MCN | Medical Consultants Network
The Power of a Second Look
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A MCN Promotional Moose Keychain (left) and the photo a client had sent us after her 5-year-old daughter dressed her Barbie in MCN’s fashionable brand (right).
The other day we received this photograph from a client. The client’s 5-year-old daughter had dressed her Barbie up in a MCN shirt that originally dressed one of our small ‘MCN Moose’ keychains. We found it delightful and wanted to share it with our readers.
Since our last post, “Putting Science Higher On the Public Agenda,” A collaboration of local science organizations and scientists have put together six questions for governor candidates to answer, much like the questions President Obama and Mitt Romney had answered in September this year.
They believe these answers belong in the upcoming live debates for Washington governor candidates, as well as posted for the public to see.
Here are the six questions:
These questions were developed in partnership with sciencedebate.org, a national nonprofit that succeeded in getting the 2012 presidential candidates to answer 14 questions. Those national questions and answers can be found at sciencedebate.org.
The NW local organizations include the Northwest Science Writers Association, ScienceOnline Seattle and the Forum on Science, Ethics and Policy. They also have some key scientist supporters, including Lisa Graumlich, Dean of the School on the Environment at the University of Washington and Ed Lazowska, Bill and Melinda Gates chair of Computer Sciences at the UW.
Some of the bi organizations such as Town Hall and Pacific Science Center have supporting them as well as feisty startup Microryza (crowdsourcing research) as a smaller supporter.
The key six key questions include climate change, ocean health, vaccinations for public health, among other science areas.
For more information – Please contact the following people:
Shawn Otto, shawn@sciencedebate.org
Sally James, NSWA, info@nwscience.org– Twitter – @nswa
Jen Davison, co-founder of ScienceonlineSeattle, at UW College of the Environment
jfrdvsn@u.washingon.edu
Seattle, WA (January 30, 2012): Medical Consultants Network is pleased to announce the appointment of Richard Leonardo as Executive Vice President. Mr. Leonardo is charged with leading MCN’s sales and marketing team nationwide.
“I am ecstatic to join the preeminent player in the medical judgment space. Not only does MCN have an industry leading product, but I am blessed to join a leadership team that has attracted the right people, built the scalable systems, and implemented the processes to ensure we can consistently meet client’s current and ever-evolving needs,” notes Mr. Leonardo.
Mr. Leonardo brings to MCN more than twenty-five years of leadership experience and marketing and sales expertise in the workers’ compensation industry. Most recently he served as Vice President, Sales and Account Management, with Express Scripts, the nation’s largest pharmacy benefit management firm.
Mr. Leonardo joins MCN at a point of strong growth for the company; during 2011 MCN experienced its highest earnings while achieving a strong rate of growth. Dr. Brian Grant, MCN’s Chair & Associate Medical Director, notes, “We welcome Rich Leonardo with enthusiasm, and look forward to continued strong growth in the coming months and years.”
Paul Mayer, MCN President and CEO, states, “We are pleased to have Rich joining the team—his recent experience will be valuable in further developing products that address pharmacy utilization in the property casualty and group health markets. He will be a valuable asset to the executive team.”
Thanks to you, our MCNtalk readers, MCN has made year end donations to three non-profit organizations you’ve chosen. We recently sponsored a contest wherein new subscribers could select a non-profit organization of their choice to receive a $100 donation. We’ve listed the organizations below and provided a bit of information about them. All are medically related and two of the three benefit seriously ill and impoverished children, one nationally, one internationally.
At MCNtalk we frequently write about the issues we face in today’s world: the rising cost of medical care, the number of uninsured Americas and attempts to widen coverage, medical challenges faced by everyone. When viewed as a whole, the magnitude of the situation is daunting, perhaps overwhelming, so it is good to have the opportunity to provide some support. As an organization, MCN and our employees are privileged to provide financial support to both the thriving arts community in Seattle as well as umbrella social services organizations such as The United Way. Thank you to everyone who participated in the recent contest by subscribing to MCNtalk, and thank you to the contest winners for their choices.
by Brian L. Grant, MD
We at MCN speak about quality in examination and review services and hear similar speech from others including competitors. The term “quality” is but a homily or empty rhetoric unless it is defined and clarified. We also believe that some may have been led astray when they allow quality to be defined along standards that lose sight of the inherent values of the medical profession. We believe that adherence to quality standards is neither negotiable nor fluid or subject to market forces. From time to time we observe within our company or learn from other quarters certain practices that we can’t endorse and ought not be endorsed or practiced by others. By raising the matter publicly we call attention to standards that should be expected by clients who order review services, by doctors who perform them, and by companies that facilitate them.
