1. Medical Evaluations Division NMC-6 Laura G
Medical Evaluations Division NMC-6 Laura G. Gillis, MD, MPH, FACOEM Chief, Medical Evaluations Division

2. NMC Mariner Medical Evaluation Process Medical Evaluations Division:
Our focus:
Consistency,
Fairness,
Use current standards of care,
Do what’s right for public safety
When fully staffed, 35 people total
Three physicians, 14 physician assistants
Staff of clerks and Certified Medical Assistants
One Administrator, 1 Program Analyst, 2 Health System Specialists
Review about files per month.

3. Specialist: Ms. Deborah Mercer, HSS Reconsiderations Dr. Thomas Stone
NMC-6 Division Chief
Dr. Laura Gillis
Operations Chief
David McGhee, MED2
Performance Analyst
Kathleen Moffitt
Kaththoffit, HSS
Screening
Specialist: Ms. Deborah Mercer, HSS
Reconsiderations
Dr. Thomas Stone
Dr. Mario Fajardo
Evaluations Specialist: Ms. Diane Hartner, HSS
Government Reviewers GOV PA- 6
CMA Contract Support
CMA – 10
PA Contract Support
CTR PA - 8
Clerical Contract Support
Clerks- 4

4. The Evaluation Process
Team Member Responsibility
Level of Review
Medical Screeners (CMA)
Waiver
Forward to Evaluator
Medical Evaluator (CTR PA)
Forward to 2nd Level
Government Reviewers( PA/ MD)
Denial
Screening
Initial Medical Review
2nd Level Review

5. NMC-6 Personnel Government Staff Contract Support
Responsible for process and quality of mariner fitness for duty determinations
Denials/ Reconsiderations
Medical Screening
Initial Medical Reviews
Data Entry and File Accountability
Inventory Management
Contribute to improvement of Division processes

6. NMC Mariner Medical Evaluation Process
Additional Medical Information (AI)
Rate-limiting step of the process
70-80% of reviewed 719Ks lack supporting objective documentation of medical conditions
Recent process changes have significantly improved consistency and reliability of information requested
NVIC provides guidance for requesting AI, but is outdated in some areas and inconsistent with current clinical guidelines in others
Patient advocacy statements vs objective data

7. Quality Assurance Review Program Process Improvement
Gov’t PA Quarterly Review of CTR performance.
Physician Quarterly Review of Gov Reviewers
Quarterly assessment of division performance
Section Team Leaders
Monitors Screening and Medical Processes
Updates MMS
Quarterly Q/A of work by screening and evaluations branches.
Since backlog was eliminated and staffing levels are now almost full, focus has shifted to QA and further process improvement. In the case of the Medical Division, this includes not only the actual process of how evaluations occur, but also going back and reviewing medical literature and clinical practice guidelines to insure that our fitness for duty determinations reflect the most current medical practice.

8. Quality Assurance Q/ A Focus Group MMS Review Schedule
Monitors quality of division work and deliverables
Comprised of Evaluation, Screening, Clerical, Gov’t, & Contract Staff
Responsible for Semi-Annual assessment of Division performance
Can recommend process changes, new initiatives and training
Quarterly review of MMS Documents
Ensures performance mirrors documented processes
ISO 9000 organization; continually looking for ways to improve our process.

9. Performance Measurement
Quality Assurance
Performance Measurement
Training Program
Daily Inventory Tracking
Daily Throughput Measurement
Performance Database
Performance Templates
New Employee Orientation
Bi-Weekly Training (Annual Calendar)
Teachable Moments

10. NMC Medical Performance Update
Week
Total Calls
Mariners
Dr's AI
Recons & Appeals
Denials
Waivers
25-Jul
349
78%
22%
67% 8% 5% 3%
1-Aug
358
77%
23%
59% 9% 6%
8-Aug
364
87%
13%
71% 4% 7%
15-Aug
310
82%
18%
56%
22-Aug
282
84%
16%
57% 2%
29-Aug
225
88%
12%
42%
Weekly Calls to Customer Service Handled by a Medical Team Member
Periodic Inventory Status Update of Files Flowing Through the Medical Team

11. Medical Evaluation Application In-Processing Medical Screening
Medical 1st Level Review
Medical 2nd Level Review

12. Medical Denials Top Denial Diagnoses: Coronary Artery Disease
2009
2010
2011
Applications Received
74741
60866
46866
Medical Denied
466
650
794
% Medical Denials
0.6%
1.1%
1.7%
Top Denial Diagnoses:
Coronary Artery Disease
Uncontrolled Diabetes Mellitus
Chronic use of Narcotics, Benzodiazepines, Sedative-hypnotics Medications
Uncontrolled Sleep Disorders
Unstable Mental Health Conditions
Seizures

13. Hot Topics Merchant Mariner Medical Advisory Committee (MMMAC)
Inaugural meeting occurred September 19-21, 2011
Composed of 10 medical professionals and 4 mariners
Committee accepted three tasks:
Top 10 Medical Conditions
Development of the Designated Medical Examiner Program
Comments to the STCW proposed rulemaking

14. On the Horizon Electronic submissions/IT overhaul
Designated Medical Examiner Program
Revisions of guidance documents (NVIC)
In conjunction with recommendations from the MMMAC
Evidenced-based approach in conjunction with current standards of care
Revision of Physical Exam Forms (719K and K/E)
Even though funding is uncertain in this economic climate, we are moving forward in the preliminary research and planning stages for different essential projects.

15. Questions?