The Doctor Will See You: Using Treatment Parameters in Work Comp

Reducing workers’ compensation claim costs requires that members of the claims management team and other interested stakeholders know and understand the law.  Part of this includes using medical treatment parameters as a tool to promote the effective management of medical costs.

 

 

What are Medical Treatment Parameters?

 

Medical treatment parameters are not present under every workers’ compensation act.  About half of all jurisdictions employ some form of these guidelines.  This requires the claims handler to research the jurisdiction they are working in to understand if they are available.

 

The use of treatment parameters were developed to provide reasonable guidelines for care of all compensable workers’ compensation injuries.  All interested stakeholders, which included medical providers, vocational experts, developed them and attorneys from both sides and other parties involved in the process.  The result is they serves as a baseline to measure the effectiveness of medical care and treatment and promote quality health care.

 

 

When do Treatment Parameters Come into Play

 

Generally, all medical care and treatment provided to an injured worker is required to be reasonable and necessary to cure and relieve the effects of the work injury.  Workers’ compensation medical treatment parameters, which are not applicable in all situations, require that a medical provider demonstrate the medical care they provide results in continuous improvement in injury care that moves the employee toward maximum medical improvement, or full resolution.  When it comes to medical treatment parameters, it is important to remember they only apply in the following situations:

 

  • Claims where primary liability has been admitted, but there is a dispute concerning the treatment plan, or whether the medical care and treatment is reasonable and necessary; and
  • Instances where primary liability is denied, but later admitted. At that point, the treatment parameters can be used as a defense to the medical care and treatment being received by the employee.

 

It is important to review applicable statues and regulations before asserting a defense based on medical treatment parameters.

 

 

Using Medical Treatment Parameters in Your Claim

 

There is a statutory presumption that the medical treatment parameters are reasonable and necessary.  In essence, they are a “one size fits all” for workers’ compensation medical care.  While it is impossible to categorize all work-related injuries, a vast majority of them are covered under these guidelines.  Major injuries covered include:

 

  • Injuries and conditions to the spinal cord, including disc herniations, vertebrae fractures and pain symptomology;
  • Upper extremity conditions including fractures, dislocations, and common syndrome including carpal tunnel and lateral epicondylitis (tennis elbow);
  • Traumatic brain injuries and cognitive dysfunctions;
  • Psychological, psychiatric care and mental illnesses; and
  • Reflex sympathetic dystrophy (RSD) or other neurological conditions.

 

 

 

What is Covered under Medical Treatment Parameters?

 

Medical treatment parameters set forth the frequency of medical care and treatment provided to the employee.  The rationale is this avoids excessive care, waste and abuse within the system.  Common procedures covered include:

 

  • Imagining such as x-rays, MRIs and CT scans;
  • Use of prescription medications, including the use of opioid-based drugs;
  • Physical therapy and chiropractic care; and
  • Procedures that must be attempted prior to surgery.

 

It is important to note that departures are permissible in jurisdictions with medical treatment parameters.  An example of who this works can be found in Jacka v. Coca-Cola Bottling Co., 580 N.W.2d 27 (Minn. 1998).  In Jacka, the Minnesota Supreme Court noted that “the treatment parameters cannot anticipate every exceptional circumstance, we acknowledge that a compensation judge may depart from the rules in those rare cases in which departure is necessary to obtain proper treatment.”

 

 

Conclusions

 

Workers’ compensation medical treatment parameters are designed to avoid waste and abuse within the system, while at the same time ensuring injured workers receive their entitled care.  This requires members of the claims management team to determine if their jurisdiction has applicable parameters, understand how they can be used and effectively use them in the claim handling process.

