Audiologists as QMEs? Keeping Focused on the Big Picture

Earlier this year, Assembly Insurance Committee Chair Jose Solorio (D-Santa Ana) introduced Assembly Bill 1454, which would allow audiologists under certain conditions to be qualified medical evaluators (QMEs), but the constant theme from the Governor's Office has been that he did not want to deal with this volatile issue on a piecemeal basis.

Earlier this year, Assembly Insurance Committee Chair Jose Solorio (D-Santa Ana) introduced Assembly Bill 1454, which would allow audiologists under certain conditions to be qualified medical evaluators (QMEs). One might be tempted to look at this as yet another example in the long history of California allowing a broad spectrum of health care professionals to engage in disability evaluations and medical treatment.

On closer examination, however, AB 1454 is identical to legislation sent to former Governor Schwarzenegger in 2007 — Senate Bill 557 (Wiggins). That bill ultimately passed out of the Legislature unanimously after a series of amendments that accommodated the concerns of various professional groups, such as the California Medical Association, and the Department of Industrial Relations. It apparently did not, however, remove the opposition of the Governor, who vetoed the bill.

So here we are in 2012 and the bill as enrolled (sent to the Governor) in 2007 has been reintroduced. There should be little if any opposition, right? Well, not so fast. The absence of opposition is not always a guarantee of legislative success — especially when there is the potential of a "big deal" on an issue in the Legislature. Workers' compensation squarely falls within that maxim.

In 2011 a number of proposals changing aspects of the workers' compensation system, including changes to the supplemental job displacement benefits and further expansion of temporary disability benefits made it to Governor Brown's desk only to be vetoed. The constant theme from the Governor's Office was that he did not want to deal with this volatile issue on a piecemeal basis.

This year, the Department of Industrial Relations is spending much of April on the road soliciting input from stakeholders across the state on how the system is performing. On March 28, the Senate Labor and Industrial Relations Committee and Assembly Insurance Committee will hold a joint hearing to discuss the effect of the SB 899 reforms on permanent disability benefits.

One might be tempted to think that all this activity may signal a larger bill in the works. Certainly there has been no shortage of reports, reviews, and commentary from the Commission on Health and Safety and Workers' Compensation (CHSWC) on what troubles this system and how to fix it. The empirical analyses they have undertaken over the past several years sets out a fairly comprehensive road map for changes that would strongly suggest we already know what to do to curb the alarming rate of increases in medical costs, the abusive practices of lien claimants and time consuming and costly litigation over permanent disability.

So, where's that bill? It doesn't exist, yet. And it probably won't until fairly late in the legislative session — perhaps as late as August. Through a variety of procedural rules and votes, a bill as potentially large and complicated as a major workers' compensation overhaul will always find a placeholder that has been parked in a strategic holding pattern awaiting what is affectionately called a "gut and amend" to put in language largely vetted by the major stakeholders in the system.

Will that happen in 2012? No one can be absolutely certain of that in early March. But one thing that is highly probably — bills such as AB 1454 won't be on a fast track to Governor Brown's desk until the bigger picture is resolved.

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