The below memo was sent to MCN consultants. We share them with you and invite you to pass them on. Or if readers have additional standards or take issue with any we have raised, we would enjoy hearing from you:
December 6, 2011
To: MCN Consultants
From: Mark Doyne MD and Brian Grant MD, Medical Directors
Regarding: Examination conduct, standards and physician demeanor
As medical directors for MCN, we review complaints that periodically arrive from claimants regarding their examinations. Every one of these is reviewed individually and each physician is given the opportunity to respond. We are passionate about the integrity of MCN examinations and expect that all MCN consultants share our values and practice accordingly. Given the nature of our work, a complaint should be reviewed in the context of the nature of the issues raised, including the possibility of there being other motivations for a given complaint among other factors. We do not take complaints at face value at all times. We review the specifics and may conclude that a complaint may lack merit. Sometimes we may choose to investigate with a call to the claimant and review the consultant’s response to the complaint. Other times we have chosen to briefly survey other claimants who have been evaluated by the consultant via phone calls to them and an audit of the corresponding reports.
Certain types of problems, when representing a pattern, will and have resulted in termination of a consulting relationship with the company for specific consultants. We believe that adherence to appropriate standards should be inherent in the profession and are obvious requirements to perform quality reports. As such, they may be beyond the scope of MCN or others to teach, and when basic standards are not adhered to, this is a serious matter.
We expect consultants performing medical reviews, whether for MCN or others, clients requesting such examinations, and competing companies to adhere to basic standards of conduct and practice.
Some of the points below have been conveyed in past memos. We are restating them as a reminder, and for the benefit of new consultants. We call upon the industry, including clients, physician consultants and MCN’s competitors, to enforce adherence to these standards, embracing them in intent and practice. We also welcome your comments and additional ideas.
Our standards (as expected of all who perform medical reviews) include but are not limited to the following:
Sufficient Time Must Be Spent with Claimants. We expect that the consultant devote sufficient time for a thorough review of records, history and physical or mental status assessment of the claimant. It is NOT appropriate to book exams in increments of less than thirty minutes. We have heard stories of companies in certain regions of the country where four to six or more exams scheduled per hour are not uncommon. Some consultants find it of benefit to review the records in the presence of the claimant. If time has been spent away from the claimant reviewing the records, however, it might be a good idea to share this fact and show those records to the claimant. Actual face time with claimants should be sufficient to perform an appropriate history and examination without creating a perception by the claimant of being rushed. It is impossible to perform a thorough history and physical of a typical injury claim in less than thirty minutes and often more time is required.
Reports Must Be of Sufficient Length. A report should be several pages or more in length, have sufficient depth to answer the questions of the client, and reflect a thoughtful, individual review of the specific case. There should be documentation of what has been reviewed. We remind you that it is not necessary to extensively quote records that have been reviewed. Some consultants issue reviews that are unnecessarily long. It should generally suffice to state the nature of the record, date, person who generated it, and a brief reference to the conclusions. The goal is to be certain that you have reviewed the document and considered it in your conclusions. If need be, one can refer to the original document at a later date.
Each Case Must Be Evaluated on Its Individual Merit with Every Examination a Unique Event. Other than a preliminary disclosure paragraph used at times, MCN does not employ any standard language in reports. We expect that consultants likewise will individualize each report in their own words. Held to the light, no two reports should ever appear the same or close to the same. Clinical boilerplate is not permitted for MCN examinations. Normal findings, if conveyed numerically, should reflect normal range and not a standard value.
Report Findings Must Be Objective and Evidence-Based. Our clients want quality, objective reports, regardless of claim impact. They want reports that are based upon data, not merely a claimant’s self-report. They use IMEs and medical reviews because they want incisive and critical medical thinking. If they wanted a report to repeat the claims of the claimant in the absence of data, they would have no need to spend the time and resources to ask for an IME and would merely accept what the claimant says. The reader of the report (more often than not a non-clinical individual) should be able to understand the reasoning behind the conclusions.
Consultants Must “Stay in the Box.” This means answering each question you are asked, not answering questions you are not asked, and staying within your area of clinical expertise. These are simple concepts, but too often not honored.
Reports Must Be Issued in a Timely Manner. A good examination ceases to be good if the consultant is late on initial report submission, signatures, clarifications, and other actions that delay report issuance. Our clients are often working under time constraints. Delays rarely add value and quality may be diminished with the passage of time as specific details can fade. We rely upon consultants being timely to meet our mutual commitments.