 

 

Author Michael Stack, Principal, COMPClub, Amaxx LLC. He is an expert in workers compensation cost containment systems and helps employers reduce their work comp costs by 20% to 50%.  He works as a consultant to large and mid-market clients, is co-author of Your Ultimate Guide To Mastering Workers Comp Costs, a comprehensive step-by-step manual of cost containment strategies based on hands-on field experience, and is founder of COMPClub, an exclusive member training program on workers compensation cost containment best practices. Through these platforms he is in the trenches on a working together with clients to implement and define best practices, which allows him to continuously be at the forefront of innovation and thought leadership in workers’ compensation cost containment. Contact: mstack@reduceyourworkerscomp.com.

 

 

©2016 Amaxx LLC. All rights reserved under International Copyright Law.

 

Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker, attorney, or qualified professional.

 

Learn To Diagnose Your Diagnostic Test Diagnosis

When an injury fails to resolve within 4-8 weeks (sometimes sooner) physicians will likely order a diagnostic test to be performed.  The test will give them an inside look at what is going on structurally, and provide evidence to injury or pain generator, so they can focus care on resolving the issue.

 

Surprisingly enough, these tests are open to physician interpretation.  If the answer is not a clear silver bullet, such as a massive disc herniation or radically pinched nerve, you will see some difference in opinion on what could actually be wrong and how it is related to the work injury.

 

This is where the adjuster plays a key role.  Their relationship with a diagnostic provider or certain physicians can be what can swing a claim one way or another.  It can mean the difference if the injury is surgical or not, and even bigger, whether the claim and ongoing treatment is related to this work injury rather than an ongoing degenerative issue.

 

 

EMG Should Be Performed By Independent Physician

 

If a worker claims on occupational injury that was not traumatic in nature, chances are the injury was caused by repetitive motion within the course of their employment history.  After treating for a period of time and the worker has made no progress, the physician will likely perform an EMG to see what is going on.

 

Believe it or not, every doctor is not an EMG expert.  Even though they perform EMG tests and they make it a part of their regular practice, this doesn’t make them effective at interpreting the results.  It is typically not in your best interest to have the treating doctor performing the EMG.  A physician is in business to treat people. This is how they make money.  And by giving “positive” EMG results, this leads to possible surgery, more physical therapy, more treatment and overall more money for this doctor and for their practice.  We would like to think that all doctors are ethical and would do the right thing, but unfortunately this is not always the case.  If this is going on with your claim, the adjuster will likely get an outside opinion from another physician, likely one that is credentialed by the “American Association of Nueromuscular Medicine (AANEM). These physicians have strict criteria for performing EMGs and interpreting their results.  And since they have no financial interest in the overall treatment plan in the claim, they can give you an objective opinion without bias.

 

If the adjuster fails to obtain another opinion, and decides to go with the treating doctor’s opinion, this can lead to huge surgical costs and other medical costs that may not be related to this work injury.  This practice over time leads to thousands and thousands of dollars wasted by the insurance carrier or TPA, otherwise known as “Leakage.”  The worker puts themselves through possibly unnecessary surgery, rehab, medication, and so on.  Your adjuster should get a second opinion every time. It is better to be safe than sorry, especially when it comes to claims and surgical costs.

 

 

 

MRI More Difficult to Interpret

 

It is typically more difficult to interpret the results of an MRI.  If 20 people off the street that had no back pain took an MRI, many of them would have arthritis, bulging discs, herniated discs, and so on.  Just because these things are present on an MRI does not mean that they are pain generators, or that they are related to whatever work injury may have occurred.

 

A treating physician may or may not decide to interpret the MRI themselves.  Some will rely on the radiologist’s opinion, and just repeat the conclusion to the patient.  Others will ask to see the actual films, and they will draw their own conclusions, in addition to whatever the radiologist concluded.

 

 

Results Should Be Confirmed With Second Opinion

 

This can lead to an ethical treatment issue.  The key is the doctor relating a positive MRI back to the work injury.  This should not just be stated, they should be using objective medical evidence and the mechanism of injury to tie it together.  Even if this done properly, a good adjuster will obtain another opinion from a qualified physician or get the MRI read by another radiologist with credentials to interpret the results.  If you have ever viewed an MRI report, two radiologists can read the same films and one report may be three paragraphs, and the other may be three pages long.  This depends on the style of the radiologist. Your adjusters should have certain ones that they like and whose opinion they trust.

