Clinical Evaluation LLC
Case Review Services
We offer case review services. These include the evaluation of individual and multiple cases for medical necessity and appropriateness of the level of service, for the evidentiary bases of interventions provided, and for indications of the provision of substandard care.
- Experience includes case review for Veterans Health Administration programs (in medicine, surgery, geriatrics, rehabilitation, prosthetics, spinal cord injury, mental health, and diagnostics), and for the Medicare program.
- We currently provide consultation to the Office of Medicare Hearings and Appeals.
- The Director of Clinical Evaluation LLC was selected as a consultant to the ECRI Institute for their contract to operate, enhance, and maintain Web-based initiatives for the U.S. Agency for Healthcare Research and Quality (AHRQ).
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We have provided consultation in the private sector and have published
in the medical literature on various malpractice issues.
South Med J. 2005 Nov;98(11):1083-7. PMID 16351028
OBJECTIVE: Although claims databases are not representative of all care delivery, their predisposition toward serious unintended injury can complement resource-intensive chart reviews and guide patient safety initiatives. MATERIALS AND METHODS: Non-Veterans Health Administration (VA) practitioners reviewed 1,949 VA malpractice claims paid during fiscal years 1998 through 2003. The portion associated with substandard care, the severity of harm, and types of negligence were identified. RESULTS: Negligent adverse events occurred in 37% (n = 723) of paid VA malpractice claims. These had high proportions of serious injury (55%) and morbidity (37%). Diagnostic negligent adverse events were most frequent (45%) and with 41% associated morbidity. The annual incidence of diagnosis-related paid VA malpractice claims was 1.95 per 100,000 patients and predicts that 122 of every 100,000 patients may have diagnostic negligent adverse events. Comparisons against non-VA data suggest this to be a healthcare industry problem. CONCLUSIONS: Diagnosis-related negligent adverse events are a serious problem in the healthcare industry.
- We have experience in evaluation of medical disability and compensation claims. Our Director has completed seven formal ACCME-approved federal training programs in compensation and pension examination.