Claimants Must Be Shown Respect During all Interactions. Remember that some claimants are nervous, apprehensive, and often unsophisticated when they report for an examination. They deserve a response to questions and an explanation of procedures as well as appropriate respect for modesty and personal boundaries. Curtness, over-familiarity, and criticism of the claimant or their treating physicians are all to be avoided. Demonstrate respect for claimants as you would want your own friends or family members to be shown respect if they were to be sent for an examination. And write a report that you would respect if issued by a colleague.
Treatment Is Never Offered During an Independent Medical Evaluation. Never offer treatment or comment on current or past treating doctors: Please remember that your credibility depends on being regarded as neutral, objective, and not vested clinically. From time to time a claimant may request that a reviewing doctor assume treatment, and there have been situations when a reviewing doctor has offered his/her own services or even issued a prescription. Offering any sort of treatment, however, should never occur. If there is an urgent medical matter observed during an evaluation, stabilization and referral to an appropriate physician or emergency facility should be undertaken.
Testing Should Only Be Performed as Necessary. Additional diagnostic testing should be only performed when necessary to answer questions posed to the examiner. In many cases testing must be authorized by MCN or the client. In our experience the need for additional testing is relatively infrequent because numerous diagnostic tests have typically been performed prior to the IME, with the results readily available in the medical records.
We are proud of our work at MCN. We have been in the business of performing medical judgment services for almost twenty-seven years and strongly believe in the value of our services to society and the integrity of the company and our consultants. We call upon all involved in requesting and providing such services to adapt and enforce standards that reflect the best of medicine and respect for the dignity of claimants.
Thank you for your support and quality consultations. If you have any questions or comments, feel free to contact Brian Grant at bgrant@mcn.com or 206.447.3449. Mark Doyne may be reached at mdoyne@mcn.com or by phone at 214.762.0784.
Sometimes what happens in Vegas doesn’t necessarily stay in Vegas. Members of Medical Consultants Network’s executive and sales teams just returned from the 21st annual National Workers’ Compensation and Disability Conference and Expo in Las Vegas, NV.
The conference is always an excellent opportunity to meet with clients in person, catch up with colleagues, and attend useful seminars as noted in workers’ compensation industry blog “Managed Care Matters.” We are pleased to have had the chance to learn more about how we can better serve our clients. And none of us minded leaving the Seattle fall (rainy) weather for a few days in the desert.
Medical Consultants Network, Inc. announces the opening of a new office in Southfield, Michigan, serving the Detroit region and supporting the company’s Midwest operations. “Entering the Detroit market allows us to further serve our growing Midwest client base,” says Brian L. Grant MD, company founder and associate medical director. “We have long served the region through our National division and our Chicago office. Our local staff look forward to strengthening close relationships with regional clients and consultants. For me this office has added meaning, since I was born and raised in the Detroit area and attended college and medical school in Michigan.”
MCN’s growing network of credentialed medical consultants includes over 16,000 physicians and related health-professionals nationwide from all medical specialties. The additional Midwest operations center allows for a special focus on further developing this network to meet the needs of our clients.
This marks MCN’s second regional expansion in 2011, following the March enhancement of our Dallas-Southwest office and operations center. MCN experienced a record first quarter in 2011 and continues to experience strong organic growth in existing and new offices across the nation as well as growth in our peer review division.
Medical Consultants Network (MCN) is pleased to announce the appointment of Dr. Mark A. Doyne as Medical Director. “MCN’s integrity, passion, and commitment to excellence and customer service are extraordinary, and I am very excited to be joining their team,” said Dr. Doyne when asked about his appointment.
Dr. Doyne holds his M. D. from the University of Tennessee College of Medicine, having completed an Internship at the University of California, San Diego and residency in orthopedic surgery (Vanderbilt University Medical Center). He is a Fellow of the American Academy of Orthopedic Surgeons , Fellow and past board member of the American Academy of Disability Evaluating Physicians, and Fellow and past president of the American College of Physician Executives. He is board certified in orthopedic surgery, and is a member of the American Medical Association, Texas Medical Association, and the Texas Orthopedic Association.
Dr. Doyne currently serves the Texas Department of Insurance—Division of Workers’ Compensation as a Designated Doctor, member of its Medical Quality Review Panel, and has served as faculty for Designated Doctor and Physician Training Courses. He has also served as a Medical Expert for the Social Security Administration in the field of disability. He has held management and leadership positions in the health care industry including: Vice President, Medical Affairs Curative Health Services; Orthopedic Consultant, Swiss Re/Reassure America Life and Health Company; Medical Director of Conservative Care and Rehabilitation Services at the Texas Back Institute; and as Chief Medical Officer, St. Thomas Hospital, Nashville, Tennessee. He has extensive experience in the oversight of Independent Medical Evaluations (IME’s) and related services and has lectured extensively on disability and orthopedic topics to industry audiences.
