One Call Care Management’s John E. Robinton, M.D. Heads Special Interest Group on Quality Issues, Fraud & Abuse in Electrodiagnostic Medicine

Workers' compensation and other lines of insurance are impacted by quality issues, fraud, and abuse that exist in electrodiagnostic (EDX) medicine, according to John E. Robinton, M.D., medical director at One Call Care Management (One Call).

According to a release, Dr. Robinton curated and moderated a Special Interest Group (SIG) to discuss these concerns at the 2013 American Association of Neuromuscular & Electrodiagnostic Medicine (AANEM) Meeting in San Antonio, Texas.

Dr. Robinton is one of only five percent of physicians across the country board certified in both Electrodiagnostic Medicine (ABEM) and Clinical Neurophysiology (ABPN-CN). He owns and operates the first AANEM-accredited electrodiagnostic laboratory in the state of New Jersey and achieved the additional distinction of "Accreditation with Exemplary Status."

"Due to his extensive experience in evaluating and addressing quality issues, and his role as a consultant to New Jersey's attorney general and insurance companies regarding Electromyography (EMG) fraud and abuse, Dr. Robinton was selected to develop and lead AANEM's first SIG to explore these concerns," said John Stanzi, president of One Call Care Diagnostics.

"Organizing this group is part of my commitment to quality care. I'm happy that this first group meeting and panel discussion were well received, and we hope it will be the first of many to follow," said Dr. Robinton. "My goal for this event was to create an open forum and bring together experts from different fields, so we could explore the issues from various perspectives with the objective of finding solutions to improve the quality of care patients receive, and to reduce fraud and abuse."

The panel represented a mix of public health, medical, legal, insurance, and investigative expertise, and included:

-Joanne Pearson, MA, BC, "Quality Improvements in an EMG Network"

-Adam Seidner, MD, "Accountable Care Organizations: How a Culture of Shared Values and Beliefs May Lead to Improvements in EDX Medicine"

-Mike Gallagher, Special Investigative Unit, and , "Understanding Fraud Examinations"

Joanne Pearson, director of clinical services at One Call, was the only presenter to address quality of testing on the panel. Pearson cited four studies. The most significant was a 2009 study of workers' compensation injury cases, in which 68 percent of EMG and Nerve Conduction Studies (NCSs) performed by non-prequalified providers were found to be not medically useful.

One Call has developed many initiatives to ensure quality in electrodiagnostic services:

-Neurology Advisory Board. One Call established a nationally recognized advisory board, which consists of five past presidents of the AANEM. Dr. Robinton and members of this board wrote the national guidelines for reporting standards for EMG in the United States.

-Quality-driven EMG/NCS Network. One Call has established a stringent provider application process, and today, offers the nation's only quality-driven EMG/NCS network. This network consists of only neurologists and physiatrists who meet and continue to adhere to quality standards on behalf of One Call clients and the injured worker. Within this network, One Call schedules over 60,000 EMG studies a year.

-Quality Review. For payers wanting to confirm tests are performed appropriately and results are medically useful, One Call offers a complimentary Quality Review service for EMG and NCS performed outside its network.

One Call Care Management (One Call) is a provider of specialized services to the workers' compensation industry that lead to faster, more efficient and more cost effective claims resolution.

More Information:

http://www.onecallcm.com

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