 

Despite the radiologist’s opinion, they will only read the MRI.  It is typically up to the surgeon to determine the cause of the injury. A radiologist may offer an opinion, but it is rarely a clear yes or no answer. There are too many variables involved since everyone’s body and function in day to day life is different.  It is up to the adjuster to work on the treating doctor, using thoughtful objective questions, to push him to make a decision on the causal relationship of the injury. If this correlation cannot be made, then by no means should a surgery proceed with authorization by the claims adjuster.

 

Failure to Obtain Causal Relation Statement Can Cost You

 

Failure to properly obtain a causal relation statement can yield thousands of dollars spent in error.  Once a surgery is performed, there is no taking it back.  Your worker had an invasive surgery performed, and medical complications are always a risk. In addition, a surgery doesn’t always mean a cure for all of ailments.  Significant leakage can occur if a positive MRI is not work related and your adjuster deems a claim, surgery, rehab, etc. compensable.  If the surgery was a multilevel spinal fusion, then you have medical cost leakage, wage leakage, vocational issues, further surgeries, and so on.

 

Before you authorize any surgery, take the time to get a few other opinions from not only qualified physicians, but qualified radiologists as well.  Most IME vendors and diagnostic providers will also have a radiologist on their roster, and this person can oftentimes be an overlooked resource. In the end, it could save you tens of thousands of dollars, if not hundreds of thousands upon the lifetime of a particular claim.

 

 

Summary

 

Remember just because a person is a physician, it doesn’t make them automatically qualified to properly read and interpret diagnostic reports.  Unreliable interpretation of diagnostics can lead to costly results for you and the worker.  Communication with the worker at this point is critical.  The injured worker may know nothing about medical, and they are going on the advice of their treating doctor.  Facing a surgery or major injury is a scary thing, and you want to relay to the worker that you are taking the time to get all of these extra opinions for their benefit, not only for the overall compensability of the claim.

 

Some injured workers respond to this as “Doctor shopping until you can find one that will deny my claim” but this is not the truth.  Adjusters have to have a clear, concise answer to causal relation. My response to the “doctor shopping” question is to respond by saying that the worker is the one that has to undergo the surgery, the lost wages, the rehab, the medication, the travel time, and the overall stress of dealing with an injury.  Whether it is work related or not, I’m going to want to cover all of the bases so you get a proper diagnosis and treatment plan.

 

 

Author Michael Stack, Principal, COMPClub, Amaxx LLC. He is an expert in workers compensation cost containment systems and helps employers reduce their work comp costs by 20% to 50%.  He works as a consultant to large and mid-market clients, is co-author of Your Ultimate Guide To Mastering Workers Comp Costs, a comprehensive step-by-step manual of cost containment strategies based on hands-on field experience, and is founder of COMPClub, an exclusive member training program on workers compensation cost containment best practices. Through these platforms he is in the trenches on a working together with clients to implement and define best practices, which allows him to continuously be at the forefront of innovation and thought leadership in workers’ compensation cost containment. Contact: mstack@reduceyourworkerscomp.com.

 

 

©2016 Amaxx LLC. All rights reserved under International Copyright Law.

 

Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker, attorney, or qualified professional.

 

Understanding Artificial Disc Technology In Your Claim

Medical technology is changing medical care and treatment injured workers receive.  One of these areas is in the field of back injury care.  This includes the use of spinal fusion surgery and artificial disc replacements.

 

 

The Changing Landscape of Back Injury Care

 

The spinal cord is the core of a person’s central nervous system.  It is composed of a series of parts that starts at the medulla oblongata near one’s brain and extends to the coccyx, otherwise known as the tailbone.  It contains a number of bones, which are called “vertebrae.”  Material referred to as “discs, which serves as a cushion between each vertebrae.  Injury to one’s spinal cord can result in damage to these discs, which include nerve root impingement and misalignment of the vertebrae.