“Mark Doyne is a preeminent expert in the field of disability evaluation. His depth and experience will bring value to our clients and management team,” said Brian L. Grant MD, Founding chair and Medical Director . With this appointment, Dr. Grant will be Associate Medical Director. Paul Mayer, President and CEO of MCN added: “Dr. Doyne has a significant presence in the marketplace with ongoing relationships among the Medical Director community. We look forward to working with him toward development of new products for the medical cost containment market. ”
About MCN. MCN is a leading provider of medical assessment and cost management solutions. Through its national carve-out network of physician consultants, MCN serves workers’ compensation, auto, disability and liability insurers and self-insured employers. MCN operates twenty-one offices nationwide, performing over 80,000 ordered services annually. MCN was founded in 1985 and serves all fifty states and Canada.
Revisiting IME Ethics and standards
As founder of MCN and a practicing physician, I am proud of what we do as a company and hold high expectations for ourselves, our consultants and indeed our clients. I write this note with a bit of trepidation, but I have never been known as one to shrink from issues.
What I am addressing is by no means the norm in many or most cases, but there are ethical situations that should not be part of our industry, even at the smallest level. Please review this post in the spirit that it is meant – to improve what we do. Please don’t shoot the messenger. But by all means, feel free to comment on this posting, or privately to me.
It has been almost two years since a major expose in the New York Times regarding certain practices in that region. For those who wish to read this series, please visit:
http://topics.nytimes.com/top/reference/timestopics/subjects/w/workers_compensation_insurance/index.html this page has all the links. Here are links to the individual articles over 3 days:
http://www.nytimes.com/2009/03/31/nyregion/31comp.html?ref=workerscompensationinsurance
http://www.nytimes.com/2009/04/01/nyregion/01comp.html?ref=workerscompensationinsurance
http://www.nytimes.com/2009/04/02/nyregion/02comp.html?ref=workerscompensationinsurance
To my knowledge the matter to a large degree “blew over” in that I am not aware of any significant regulatory or other outcomes on this issue or sanctions against the company featured, though I have heard that they have changed names.
I believe that it may be time to revisit standards in performance of IMEs, especially in regions of the country where we have observed that certain practices that we regard as improper and indefensible may indeed continue to be practiced by certain consultants and IME companies. Not asking, for example, how it can be that they receive and accept examination reports at price points, length and quality that would not be possible elsewhere in the country. All clients deserve the highest quality standards from those they rely upon for important services, which in the case of IME’s means unbiased, thorough, evidenced-based assessments performed by engaged and dedicated consultants.
With recent disruption in the industry, including a very large consolidation of a number of smaller companies, it is our hope that those who oversee large numbers of IMEs will endorse some or all of the points we are raising, and take appropriate actions in their own companies to insure integrity in all exams. Likewise all doctors who examinations must perform at the highest medical standards and not allow a lower standard for IME’s.
The basic principle is to do right by clients, claimants and society. And since we facilitate medical examinations, let doctors do their jobs properly and insist that high standards be followed and maintained.
Clients who order exams generally receive quality exams, but they should still ask questions if they see possible issues, and use common sense. Doctors who do exams, whocan’t or won’t practice in a way that treats each claim and claimant as individuals, with respect and dignity, give the process enough time, write original reports where critical thinking is employed, and remember why they entered (or should have entered) the profession, should not do exams. There are certain acts that MCN finds unacceptable. We believe all involved in the business should feel likewise and take appropriate measures to ensure that substandard performance does not occur. In no particular order they include:
Exams that are too brief: We believe that a reasonable rule of thumb is that an IME should take no less than 30 minutes— and often much longer—to perform. We generally schedule an hour in our own facilities, sometimes a bit less, but never more than two an hour, and we question at times whether this is optimal. The time must allow for review of appropriate records, a history from the claimant, a focused and appropriate physical or mental status examination, and an original report. We have observed with our own eyes the extreme of the company cited in one of the articles I liked cited above scheduling 12 exams in an hour, with an expectation of perhaps 4 no shows and therefore approximately 8 exams to be done. This timeframe is simply impossible. Further, I think that it is also impossible to do 4 proper exams in an hour. Attempting to cut corners on time does not work; it leads to claimants who feel rushed and not heard, reports that are shoddy, and conclusions that are inarticulate if not inaccurate.
