Jon B Tucker M D Medical Director Tucker
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 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 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 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 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 6 th 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 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. Mc. Nulty, J. D. , Chief Executive Officer � � Phone: 412 -276 -6241 Website: www. tuckerime. com Facebook Linked. In
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