 

Traditional surgical procedures involving the spinal cord and discs include fusion surgery.  When this procedure is performed, hardware is affixed to adjoining vertebrae to reduce the impingement of nerves.  While this procedure is often effective, the downside is it will decrease motion within the spinal column.

 

To address this downside, medical device manufactures have created artificial disc technology.  The use of this procedure, commonly referred to as an “intervertebral disc arthroplasty,” eliminates the need for a fusion surgery by providing the same benefits as a fusion, but without the loss of motion in the spine.

 

 

How Does this Affect My Claim?

 

There are a number of pros and cons associated with the use of artificial disc technology.  Claims handlers working on files that involve such procedures require caution.

 

  • Pros related to artificial disc technology:
    • Quicker healing times and possible return to work;
    • Less loss of motion following surgery, which can reduce exposure for claims related to Permanent Partial Disability; and
    • Increased satisfaction with post-surgical results.

 

  • Cons related to artificial disc technology:
    • Evolving technology that sometimes does not have a consistent result;
    • Hardware failure can be catastrophic; and
    • Varied surgical costs that can be more expensive from traditional spinal fusion procedures.

 

 

Defending Cases that Involve Artificial Disc Replacements

 

There is a growing body of case law dealing with the reasonableness and necessity of artificial disc replacement requests across the country.  Several years ago, this advance in medical technology was rarely considered and viewed by many as questionable even though it was being used with increasing frequency outside the United States.  The FDA has been reviewing these procedures and they are gaining acceptance in domestic medical treatment.  The result is more injured workers opting for an artificial disc replacement following a severe back injury.

 

Important issues to consider when analyzing these cases from a claim management standpoint include:

 

  • The prior medical history of the claimant and their response to surgical requests. The prior use of cigarettes and tobacco products is another important matter to consider.  Patients who have used or are currently using these products have a well-documented poor response when recovering;

 

  • The potential medical costs of artificial disc procedures compared to spinal fusions. Medical technology is constantly changing.  So are the costs of these medical procedures.  As the technology develops and becomes cheaper, it may be more difficult for insurance carriers to argue the standard approach of fusion surgeries is appropriate; and

 

  • Interested stakeholders would also consider the expertise of their independent medical examiner when defending a case where use of an artificial disc replacement could be an issue. It is well documented that a compensation judge may ultimately accept one expert’s opinion over another if they have a background in this area, or at least the proper foundation and scientific knowledge to give a credible opinion.

 

 

Author Michael Stack, Principal, COMPClub, Amaxx LLC. He is an expert in workers compensation cost containment systems and helps employers reduce their work comp costs by 20% to 50%.  He works as a consultant to large and mid-market clients, is co-author of Your Ultimate Guide To Mastering Workers Comp Costs, a comprehensive step-by-step manual of cost containment strategies based on hands-on field experience, and is founder of COMPClub, an exclusive member training program on workers compensation cost containment best practices. Through these platforms he is in the trenches on a working together with clients to implement and define best practices, which allows him to continuously be at the forefront of innovation and thought leadership in workers’ compensation cost containment. Contact: mstack@reduceyourworkerscomp.com.

 

 

©2016 Amaxx LLC. All rights reserved under International Copyright Law.

 

Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker, attorney, or qualified professional.

 

Chronic Pain Management: 3 Tips to Help Injured Workers Avoid Opioid Addiction

Jennifer mcgregor articleManaging chronic pain with today’s medical advancements can mean a very high risk of addiction to opioids, found in most prescription pain medications. In the US, use of opioids such as morphine, oxycodone, and hydrocodone, all of which have a high potential for addiction, has grown in recent years. Of course, for many people, life without a pain management plan is simply not feasible. Given the necessity of pain management, here are a few ways you can work to prevent addiction.

