How much do C&P examiners make for DBQ’s on VA disability claims? Not much compared to things in the private sector to be honest.
Dane Street, a company that has been trying to enter the compensation and pension exam market for Veterans disability claims, has been recruiting for physicians psychologists to do DBQ’s.
Here is a vague fee schedule, though the recruiter notes that they can’t tell potential providers what they pay for any specific DBQ until they have actually signed up and are in the “orientation and training.” The recruiter did tell me over email that “Psychological DBQs are often categorized as Level C or higher.” The recruiter also wrote in his email in relation to the fee schedule that “things are not currently negotiable.”
We can’t really accuse Dane Street of too many quality errors yet since they haven’t done the volume that VES, QTC, LHI (or whatever their parent companies want to call them now) have done. But it does remind me:
Per the VA’s own OIG “some of the exams produced by vendors have not met contractual accuracy requirements. As a result, claims processors may have used inaccurate or insufficient medical evidence to decide veterans’ claims.“ The OIG found that the contractors QTC, VES and LHI “failed to consistently provide VBA with the accurate exams required by the contracts.” The OIG notes that “ALL THREE VENDORS HAVE BEEN BELOW THE CONTRACT’S 92% ACCURACY REQUIREMENT SINCE AT LEAST 2017.” Most errors– including a significant number that “had the potential to affect claims decisions–” aren’t corrected before the claims processors decided the claims per the OIG. [See: https://www.va.gov/oig/publications/report-summary.asp?id=5152]
The VA’s own researchers have also identified contract exams as being plagued with errors. The VA researchers noted “there are several possible explanations for the observed deficiencies in contract exams, including lack of supervision, more limited access to VA treatment records, and inadequate training and experience. An additional explanation is that, unlike exams by salaried VA staff, contractors are paid a flat fee for each exam which is a small fraction of the typical fees paid for forensic psychological evaluation in the community. Thus, there is a financial incentive to complete exams quickly, which would preclude careful record review, psychological testing, and detailed report preparation.” The authors go on to suggest that “anecdotally, it is not uncommon for veterans seen by contractors needing to be reexamined, at times with requests for second and even third opinions to resolve “conflicting medical evidence” after a contract examiner rendered an opinion that contradicted those in the veteran’s records or in previous C&P exams. Inefficiencies resulting from poor exams increase the workload for both examiners and VBA personnel and increase the costs for VA C&P operations overall” [see Meisler, A. W., & Gianoli, M. O. (2022). The Department of Veterans Affairs disability examination program for PTSD: Critical analysis and strategies for remediation. Psychology, Public Policy, and Law].
Here is some more text from the agreement (nothing in it refers to whether someone is a psychologist or physician or any other type of specialty):
II. Service Fees:
- Compensation Structure: You will be compensated at a base rate of approximately $1,000
per day for conducting VA Examinations. This base rate is determined based on an average
workload consisting of a combination of Level A exams, Level B exams, Medical Opinions,
and No Shows. - Daily Rate Adjustments: The daily compensation rate may fluctuate based on the number and
complexity of Disability Benefits Questionnaires (DBQs) associated with the VA Examinations
and the occurrence of No Shows. Specifically:
a. DBQ Volume and Complexity: The number and complexity of DBQs you complete
may result in additional compensation beyond the base rate. The more DBQs
completed, or the more complex the examinations, the higher the potential daily rate.
b. No Shows: In the event that the scheduled attendee (a “Veteran”) does not attend a
scheduled examination (a “No Show”), the Physician will still receive compensation
for time allocated to such appointments, as outlined in the No Show policy. - Potential for Earnings in Excess of Base Rate: You have the opportunity to earn in excess of
the estimated $1,000 per day base rate. Earnings may increase as you conduct more VA
Examinations or complete additional or more complex DBQs within a given day. - Calculation of Compensation:
a. The estimated base rate of $1,000 per day is based on an average workload consisting
of a reasonable mix of Level A and Level B exams, Medical Opinions, and No Shows.
b. Compensation for any day shall be calculated by factoring in the actual number and
type of examinations conducted, including the number of DBQs completed, the
complexity of the cases, and any No Shows.
c. Any additional compensation due to exceeding the average workload will be paid
accordingly. - No Show Policy: If a Veteran does not attend a scheduled examination, the Physician will
receive compensation for a portion of the time allocated for that examination in accordance
with the Company’s No Show policy.
Here is some information from the recruiting email in case you’re interested:
Below is a general information letter, and I am augmenting that with particulars that may address other questions that manifest.
– currently, all exams are scheduled face-to-face
– if you do not have an office to schedule exams into, there are secure VA-approved exam spaces being established where VA census efforts locate veterans who have applied for the exams – these exam spaces would be located within a 50-mile radius of your zip code.
– exams are being performed in all 50 states, so if you know a physician for whom this might be interesting, please pass my contact information to them.
– currently, all training is done on your own time and available online.
I have attached a fee schedule to this email.
I do not know what DBQs correlate to the levels A-E that they have been assigned.
+++
Dane Street is hiring Physicians across multiple disciplines to offer medical disabilities examinations from their own office or from a secure VA-approved exam space to the local veteran population.
The exams are the driving aspect of the Medical Disabilities Examination (MDE) project, the purpose of which is to determine if certain claimed contentions were incurred during active service and what kind of treatment and/or compensation the patient is allowed from the VA.
A VA census locates a target population of veteran applicants and establishes a secure approved location – in either a created space or an available clinic space. Our training and scheduling partner Capital Bridge locates needs based on your zip code and availability. Ex: one day per week, 4 hours every Tuesday and Thursday, 6 hours in one day every other week, etc.. You would receive electronic medical records and scheduled exams several weeks ahead of a proposed exam block.
The exams are based on a Disabilities Questionnaire (DBQ) authored by the VA – training is provided, establishing or expanding expertise regarding independent medical examinations.
It’s an examination only. No treatment or diagnosis is offered to the patient. All information is recorded to the DBQ with your medical opinion, and submitted to the VA.
The compensation is scaled to an 8-hour block with an approximated minimum of $1,000 to an approximated maximum of $2,400 per 8-hour block relative to the level of DBQ completed. DBQs are qualified as levels A to E, with higher fees attached to the more complex DBQs.
I do not have the per DBQ fee schedule. That is offered to providers during orientation and training, available online following onboarding.
Staffing assistance is not currently provided.
For a little context in terms of their “base” case of $1,000 for an 8 hour day, it actually breaks down to less per hour than Medicare would pay a psychologist for a diagnostic intake (and a large number of psychologists won’t accept Medicare because the fees are too low). It is less than the average cost of a 45 minute psychotherapy session in many states (something that doesn’t require the extensive file review of thousands of pages and completing a DBQ). So it is fair to wonder who the examiners are that are accepting the low rates noted by Dane Street and those the third party contractors which are generally consistent with this. The rates paid by the government contract organizations haven’t changed all that much in years despite inflation.