Use of Boilerplate in substantive content areas: The history, examination and conclusions must be original. Templates can provide a framework to follow or serve as an introduction or disclaimer. But the words used in an exam should be original. Measurements should be real and reflect human variation. Normal findings if quantified should reflect a range of normal. While a 90 degree flexion for example, might be normal, normal flexion will be vary from 90 degrees, while still in a normal range. So the number would be expected to not be 90. Yet I have observed reports where normal variation appears absent. No two exams should ever look the same in language when it comes to the history, examination or conclusions.
Reports that are too brief: I am not prepared to state how long an exam should be, but can state with a high level of comfort that an assessment of a complex injury with records to review, a history to cite and an examination and assessment to record generally ought to be more than 2-3 pages.
Ghost-writing of reports or examination performance: It is the physician’s job, and his/her’s alone, to take the history, review records, perform a substantive examination and issue the final report. And it should be the physician contacted for the exam who completes this work. It may not be delegated. While rare, we have seen instances where this is not followed, despite clear guidelines on the matter. The physician must not sign their name on the work of others. While it may be the practice of a particular physician to delegate certain practice tasks, that is not the standard in IMEs, and certainly not something to be imposed upon an unaware client or IME company.
Ordering unnecessary tests, especially when personal or corporate gain may be involved: It is no secret that society has been looking very carefully at real or perceived conflict of interests in medical services. Fortunately our clients call us and ask for exams and we don’t drive the demand. But we do expect that consultants make a determination as to whether a particular study is needed. Interestingly, when it comes to typical orthopedic type examinations, we find that the common frequency of ordering of studies in situations where testing is not on site is less than 5%. However we have learned that in situations where physician practices or certain IME companies have X-ray equipment on site, the incidence of use increases to approximately 35%. This is a massive variable and suggests that something may be amiss. The only indication for a study should be if it is necessary for a quality report. Often it is not, or prior studies are more than adequate. If a consultant is ordering common films uncritically, or clients see this taking place, questions should be asked. We believe that clients should consider exercising the option of requiring approval for studies, to insert a bit of friction in the process, especially if X-rays appear to be a norm with a particular setting, consultant or company.
Think about the New York Times test: The homily that one should never do something that they would not mind seeing on the front page of the New York Times holds true. And as you can see above, aberrant behavior in our field made the front page two years ago. Or to frame this in another manner, don’t do anything in our businesses or tolerate practices that we would not subject our immediate family members and best friends to. Some of what I have observed over the years would suggest that if this were the case, some people really dislike their friends and families, to allow certain practices to not only take place, but persist.
Some of these practices have been defended on the basis that questionable claims and claimants may justify them. To this I only can shake my head. Yes there are questionable claims and claimants but this in no way justifies lowering our standards of dignity and respect for what we do as physicians and companies.
Other justifications have included the belief that this is what the client wants and that they are price sensitive and therefore a hurried approach, done cheaply and below standard is therefore acceptable. I don’t believe that clients want claimants to be mistreated, and while price may be an issue, clients realistically understand that quality does carry a price and one can’t cut corners in key areas and achieve a defensible and acceptable product. I believe there may be business risk in the long-term if questionable practices are tolerated. Also, the practice of medicine is the province of physicians, and just as a client would not tell a doctor how to provide treatment, the client hopefully should rely upon ethical and trained physicians to be the final arbiter on examination performance and quality.
The consequences of inattention to ethical medical examination practices creates an uneven playing field in the provision of IME’s; those who do quality work and those who don’t. Some IME provider will take a pass on work at a price that could only be provided sub-optimally. Fortunately we at MCN and many of our ethical competitors are blessed with great consultants and clients who value integrity in the work they do and the examinations they expect. We as a company will continue to strive for the highest standards of integrity. We invite all consultants, clients and competing companies to set similar bars of expectation.
In closing, I invite a dialogue, comments, even respectful challenges to these ideas. We also may have missed some additional issue and areas bearing attention. Please raise them.
Brian L. Grant, MD
Chair and Medical Director, MCN
MCN has watched with interest recent activities in our sector. Managed Care Matters, a widely read blog by Joseph Paduda posted on this today.
For those wondering if MCN is “in play.” The answer is that we are currently focused on the basics: doing good work, with great people, across the US and Canada. As a result of the consolidation, we are now the Second largest company providing our services to the non-governmental market and are the oldest continuously operating national IME company.
Note: An additional comment was subsequently posted on Paduda’s blog