 

 

Ask for Small Doses

 

Tell your doctor that you are worried about the risk of addiction down the road, and ask if it would be possible to receive small, frequent prescriptions. Possessing only a small amount at a time with no excess removes much of the temptation and possibility for misuse. You will want to ensure that you have just enough medication to last until the next refill, meaning you are far less likely to take more than you need.

 

 

Have a Trusted Loved One Hold Your Medication

 

If you simply do not trust yourself enough to stay on track with your dosage, have a spouse or a trusted loved one keep the medication in an undisclosed location that you’re not likely to find. They will need to accept the job of dispensing the proper dosage, keeping track of when you are allowed your next dose.

 

Having someone you trust dispense your pain medication can prevent addiction, overdose, and unintentional mixing of substances. However, it is important that you are upfront with your loved one, fully disclosing the responsibility of their task.

 

 

Seek Alternative Treatments

 

For some chronic pain, it is possible to remove pharmaceuticals from the equation. Instead, you may want to test some up and coming alternative methods for pain management. A few popular options are exercise, reconfigured diet, and herbal remedies.

 

Yoga is an ideal way to start using exercise to treat chronic pain. It focuses on both strength and flexibility for the entire body while including the added benefit of meditative practice. Exercise can work against chronic pain by strengthening muscles and joints while aiding the nervous system in relaxing, thereby preventing flare-ups.

 

Diet also has a huge role to play in pain management. Inflammation is often the cause of chronic pain, meaning by incorporating more anti-inflammatory foods, you can reduce your pain. A few examples of these foods might be salmon, dark, leafy greens, bright peppers, and almonds.

 

Herbal remedies are also rising in popular treatment plans. Some herbs are a great, non-addictive way to reduce inflammation and dull pain. Some options might be turmeric, ginger, and Holy Basil tea, all readily available at the local grocery store.

 

Preventing addiction in those with chronic pain can be difficult, particularly if the chronic pain is not treatable with alternative options. If possible, weaning yourself from the pharmaceuticals is the best way to avoid addiction. However, when that is not a possibility, reach out to loved ones. Preventing addiction on your own can be difficult and having your loved ones nearby and aware of your situation is the best way to keep yourself honest. Also, keep in mind that addiction is not a guaranteed outcome. Plenty of people around the world take these medications on a long-term basis to treat their pain without it impacting their daily life. Though pain is not a sure-fire path to addiction, you should still be aware of and take steps to minimize your risks.

 

 

Jennifer McGregor is a pre-med student at the University of Michigan. She helped create PublicHealthLibrary.org with a friend as part of a class project. With it, she hopes to provide access to trustworthy health and medical resources. Contact: jmcgreg@publichealthlibrary.org

Stopping the Opioid Drug Epidemic In Workers’ Compensation

pillsThe opioid-based drug epidemic is causing havoc across the United States.  It is also leading to increased costs in workers’ compensation programs and is a main driver in negative patient outcomes in our healthcare system.

 

The cost of this epidemic affects not only injured workers, but also employers and their bottom line. In fact, at least $60 billion is lost every year due to decreased productivity. It was reported in the 2015 Express Scripts Workers’ Compensation Drug Trend Report the average cost to workers’ compensation payers per opioid prescription in 2015 was $154.66

 

The stakes are high.  Now is the time to take action.

 

 

Treating Chronic Pain in the United States

 

The term “chronic pain” can have different meanings to patients, caregivers and prescribers. This has resulted in a common misunderstanding of what type of pain meets this definition and how to best treat it.

 

According to the National Institutes of Health, chronic pain is defined as pain that lasts more than 12 weeks following an injury. This pain can be the result of any type of incident and the level of severity is subjective and unique to the individual. For many years, the primary goal of therapy was to relieve pain and there was an emphasis on escalating doses of opioid-based medications as a mainstay of treatment. This has led to an over-use of opioid-based medications to treat pain beyond the recommend acute phase of care, often without a documented improvement in the patient’s function. Notably, roughly 6,600 people in the United States become addicted to medications intended to treat chronic pain every year.

