Recently ignitephysio podcast hosts Andrew Koppejan and Maxi Miciak sat down with physiotherapists Jeff Begg and Simon Cooke, along with Julie Chartrand, medical claims advisor with Peace Hills Insurance, across two interviews (see here and here) to chat about MVA regulations in Alberta and common challenges that come with managing MVA patients.
This article is part of a series covering car accident treatment within Alberta, specifically looking at the Diagnostic & Treatment Protocol Regulations (DTPR). You can read a backgrounder on the DTPR here or read our article on common challenges here. This particular article dives into the topic of the Injury Management Consultant — a roster of experienced healthcare providers that can support therapists in treating more challenging MVA cases.
IMCs within Alberta have been underutilized by those treating MVA patients, as Simon pointed out in the podcast, “I would say the majority of new physiotherapists don’t know they exist and I would think that with some of the conversations I’ve had with insurers as well, particularly new adjusters, don\’t understand the process either.”
What is an IMC?
As discussed in this article here, the IMC or Injury Management Consultant is a primary healthcare provider that meets certain requirements and experience with MVA patient care under the Diagnostic & Treatment Protocols Regulation (DTPR).
As Simon shares in the podcast, the IMC was designed with two purposes in mind. “One was to confirm a diagnosis so if a therapist had made a diagnosis of say WAD 2 and then was concerned perhaps in the first three weeks, ‘Maybe this isn’t the right diagnosis’, they could refer that patient out to an IMC.”
The second reason for referring to an IMC would be “to ask for help with the treatment plan, [you might say] ‘the patient is progressing at a rate that is slower than I would expect, or they’re presenting in ways that I don’t feel comfortable assessing and treating. Can you please provide some treatment recommendations for this patient?’”
The IMC brings an additional, experienced perspective to the management of the patient, and doesn’t focus solely on a tissue-based evaluation, but also looks to incorporate a biopsychosocial perspective. As Simon points out. “The IMC would evaluate the patient …. with a preference towards a biopsychosocial model of care. Looking at bigger things than just structural medical tissue at fault… “
As the referring healthcare practitioner, you (and the insurance company) will receive a detailed report from the IMC giving details of their assessment as well as a detailed treatment plan.
Understanding the IMC Referral Process
Sending your patient to another practitioner for a second opinion does not mean that you are going to lose your patient.
They’re your patient.
All you are doing is consulting with a colleague who is going to either confirm your diagnosis and treatment plan, or give you suggestions on how to better treat your patient. It is also a great opportunity for professional development, and to deepen your local network of colleagues.
To make an IMC referral, you will need to complete the AB-5 Form. You can view the form here and you can access a fillable PDF version from Alberta Finance here (you will need Adobe Acrobat to view and complete the form).
The key is to fill out the form with as much detail as possible, highlighting any specific questions or concerns you may have. You may feel confident with certain patient injuries, but are unclear regarding a specific body part or set of symptoms. Jeff recommends including this information in your referral so the IMC knows where to focus their evaluation. As he highlights “It\’s really up to their referring practitioner, but the more specific questions you ask, the more detailed answers you\’ll get.”
Some things to consider when choosing who to refer your patient to are:
- Proximity of the IMC physiotherapist’s office to the patient’s home
- Availability of the IMC to see the patient
- Area of practice most applicable to patient specific needs (biomechanical, pain specialty, etc.)
- Practitioner’s availability
Given the limited use up until now of the IMC process within the province, it’s important that you have open communication with the insurance adjuster. Although you’re authorized to refer for an IMC consultation, it is helpful to keep the insurance adjuster in the loop.
Simon recommends connecting with the insurance adjuster as it can help improve the overall relationship and collaboration, which in turn improves patient care. “I would notify the insurer by telephone [by saying], ‘Hey, an IMC referral will be coming across your desk, just so it doesn\’t surprise you’ and then you fax the referral form off to the IMC and to your insurance company. That would be the process I would follow. Technically, the phone call part doesn\’t have to happen. You could simply just do the referral. The fax will go to the therapist and to the insurer and that will be how the insurer would find out, but with past experience being what it is, I\’ve learned that the phone call goes a long way to smoothing over the process.”
When Can You Authorize an IMC?
There has been confusion within the physiotherapy community, as well as with insurers, regarding if and when primary healthcare providers such as physiotherapists can request and/or authorize IMC referrals.
It’s important to recognize as primary healthcare providers within Alberta, the power of language. Within defined parameters of the DTPR, you are authorized to refer a patient to an IMC.
During the podcast interview with Jeff and Simon, Jeff highlighted that distinction.
“We’re not requesting that the insurer [authorizes] it,” explains Jeff, “because there\’s nowhere in the regulations that say we need to request. In fact what it says is that a health care practitioner may authorize a visit to an IMC et cetera. We are also required to send the referral form not just to the IMC person but to the adjuster so we are informing the adjuster by paper in writing why we\’re doing this.”
We spoke to John Ryan, Compliance Officer at the Superintendent of Insurance Office, who confirmed the following regulations:
- If a client with a WAD 1 or 2 injury has alerting factors that may influence prognosis, the health care practitioner must seek to reassess the client within 21 days of the accident, and if the injury is not resolving, authorize a visit to an IMC for an assessment.
- If the patient has used up all the visits authorized under the regulation (10 or 21 depending on the injury), or if 90 days have passed, the insurer must first approve the IMC.
- In the time period between 21 and 90 days and while the patient still has not used up their authorized visits, the PT is not required to gain approval from the insurance company for the IMC.
- Section 16(5) of the DTPR is the only section that requires approval from the insurance company, and only after 90 days or 10 or 21 treatments depending on the WAD severity.
Key Takeaway: There is no need to request permission for an IMC referral from an insurance adjuster within the protocols (90 days from date of accident), unless the patient has used all of the treatment visits they are authorized under the DTPR. Although it’s preferable to make an IMC referral within the first three weeks when alerting factors should be identified, it is not required.
What Can You Do If You Get Pushback From The Adjuster?
As mentioned earlier, some adjusters may not be familiar with the regulations relating to IMC referrals and you may receive pushback regarding your referrals.
Jeff has experience dealing with adjusters who aren’t familiar with the process, “I\’ve had adjusters say to me ‘I\’ve been doing this for eight years and I\’ve never heard of anyone doing an IMC before.’ That’s no fault of their own, but we need to… tell them we\’re just going by the regulations, tell them the page number if you want, highlight it in your book and just state to them that this is what we\’re doing, and here\’s why.”
If things get unpleasant, remember that you can direct insurance adjusters to request clarification from Compliance Officers within the Superintendent of Insurance\’s office.
How Do I Find an IMC?
There is a roster of physiotherapists on the IMC register which can be found here.
Make sure to check out our other articles that discuss overcoming common challenges associated with MVA caseload management here and important backgrounder information on the DTPR here.