By Dr. Steven G. Crawford, MD, CIME, IMX Medical Management Services
Most of us working in the field of occupational medicine are familiar with the term “independent medical examination,” most commonly referred to as an IME. However, many are not fully aware of what an IME is. In fact, an IME can serve multiple purposes depending on the needs of the requesting party. This article is designed to give you an overview of IMEs, why they are requested, and what requirements are necessary if you are considering expansion of your services to include offering IMEs.
Basics
A simple and broad definition of an IME is an “examination performed by a physician who is not connected to or involved with the patient being examined.” The examiner is therefore “independent.” Often included in this arrangement is the understanding that the physician is not treating the examinee currently and has not treated him or her in the past. Notice I’m using the word examinee (not patient) to refer to the individual being evaluated, and that is because the IME is not intended to provide treatment. In the IME scenario, the examinee is not a patient, and the physician is not treating the examinee, unlike the usual patient-doctor relationship. No “doctor-patient relationship,” in a legal sense, is being implied, and no treatment is to be rendered. In the simplest terms, the doctor is the “examiner,” and the patient is the “examinee.”
Purpose of an IME
There are many reasons to request an IME, and the reasons are often associated with the intent of moving a case toward closure. Reasons for IMEs can include second opinions in surgical cases, to address the need for additional treatment, or to determine if the IW’s recovery has medically plateaued. IMEs can also help to determine if an IW can return to the prior level of employment. When complicated cases seem to be out of control, an IME can provide a review with future treatment options. The caveat here is to make sure the examining physician knows what questions are being asked!
What Is Required?
From a staffing perspective, the requirements for the office and support staff are minimal and are usually already in place. A greeter at the front desk and back-office staff to set the patient up for the evaluating physician are essential for an office already seeing patients, so minimal adjustments, if any, will be required. The scheduling system is already in place as is the process for handling the medical records. The clinical space is likely already in place, too. The requirements include an examination room and a workspace for the physician. A dictation system is required as the reports are typically typed letters to the requesting party. Finding the physician to do the exam may be more challenging as the physician needs to have experience in the field of on-the-job injuries and have an in-depth knowledge of the workers’ compensation system. The physician must have the requisite certification in the field in which they practice and, ideally, have an interest in doing the exams. Revenue sharing or other financial incentives could possibly pique the interest of the physician.
Marketing
To increase patient volume for new, or established services, involves marketing to the client, and IME services are no different. The target audience here includes the gamut of players in the field of workers’ compensation. Relationships with employers, insurance companies, third-party administrators, and legal firms are critically important to building referral sources for IMEs. The advantage here is your practice likely already has contact with these players, which creates “warm doors” for the marketing team to open.
The Deliverable
There are many components to establishing an IME business (scheduling, handling medical records, report production, etc.), but most important is the IME report, the deliverable. It is the final product the requesting client sees, and producing high-quality reports is the best way to grow the business. The report should include a detailed history of where and how the injury occurred (mechanism of injury) and the treatment rendered as a result of that injury. This information comes from a thorough review of the medical treatment records. The examiner also performs an interview of the examinee and inquires about prior injuries, current medical conditions, recreational activities, and employment history. A thorough physical examination is then performed with special attention to the injured body part in question. The examiner then assimilates all of the gathered information and answers the questions asked. Perhaps the most important component of the report is the evidence-based medical explanation behind the opinions and conclusions offered.
Summary
An IME can be many things and can serve multiple purposes. Adding IME services to your business does not require many adjustments for your established clinic; the key is taking advantage of relationships you already have and finding a qualified doctor to provide the service.
