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Mark van Hemert, DC, DACS
IME was originally an acronym for independent medical examination, but the IME doctor is now chosen by and paid by the insurance industry. The acronym now stands for insurance medical examination.
The most recent development in the insurance medical examination has been the multidisciplinary examination, where a chiropractor and a medical doctor, both with higher credentials than the average clinician, examine the patient simultaneously.
This creates an appearance of a high level of specialization and expertise. The opinion in a majority of these reviews is that care beyond two months is not needed. The rational is that the laying down of scar tissue is completed by the eighth week and therefore further treatment in not medically necessary or therapeutic.
They state that the patient is at maximum improvement and no further treatment is necessary. This rational does not consider the remodeling and strengthening of scar tissue, nor the need to restore maximum joint function.
However, without an attending physician who is knowledgeable about the guidelines and who has accumulated objective data of improvement, the professional response to this rational will be based solely on opinion and not fact.
Mercy specifically does not give a limit for reasonable care, but observations, assessments and the definitions of care based on scientific evidence.
It states that these guidelines are not designed to be a cookbook. The listed time for acute stage of care ranges from 8-16 weeks, depending on which of three cited references you go by.
In reviewing those references, I believe that the eight weeks refer to the acute healing cycle of the injury, and the 16 weeks to the acute physiology or rehabilitative healing time.
The healing and rehabilitative acute stages are followed by the subacute stage, before the unresponsive chronic phase of function and pain begin. Rebuttals of IME opinions using the Mercy guidelines increase your credibility when justifying your clinical rational to claims adjudicators.
The insurance industry recognizes the Mercy document as the authority in the chiropractic profession. The parameter of clinical practice that Mercy most fully addresses is the trauma induced patient.
Perhaps if "Acute Traumatic Cases" had been added to the title of the guidelines the criticism of the document would have been muted. Mercy creates a solid, well thought out guideline for the traumatic personal injury and workers' compensation case.
Mercy very effectively deals with narrow minded, nonflexible professional rational and makes the third-party payers conform to a set of standards which is fair to the patient and respectful of.
Read More of this article
- Well Managed Chiropractic Soft Tissue Injury
- Managing Soft Tissue Injury with Chiropractic
- Soft Tissue Treatments Personal Injury Case
- Frequency of Care for a Soft Tissue Injury
- Treatment Times for a Soft Tissue Injury
- Orthopedic Supports for Soft Tissue injuries
- Special Tests for Soft Tissue Injuries
- Narrative Reports for Soft Tissue Injuries personal Injury Cases
- End Points of Care Personal Injury Case
- Prognosis & Fees Personal Injuries Personal Injury Case
- An Introduction to Outcome Assessment Personal Injury(Part 1)
- Outcome Assessment personal Injury(Part 2)
- Personal Injury Outcome Assessment(Part 3)
Writers Bio
Dr. Steven R. Jones is a licensed Chiropractor in the state of California. He received his doctorate from Palmer College of Chiropractic-West in Sunnyvale, California. Dr. Jones has treated his patients for over 15 years at his own San Diego Chiropractic practice.
Dr. Jones is accepting new patients and would be happy to consult with you regarding your chiropractic needs.
Call Steve Jones at
(619) 280 0554
San Diego Chiropractic
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Chiropractic San Diego Website to make an appointment
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