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The Medical Evaluations Division of NMC-6, led by Dr. Laura G. Gillis, focuses on consistency and fairness in evaluating mariner fitness for duty. With a dedicated team comprised of physicians, physician assistants, and administrative staff, the division ensures that evaluations meet current standards of care. The process includes medical screening, initial reviews, data entry, and file accountability. The division also contributes to process improvements and performs quality assurance reviews. Denial and reconsideration cases are handled with additional medical information, and the top denial diagnoses include coronary artery disease, uncontrolled diabetes, and chronic use of medications. The division stays updated with industry developments through the Merchant Mariner Medical Advisory Committee (MMMAC) and is continuously striving for improvement.
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Medical Evaluations DivisionNMC-6Laura G. Gillis, MD, MPH, FACOEMChief, Medical Evaluations Division
NMCMariner Medical Evaluation Process Medical Evaluations Division: • Our focus: • Consistency, • Fairness, • Use current standards of care, • Do what’s right for public safety • When fully staffed, 35 people total • Three physicians, 14 physician assistants • Staff of clerks and Certified Medical Assistants • One Administrator, 1 Program Analyst, 2 Health System Specialists
The Evaluation Process Team Member Responsibility Level of Review
NMC-6 Personnel Government Staff Contract Support Medical Screening Initial Medical Reviews Data Entry and File Accountability Inventory Management Contribute to improvement of Division processes • Responsible for process and quality of mariner fitness for duty determinations • Denials/ Reconsiderations
NMCMariner Medical Evaluation Process Additional Medical Information (AI) • Rate-limiting step of the process • 70-80% of reviewed 719Ks lack supporting objective documentation of medical conditions • Recent process changes have significantly improved consistency and reliability of information requested • NVIC 04-08 provides guidance for requesting AI, but is outdated in some areas and inconsistent with current clinical guidelines in others • Patient advocacy statements vs objective data
Quality Assurance Review Program Process Improvement Section Team Leaders Monitors Screening and Medical Processes Updates MMS Quarterly Q/A of work by screening and evaluations branches. • Gov’t PA Quarterly Review of CTR performance. • Physician Quarterly Review of Gov Reviewers • Quarterly assessment of division performance
Quality Assurance Q/ A Focus Group MMS Review Schedule Quarterly review of MMS Documents Ensures performance mirrors documented processes • Monitors quality of division work and deliverables • Comprised of Evaluation, Screening, Clerical, Gov’t, & Contract Staff • Responsible for Semi-Annual assessment of Division performance • Can recommend process changes, new initiatives and training
Quality Assurance Performance Measurement Training Program New Employee Orientation Bi-Weekly Training (Annual Calendar) Teachable Moments • Daily Inventory Tracking • Daily Throughput Measurement • Performance Database • Performance Templates
NMC Medical Performance Update Weekly Calls to Customer Service Handled by a Medical Team Member Periodic Inventory Status Update of Files Flowing Through the Medical Team
Medical Denials • Top Denial Diagnoses: • Coronary Artery Disease • Uncontrolled Diabetes Mellitus • Chronic use of Narcotics, Benzodiazepines, Sedative-hypnotics Medications • Uncontrolled Sleep Disorders • Unstable Mental Health Conditions • Seizures
Hot Topics • Merchant Mariner Medical Advisory Committee (MMMAC) • Inaugural meeting occurred September 19-21, 2011 • Composed of 10 medical professionals and 4 mariners • Committee accepted three tasks: • Top 10 Medical Conditions • Development of the Designated Medical Examiner Program • Comments to the STCW proposed rulemaking
On the Horizon • Electronic submissions/IT overhaul • Designated Medical Examiner Program • Revisions of guidance documents (NVIC) • In conjunction with recommendations from the MMMAC • Evidenced-based approach in conjunction with current standards of care • Revision of Physical Exam Forms (719K and K/E)