them.  In today's environment the Plaintiff doctor takes all the stress while the Peer Reviewer, the IME doctor and the DME doctor are protected and simply write the report and get paid.  The playing field has to be leveled, which in my opinion will have an effect, it may not be in the short term but it will create a change.  This is what the lawyer said...

" I’m not trying to talk you into litigating if you don’t wish to.  It’s a pain in the butt--you will have to give deposition testimony, take off work to come to court, etc.  So I understand if you don’t wish to do so.​"

This is what the plaintiff doctors deal with every day, most IME, Peer Review or DME doctors are shielded from this and actually have very little experience in deposition etc., especially Chiropractors.  So, this all goes back to the IME Rebuttal Program, we establish a rational scientific rebuttal that shows scientific consensus on the matter and then this claimant can file a complaint with the State Board, and I would also have the Plaintiff Lawyer subpoena the Peer Reviewer for Deposition.  Do this to a Peer Reviewer 100 times and I can ALMOST guarantee they will quit doing them.  
 
We must all take pro-active roles in leveling the playing field.
 
 
Respectfully,



Mark Studin DC, FASBE(C), DAAPM, DAAMLP

Adjunct Assistant Professor of Clinical Sciences, University of Bridgeport, College of Chiropractic
Educational Presenter, Accreditation Council for Continuing Medical Education Joint Partnership with the State University of New York at Buffalo, School of Medicine and Biomedical Sciences

Academy of Chiropractic
US Chiropractic Directory
631-786-4253
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