 

In late 2015, the Obama Administration took steps to address this pressing issue. It was suggested that the medical community take a fresh approach to treating people suffering from pain, including individuals receiving care following work-related injuries. This approach includes both pharmacologic and nonpharmacologic methods to address pain, as well as a specific focus on guidance for prescribing opioids. An additional focus of this new approach included the use of medication-assisted treatment to avoid dependency issues if use of opioids becomes problematic.

 

 

Team Efforts in Combatting Opioid-Based Drug Abuse

 

Everyone involved in the treatment of patients in pain has a role when it comes to battling the “legal” drug epidemic in the United States.

 

Prescribers: The focus of all medical care and treatment should be on improving the patient’s functional ability post-injury. This includes the establishment of pain-management goals and promoting healing and the avoidance of merely masking pain. This is a delicate balance that must be struck to ensure adequate pain relief for the patient, yet not promoting reliance on opioid analgesics.

 

Payers/Employers: There has been a concern within the insurance industry regarding the reliance on Schedule II and III controlled substances for pain relief. Members of the claim management team play an important role as they monitor medical claims and urge compliance with applicable workers’ compensation treatment parameters. They should also ensure that claimants are receiving the care they need, including nonpharmacologic therapy. They should also address the issue of possible abuse as it arises and provide treatment where necessary.

 

 

Solutions to Avoid Abuse

 

In order to address the opioid abuse epidemic in this country, it is recommended that payer organizations partner with a pharmacy benefit manager (PBM) to monitor opioid utilization and detect potential instances of abuse among a patient population. Through a PBM, proactive prescription monitoring is enhanced through various comprehensive tools and triggers at the pharmacy. Your PBM should offer multiple point-of-sale programs that detect opioid utilization and allow payers to make real-time decisions on whether patients can obtain opioid medications from the pharmacist based on various criteria. Solutions to detect fraud, waste and abuse, as well as educational outreach to physicians and patients are also critical components.

 

It is also recommended that prescribers and pharmacies leverage the data found in prescription drug monitoring programs (PDMPs) prior to prescribing opioids. Prescribers should perform appropriate risk screening for substance abuse and use opioid contracts with clear expectations for prescribing opioids and urine drug testing.

 

 

Conclusions

 

The battle against the abuse of opioid-based prescription medications needs to be taken seriously. Failing to do so impacts injured workers and their employers. Interested parties need to take a proactive approach and seek out unique tools to reduce negative outcomes due to opioids in workers’ compensation claims.

 

 

Author Michael Stack, Principal, COMPClub, Amaxx LLC. He is an expert in workers compensation cost containment systems and helps employers reduce their work comp costs by 20% to 50%.  He works as a consultant to large and mid-market clients, is co-author of Your Ultimate Guide To Mastering Workers Comp Costs, a comprehensive step-by-step manual of cost containment strategies based on hands-on field experience, and is founder of COMPClub, an exclusive member training program on workers compensation cost containment best practices. Through these platforms he is in the trenches on a working together with clients to implement and define best practices, which allows him to continuously be at the forefront of innovation and thought leadership in workers’ compensation cost containment. Contact: mstack@reduceyourworkerscomp.com.

 

 

©2016 Amaxx LLC. All rights reserved under International Copyright Law.

 

Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker, attorney, or qualified professional.

 

Broadspire Medigram: Revisiting Some Controversial Topics

dr. jake headshotBy Jacob Lazarovic, MD, FAAFP Senior Vice President and Chief Medical Officer, Broadspire

 

REVISITING SOME CONTROVERSIAL TOPICS

 

TAKING OUR PULSE

 

Practicing medicine, or making decisions about the appropriateness of treatment, and the presence and extent of disability, is not always a straightforward issue. How many times have you heard the “experts” change their minds about whether a certain vitamin is useful, or whether eggs and coffee are good or bad for you?

 

In our world, we also must confront controversial issues and ensure that we are adopting “best practices” based on the most current evidence-based medical research.

