Review / Cosign on DOT physicals

[CampnPA]

I am an OccMed PA in GA. We do a lot DOT physicals in my clinic and I have been a FMCSA medical examiner for about 7 years now. Just recently a new doctor to our practice has started reviewing DOT physicals, with out the other providers knowing, saying he is doing it as a "quality improvement and standardizing our clinical process"... As I understand it:

1) A CME has the final say in the determination of a DOT physical. 

2) DOT physicals do not require a "review" or "co-signature".

Anyone here dealt with this or have some insight? 

- Cheers

[rev ronin]

42 minutes ago, CampnPA said:

I am an OccMed PA in GA. We do a lot DOT physicals in my clinic and I have been a FMCSA medical examiner for about 7 years now. Just recently a new doctor to our practice has started reviewing DOT physicals, with out the other providers knowing, saying he is doing it as a "quality improvement and standardizing our clinical process"... As I understand it:

1) A CME has the final say in the determination of a DOT physical. 

2) DOT physicals do not require a "review" or "co-signature".

Anyone here dealt with this or have some insight? 

- Cheers

Both statements are correct.  If he wants to re-do your work he can sign his own DOT medical card for the examinee.

[CampnPA]

1 hour ago, rev ronin said:

Both statements are correct.  If he wants to re-do your work he can sign his own DOT medical card for the examinee.

RR - thank you! That was my understanding. Unfortunately I cannot find and specific document that eludes to the fact that the CME who did the physical has the final say; regardless of credentials. 

[sas5814]

Punch him in the face. ok maybe not that. Its been a long week.

 

I did DOT physicals for years and nobody ever co-signed my note and there is no requirement. If he isn't your SP and they aren't his patients he is committing a HIPPA violation by reading their exams. He has no need to know and isn't facilitating care.

 

If he is your SP then he can probably do whatever he wants but I'd call him on it. He cannot override your decision regardless. Like Rev said...have him sign his own cards after he does his own eval.

 

 

[rev ronin]

(Technically Occ Med stuff isn't covered by HIPAA)

[ventana]

Make sure no state law requirement. 
I would then ask him if he is also review other docs notes?

then politely explain you would appreciate it if he stopped.  Period.  Hard stop. 

[sas5814]

30 minutes ago, rev ronin said:

(Technically Occ Med stuff isn't covered by HIPAA)

That's interesting! Given it is a H&P I wonder how that loophole applies. Learn something new every day.

 

Ok I'm going back to punch him in the face. It applies universally.

 

I found this. Seems its mostly OSHA but the rules are very similar and HIPAA may apply in some cases:

 

HIPAA?

 

Edited January 6, 2023 by sas5814

[rev ronin]

51 minutes ago, sas5814 said:

That's interesting! Given it is a H&P I wonder how that loophole applies.

It's not a loophole. The feds have no authority to impose federal restrictions on state workers' comp programs. Anyone can be exempt from HIPAA--just don't participate in medicare, medicaid, or bill insurance electronically.

[ShakaHoo]

It’s ultimately the medical examiners decision…

That being said if some physician wants to “co-sign” - I say let them. If something ever happened I would say they fully agreed with my assessment and plan. 
 

When I have a challenging DOT case, I will document I discussed with my attending physician (whether or not the protects me or not is another story)

[rev ronin]

When I have a challenging DOT case, I send the driver to the appropriate specialist for clearance. I practice team based medicine.

[ventana]

I do not consult an IM doc on DOT

read the reg

make the referral. 
 

we don’t need anything more. 

[ShakaHoo]

16 hours ago, rev ronin said:

When I have a challenging DOT case, I send the driver to the appropriate specialist for clearance. I practice team based medicine.

As do I, however the regulations are very clear that YOU are signing the card, not the specialist. 
 

They can sign off and give clearance on every patient to avoid conflict with their patient, but they are not the NRCME. 

[ShakaHoo]

My patient with history of CABG is stable. 
 

My patient with substance abuse history is stable…

 

My patient with diabetes on insulin is stable…

 

Doesn’t absolve you of the ultimate liability (but does give you a better defense god forbid something ever happen)

[rev ronin]

2 hours ago, ShakaHoo said:

My patient with history of CABG is stable. 
 

My patient with substance abuse history is stable…

 

My patient with diabetes on insulin is stable…

 

Doesn’t absolve you of the ultimate liability (but does give you a better defense god forbid something ever happen)

Here's one area where I think the "rank" structure works in our favor: Board certified cardiologist says post-CABG patient is stable. PA-C accepts board certified cardiologist's letter at face value. Something bad happens. Now... what PA is going to get sued or sanctioned by their medical board for relying on the duly-documented opinion of a board-certified specialist? WE'RE not the ones at the top of the food chain here. We slog through stuff, identify things needing specialist sign off, and then trust the specialist to do his or her job. While anyone can sue anyone for anything at any time, I can't see that getting far at all. Imagine trying to explain to a jury why the PA should be found liable...

[CAdamsPAC]

2 hours ago, ventana said:

I do not consult an IM doc on DOT

read the reg

make the referral. 
 

we don’t need anything more. 

LOL! 

 

[rev ronin]

On 1/6/2023 at 12:58 PM, sas5814 said:

I found this. Seems its mostly OSHA but the rules are very similar and HIPAA may apply in some cases:

HIPAA?

Ok, so I read through that linked article, and it's among the more technically accurate but misleading HIPAA articles I've read. He mentions that most occ med places aren't necessarily covered entities (true), but then goes to write the final 2/3rds of the article as if every occ med practice was a covered entity--that is, one subject to HIPAA. In fact, he should have expanded a bit on how to stay away from being a covered entity, which is realistically achievable for most occ med practices unless they have some need to bill commercial, medicare, or medicaid insurances.

As far as OSHA goes? I send nothing to the employer that's HIPAA-protected info, because every single claim has a blanket, permanent, essentially irrevocable disclosure linked to signing the claim form: employees seeking workers' comp care don't have a choice to NOT consent to data sharing.

[ShakaHoo]

12 hours ago, rev ronin said:

Here's one area where I think the "rank" structure works in our favor: Board certified cardiologist says post-CABG patient is stable. PA-C accepts board certified cardiologist's letter at face value. Something bad happens. Now... what PA is going to get sued or sanctioned by their medical board for relying on the duly-documented opinion of a board-certified specialist? WE'RE not the ones at the top of the food chain here. We slog through stuff, identify things needing specialist sign off, and then trust the specialist to do his or her job. While anyone can sue anyone for anything at any time, I can't see that getting far at all. Imagine trying to explain to a jury why the PA should be found liable...

I agree, unlikely to go that far…

 

However, if the medical review board recommends  X, Y, and Z - for a medical condition…

 

and you accept a specialists clearance letter - when they did not perform X, Y, and Z prior to making their determination….

They can always turn around and say that you are the NRCME, and never informed them of the recommendations…

 

Unlikely yes, impossible, No.