Updated June 26, 2020
The novel coronavirus 2019 (COVID-19) pandemic has necessitated that physicians reappraise how they accomplish many tasks, including how they assess impairment and perform independent medical evaluations (IMEs). Because no one knows how long the pandemic will last, stakeholders need information from evaluations to make claims decisions and achieve claims closure as people’s livelihoods are at stake. It is essential to develop new approaches for completing IMEs.
Download "Virtual medical and impairment assessments" (PDF), by Christopher R. Brigham, MD, et al., from the May-June 2020 AMA Guides® Newsletter.
Paradigm shift in IME
According to the authors, best practice standards for IMEs were published in Sept.-Oct. 2017, which, unfortunately, are not met by many IMEs. As the medical world advances telemedicine practices, this paradigm shift in IME could be used as an opportunity to improve the quality of IME work. Through this article, the authors hope to provide insights into virtual assessments and offers guidance on how to conduct IMEs efficiently and effectively.
IME policies, procedures and security
The authors discuss the need for appropriate policies, procedures and security, which is similar to telemedicine for clinical care; however, unlike most virtual care in telemedicine, virtual IME needs to incorporate video and audio. In tandem with laying the policy groundwork to prepare for virtual IME, multiple data sources (referral letter, medical records imaging, examinee history, etc.) are needed for an evaluation and how each element is amenable or not to the virtual environment.
Some aspects of the physical examination, especially for musculoskeletal and neurological assessments, are not amenable to virtual assessment. The authors acknowledge that with some evaluations, such data are crucial, particularly when the data are not available in other documents and/or when the reliability is questionable.
Adequate and fair reimbursement for virtual evaluations
In addition to outlining the pertinent fundamental information for each component and step-by-steps needs of a virtual IME from the examinee, physician, referral, technology or agreement to getting informed consent, the authors discuss the need for adequate and fair reimbursement for virtual evaluations, which may be mistakenly understood to be inferior or to take less time. In the authors’ opinion, virtual evaluations may take the same amount of time or more as an in-person evaluation. Therefore, the fees should be commensurate with the time and effort involved.
Performance of virtual evaluations
The performance of virtual evaluations are new issues for payers, jurisdictions and the law. Workers’ compensation jurisdictions will likely react differently to the use of virtual IMEs. Some jurisdictions may not permit them and prefer to delay case progress until it is safe to perform an in-person examination. The longer the pandemic lasts, the more likely it is that virtual evaluations will improve the evaluation process and will gain widespread acceptance as a viable methodology for decision-making and claim determination, according to the authors.