 

So today we will revisit a few ongoing issues, see what the prevailing wisdom is, and review our current approaches.

 

JUST WHAT THE DOCTOR ORDERED

 

  1. Fibromyalgia

 

Fibromyalgia is not quite a disease, but rather a syndrome of various complaints involving fatigue, pains in muscles and other soft-tissues, and sleep disturbances. It doesn’t qualify as a disease because, to this point, there is really no firm evidence of any objective physical findings (that can be seen in lab tests, x- rays, tissue biopsies, etc.). It remains a largely subjective phenomenon.

 

There is debate about its cause, with proponents disputing whether it is a “brain” condition or a musculoskeletal one. Some scientists claim to have noted abnormalities on central nervous testing, such as MRIs. Others feel that is a psychological state akin to depression, which is why anti-depressants are often successfully used to treat it.

 

In 2013, one laboratory claimed to have discovered a blood test that can diagnose fibromyalgia, which would be a breakthrough. However, even though some insurance carriers now reimburse the test, many others consider it to be of unproven value, as do many researchers.

 

From our perspective the most important fact is that, regardless of what stance one takes on the above, there is certainly no evidence of an occupational causation. Consequently, our policy remains as follows, per our medical advisory on the subject:

 

FIBROMYALGIA MEDICAL ADVISORY

 

Medical Advisory:

Based on the above considerations, fibromyalgia, chronic fatigue syndrome (FM/CFS) and other related conditions, and treatments for such conditions, cannot be considered work-related. There is no evidence at all to substantiate any occupational factors or injuries as causative. The current best hypothesis is that FM/CFS, to the extent that it has “legitimacy as a discrete entity” represents a genetic pain sensitization phenomenon due to dysregulation of pain pathways related to atypical neurotransmitter levels. 

 

With respect to disability (functional impairment), this needs to be carefully evaluated based on objective evidence of physical and cognitive deficits. 

 

 

B)  Viscosupplementation (hyaluronic acid, HA) injections to the knee

 

These injections have been used for a long time to reduce the pain and stiffness of arthritic knees. They can be thought of as a “lubricant” that cushions the knee as the joint is in motion. However, there have always been skeptics questioning the effectiveness of this therapy.

 

Several recent studies, one of which is excerpted below, now validate this skepticism, demonstrating that there is no, or minimal, benefit from HA injections.

 

However, the Official Disability Guidelines (ODG) continue to recommend this therapy, although a very long list of utilization criteria must be met prior to approval. As further evidence is published, ODG may reconsider its stance on viscosupplementation.

 

Of course causality is also an important consideration. Knee osteoarthritis is a degenerative condition which, unfortunately, many of us will get, and not necessarily related to occupational activities. It typically affects multiple joints in the body and is thought to have a genetic predisposition as well. A careful analysis to determine whether the condition is genuinely causally related to an individual’s occupation is recommended.

 

ODG:

Recommended as an option for severe knee osteoarthritis (OA) for patients who have not responded adequately to conservative treatment (exercise, NSAIDs, corticosteroid injections), in order to potentially delay total joint replacement. Higher quality studies have shown the magnitude of improvement to be modest at best. While medial and/or lateral compartment OA is a recommended indication, there is insufficient evidence for other conditions including patella-femoral arthritis, chondromalacia patella, patella-femoral syndrome (kneecap pain), or osteochondritis dissecans. 

 


C)  Platelet Rich Plasma (PRP)

 

PRP is one of several blood products that can be extracted from a patient’s own blood, and then injected into a painful body part. In the case of PRP, the blood is concentrated to achieve a high number of platelets, which contain growth factors that, theoretically, when injected into damaged tissue, can help to heal and strengthen the involved area. It is commonly used for soft tissue injuries, although you may have noticed local newspaper ads in which medical entrepreneurs advertise its use for myriad conditions. Similar claims are being made for stem cell therapy.

