EMG and NCS reports performed by 'non-prequalified' physicians are found to be unreliable

Oct 26 2009

In a recent study of workers’ compensation injury cases, Electromyography (EMG) and Nerve Conduction Studies (NCSs), which were performed by physicians who were not evaluated and pre-determined to meet a certain level of quality, were discovered to be highly unreliable. In fact, 68 percent of the medical reports from these “non-prequalified” physicians were determined not to be medically useful.

One Call Medical, the nation’s premier leader in diagnostic testing for workers’ compensation, presented the study results at this year’s Annual American Association of Neuromuscular & Electrodiagnostic Medicine (AANEM) Meeting, and the results are also published in this month’s issue of Muscle & Nerve.

EMG and NCSs are essential in determining the existence and extent of muscle and nerve damage in an injured employee. When EMG and NCSs are performed incorrectly, treating physicians may make treatment decisions based on inaccurate information. This can derail a patient’s entire treatment plan, leading to unnecessary or inappropriate medical services, delays in recovery, and extended disability.

“In the field of electrodiagnostic medicine, the quality of providers varies widely,” said Dr. John Robinton, One Call Medical’s medical director and chairman of the Neurodiagnostic Medical Advisory Board. “The good news is One Call Medical has established a rigorous provider credentialing process, wherein we carefully select providers who meet and continually adhere to quality standards. By using this type of pre-qualified provider network, the workers’ compensation industry can ensure the medical usefulness of EMG and NCS results.”

The study reviewed 140 reports to assess the medical usefulness of EMG and NCS reports performed by providers who had not undergone a pre-qualification process. Each report was graded by an American Board of Electrodiagnostic Medicine board certified neurologist who was also certified in clinical neurophysiology. Failure to satisfy medical usefulness was determined by factors that included, but were not limited to: a lack of adherence to AANEM guidelines, incomplete examination information, and data inconsistency and unreliability.

Out of the 140 NCS/EMG reports reviewed, 68 percent were considered not medically useful. As a result of the quality review, surgeries were cancelled in a number of cases, and repeat studies were requested by other physicians.

One Call Medical’s solution to the problem of unreliable EMG and NCS is threefold:

• A Network of Quality Providers. One Call Medical is the only company to establish a network of quality EMG and NCS providers. Using a rigorous credentialing process, it has selected only the best neurologists and physiatrists. Its credentialing process includes a clinical review of sample tests to ensure adherence to report standards.
• Ongoing Quality Improvement. On an ongoing basis, One Call Medical’s Clinical Services team reviews all provider reports to ensure continual adherence to quality guidelines and proprietary standards. Through continued monitoring, One Call Medical can detect deficiencies and take corrective action to improve outcomes.
• Quality Review. One Call Medical offers payers a “Quality Review” for EMG and NCSs performed outside its network. By requesting this service, payers can obtain an opinion of whether an EMG or NCS was appropriately performed, and if the exam is medically useful.