Opinion: Medical Exam Changes to Affect Carriers
By Dr. Michael Megehee
President
TeamCME
Nationwide Medical Examiner Network
This Opinion piece appears in the Feb. 15 print edition of Transport Topics. Click here to subscribe today.
The final rule for the Federal Motor Carrier Safety Administration’s National Registry of Certified Medical Examiners is expected late this summer and is causing concern about rising prices and availability among drivers and motor carriers.
When the final rule takes effect, medical and osteopathic doctors, nurse practitioners, physician assistants and chiropractic physicians who currently perform the commercial motor vehicle driver medical exam will be required to attend training classes and pass a certification test.
Until now, few requirements have been imposed on physicians conducting CMV medical exams, so it’s no surprise that the upcoming change is expected to decrease the ranks of those providing this service.
For carriers, much of the concern centers on the medical examiners they now use. No physician wants to take a federally mandated training course, much less have to pass a national certification test, which makes the new procedure an unavoidable deterrent for providers.
The training also will cost some money, but physicians might view their time attending the training and studying for the certification test as the larger deterrent: The busier the medical practice, the less interested the physician will be in performing the CMV exams.
An insidious consideration is how the fee for a medical exam compares with the fee for other office procedures. Clinics prefer to perform the procedures that pay the best. With the amount that patients pay for a typical office visit soaring, the prospect of providing the less lucrative medical exams becomes less attractive.
However, for certain providers — chiropractors, for example — the fee for a driver medical exam is more than the fee they receive for most other procedures. This incentive already has significantly increased the number of chiropractic physicians performing the medical exams.
The concern over price and availability is fueled by the law of supply and demand. As demand increases or supply decreases, prices tend to go up. The U.S. Department of Transportation already has predicted that increased truck use over the next five years will cause an increase in the number of CMV drivers. This increase alone would tend to push prices higher. Combined with the expected decrease in providers, a price increase would seem all but guaranteed.
Back in 1999, when the DOT proposed mandatory training for its medical review officers, I made that same supply-and-demand argument. Armed as I was with this irrefutable law of economics, how could I have been so wrong?
Sometime ago, the going rate for the services of a DOT medical review officer was $7; today, our companies pay only half that amount. Why? The answer is “economy of scale” — methods of mass production lower the cost per unit, resulting in a lower price.
Unfortunately, to benefit from the economy of scale, large numbers of exams must be funneled into fewer clinics, which is counterproductive to having providers widely available.
Nationwide availability is a concern with no easy answer. In large cities, medical and osteopathic clinics and hospitals that specialize in occupational health will continue the exams, but medical providers in private practice are less certain.
However, keep in mind that the medical exam can be performed by any of these health-care professionals:
• Medical doctors.
• Osteopaths.
• Nurse practitioners.
• Physician assistants.
• Chiropractors.
Every medical examiner will complete the same training course and certification test, so there should be little difference between providers in their ability or judgment.
One bit of good news is the renewed interest in establishing clinics based at truck stops.
New developments include nationwide networks of medical examiners, urgent care clinics and hospital-based facilities, and many of them use tools such as the Internet to broadcast their availability.
More chiropractic physicians, nurse practitioners and physician assistants have joined the ranks of the medical and osteopathic doctors who, before 1992, were the only ones conducting medical exams.
Motor carriers can prepare by consulting their current provider, who, in fact, might be unaware of the upcoming changes. Large motor carriers have the advantage here, because they can offer clinics for large numbers of medical exams. Smaller motor carriers may benefit by acting now to find providers who are aware of the upcoming requirement and intend to continue the exams.
Owner-operators who use their own primary-care physicians are among the most likely to be looking for a new provider because they can’t offer economies of scale.
We can look back to 2000 to see the effects of mandatory training on drug-testing costs and availability, and I think most would agree the outcome has been positive.
The National Register of Certified Medical Examiners likely will have a similar result.
Based in Pendleton, Ore., the author is an FMCSA-designated “Subject Matter Expert” and president of TeamCME, a nationwide network of more than 400 DOT medical examiners.
