1a. Are you an adjuster, a case manager, or other?
1b. If other, please describe.

2. Do you attend the appointments with the patients? yes no

3a. Does your company belong to a bill review group? yes no
3b. If yes, which one?

4a. Is the claims adjuster authorized to deal with
specific questions concerning payments? yes no
4b. If not, who should be contacted?

5. Does your company have voice mail? yes no

Based on your experience, please respond to your experience with each of the following groups:

• CO - Carondelet Orthopaedic Surgeons, P. C.
• DD - Dickson-Diveley Midwest Orthopaedic Clinic
• DFP - Drisko, Fee & Parkins
• JCO - Johnson County Orthopedics
• KCBJC - Kansas City Bone & Joint Clinic
• OPA - Orthopaedic Professional Assoc.
• OSMCC - Orthopaedic Sports Medicine Consultants chtd.
• RO - Rockhill Orthopaedics

Rate each group on a scale of 1 to 5, where:

• 5 = Excellent
• 4 = Very Good
• 3 = Good
• 2 = Fair
• 1 = Poor

6a. Are the groups responsive to your calls for new patient appointments?
CO  DD  DFP  JCO  KCBJC  OPA  OSMCC RO

6b. appointments for IME?
CO  DD  DFP  JCO  KCBJC  OPA  OSMCC  RO

7. Do you feel that you know the individual(s) in our office to contact for different needs, (i.e., scheduling, records, medical questions, etc.)
CO  DD  DFP  JCO  KCBJC  OPA  OSMCC  RO

8. Do you feel our staff has a good understanding of work comp issues?
CO  DD  DFP  JCO  KCBJC  OPA  OSMCC  RO

9. Do you find our staff to be cooperative and easy to deal with?
CO  DD  DFP  JCO  KCBJC  OPA  OSMCC  RO

10. Do you receive the dictation in a reasonable amount of time?
CO  DD  DFP  JCO  KCBJC  OPA  OSMCC  RO

11. Do you find our doctors are giving you details concerning treatment plans, restrictions and work status in each dictation?
CO  DD  DFP  JCO  KCBJC  OPA  OSMCC  RO

12. Do you feel like our physicians have a good understanding of work comp issues?
CO  DD  DFP  JCO  KCBJC  OPA  OSMCC  RO

13. Are you able to get messages to and from the physician in a timely manner?
CO  DD  DFP  JCO  KCBJC  OPA  OSMCC  RO

14. Are you able to make direct contact with the physician when necessary?
CO  DD  DFP  JCO  KCBJC  OPA  OSMCC  RO

15a. Do you feel our physicians conclude treatment within a reasonable amount of time?
CO  DD  DFP  JCO  KCBJC  OPA  OSMCC  RO

15b. If not, how could this be improved?

Based on your experience, please rate each physician on a scale of 1 to 5, where:

• 5 = Excellent
• 4 = Very Good
• 3 = Good
• 2 = Fair
• 1 = Poor

16. Are you generally satisfied with the treatment plans and timeliness of care after referring to one of these physicians?

Please designate which group(s) the comments apply to on questions 17 and 18.

17. What area in the practices needs the most improvement?

18. What is the greatest strength of the practice?

Please feel free to submit the survey anonymously, or fill in the information below.