The Essential IME and IRE Jon B. Tucker, M.D. Medical Director Tucker IME, Inc. Pittsburgh, PA The Essential IME and IRE

Specialties: Addiction Adolescent Medicine Cardiology Chiropractic Dermatology Electronic Medical/Health Records Endocrinology Geriatrics Gynecologic-Oncology/Robotic Surgery Internal Medicine Neurology Neurosurgery Neuropsychology Oncology

Specialties continued… Ophthalmology Oral and Maxillofacial Surgery Orthopedic Surgery Otolaryngology Pain Management /Addiction Medicine Pediatric and Maternal/Fetal Cardiology Physical Medicine and Rehabilitation Psychology Psychiatry Radiology, Neuroradiology Thoracic Surgery Traumatic Brain Injury/Concussion/Neuroradiology Urology/Urological Surgery And Many More

Tucker IME Locations Physicians serving various regions including: Philadelphia/ Eastern PA Central PA Pittsburgh/Western PA Ohio West Virginia Texas

Components of an IME Interview Diagnostics Physical Examination Imaging studies Objective testing Laboratory Physical Examination Medical Records Review Expert Opinion Recommendations

Interview History – examinee’s perspective Q and A History of the injury Mechanism of injury Relevant past medical and surgical history Pre-existing disorder(s) Examinee’s theory of injury Treatment history, examinee’s perspective Occupational disability history

Interview Current complaints Symptoms Ongoing or planned treatment Medications Work status

Diagnostics Imaging Studies Objective testing Provide the images Forensic interpretation differs from radiological reports Current imaging or new imaging can be helpful Objective testing Lab data Electrodiagnostic studies Specialty driven testing (non musculoskeletal)

Physical Examination More than 80% of IMEs are musculoskeletal General condition may or may not be helpful to document Body habitus Gait pattern, body station Hygiene Overall health appearance Substance abuse suspicion

Physical Examination Focus on injured body part(s) All areas Spine General appearance and condition Observational examination (very important) Peripheral neurological examination Range of motion Symptom magnification/pain behavior mannerisms Level of cooperation with examiner Spine Shoulder , upper extremity, hand Stability/Instability Specific functional examination tests

Physical Examination Hip and lower extremity Gait Alignment Specific exam maneuvers for stability/instability/joint disorders

Records Review Chronological, by provider Synopsis of the “high points” Avoid any emphasis of prejudicial opinions made by others Separate by category, expert v. non-expert General medical Occupational medicine Specialist Allied health Testimony

Expert Opinion We divide into two sections “Impression” “Recommendations”

Expert Opinion Impression Diagnosis (es) Causation Relatedness Aggravation

Recommendations Prognosis MMI Disability Additional treatment Relatedness of ongoing/additional treatment to the injury MMI Time to MMI Full functional recovery? Disability Past, present, future Ability to return to work

Physician’s Estimate of Physical Capabilities General format is Dept. of Labor Guidelines Sedentary, Light, Medium, Heavy Body position and time limitations Upper Extremity position/effort limitations Lower Extremity position/effort limitations Special considerations and limitations TEMPORARY VS. PERMANENT FCE NEEDED?

Impairment Rating Exam (IRE) An IRE is an IME PLUS Determination that MMI has been attained An AMA Guides to Permanent Impairment 6th ed. rating is calculated MINUS No opinion of causation/aggravation rendered No opinion of occupational disability rendered

MMI Maximum Medical Improvement MMI is reached after sufficient time has passed for healing and recovery expected to occur from the treatment methodology chosen.  All reasonable medical treatment has been offered and it has reached an effective clinical plateau beyond which significant improvement or decline is not anticipated In practice, the condition is not expected to appreciably change in the next 12 months.

Repeat IMEs When to do MMI not attained at prior exam Temporary PCE rendered at prior exam Prior exam was difficult Ongoing disability Change in condition Questionable treatment Case management checkpoints Termination/suspension/C&R

Utilization Reviews Essentials Pitfalls Record Review Medical necessity and reasonableness only Pitfalls Need to speak with treating physician, in practice this is very difficult Lack of examination, must rely upon the diagnoses rendered by others Practical use should be coordinated with IME

Option to Treat after IME It happens! Avoid in most cases Must meet all three criteria Examinee/IW, employer/TPA, and physician must all agree IME physician, as a treating physician, has superior treatment skill/knowledge/expertise and the trust of the IW Generally, the employer/TPA must be SURE that their IW will not receive appropriate care in their current setting

Questions/Comments Contact us at Tucker IME anytime to help find the best expert or team of experts for your needs. Jon B. Tucker, M.D., Chief Medical Director or Eleanor P. McNulty, J.D., Chief Executive Officer Phone: 412-276-6241 Website: www.tuckerime.com Facebook LinkedIn