 

Despite all the fuss, there remains no consensus that PRP or related therapies have meaningful benefit. Broadspire’s medical advisory, as well as the ODG, reinforce this view. The prevailing recommendation is that this therapy should be confined to rigorous clinical studies, and not used in the general population.

 

Medical advisory:

Blood product injection therapies are not recommended for certification/ authorization due to an absence of high-grade medical evidence permitting an evaluation or confirmation of the efficacy of this modality. There is currently insufficient evidence to support the use of these injection therapies.  Rigorous studies of sufficient sample size, using validated clinical, radiological and biomechanical measures and tissue injury healing response biomarkers are needed to determine long-term effectiveness and safety. 


BLOOD PRODUCT INJECTIONS MEDICAL ADVISORY
 

 

 

ODG:  Platelet-rich plasma (PRP)

Not recommended for chronic pain except in a research setting. PRP therapies are more complicated than previously acknowledged, and an understanding of the fundamental processes and pivotal molecules involved will need to be elucidated. PRP therapies in clinical trials await assessment. Platelet-rich plasma (PRP) therapy is a recently developed technique that uses a concentrated portion of autologous blood to try to improve and accelerate the healing of various tissues. There is considerable interest in using PRP for the treatment of musculoskeletal disorders, particularly athletic injuries. Because PRP products are safe and easy to prepare and administer, there has been increased attention toward using PRP in numerous clinical settings. Platelet-rich plasma has been used to treat conditions such as lateral epicondylitis, ligament and muscle strains, and tears of the rotator cuff, anterior cruciate ligament, Achilles tendon, plastic surgery and other conditions. Platelet-rich plasma can be applied at the site of injury either during surgery or through an injection performed in the physician’s office. However, there is little published clinical evidence that proves its efficacy in treating the multitude of injuries/disorders that are thought to benefit from PRP. 

 
CIRCULATING IN THE PRESS 

 

More Insurance Companies Now Paying for Fibromyalgia Blood Test

 

“In 2013, Los Angeles-based biomedical company EpicGenetics made international headlines when it introduced FM/a, the first ever fibromyalgia blood test.

 

While FM/a hasn’t caught on in most doctors’ offices, more insurance companies are now paying for the test.

 

Dr. Bruce Gillis, EpicGenetics’ CEO, says the No. 1 reason patients get the test is to prove to family members and others that they are really sick.

 

He believes physician bias is the main reason why the test is not more widely used.

 

The legitimacy of fibromyalgia has been complicated for decades because of the lack of a diagnostic test to prove its existence. It’s typically a diagnosis of exclusion – meaning illnesses with similar symptoms have been ruled out through extensive (i.e. often expensive) medical testing.

 

We believe [the term] fibromyalgia is a misnomer, he says. These people aren’t suffering with anything that’s affecting the muscles, per say. What they are suffering with is their immune system cannot produce normal quantities of protective proteins. There are cells in the immune system called peripheral blood mononuclear cells. They are not producing normal quantities of the protective proteins called chemokines and cytokines.

 

EpicGenetics’ research and the FM/a test aren’t without critics. Fibromyalgia expert Dr. Daniel Clauw has said EpicGenetics’ studies contradict other research, which has shown normal or elevated cytokine levels in fibromyalgia sufferers.

 

Researcher and rheumatologist Dr. Fred Wolfe called one of EpicGenetics’ studies “junk science”, saying it didn’t meet minimal scientific standards.”

 

 

Viscosupplementation for Osteoarthritis of the Knee

 

“Knee osteoarthritis is responsible for a large burden of care and cost within health care. Osteoarthritis results from an imbalance between the breakdown and repair of articular cartilage in any joint and occurs as a result of multiple risk factors including mechanical overload (obesity, heavy lifting), trauma, overuse (repetitive knee bending), and genetic predisposition.

 

The CDC (U.S. Centers for Disease control and Prevention) reports that one in two individuals may develop symptoms of osteoarthritis in at least one knee by eighty five years of age.

 

In conclusion, this best-evidence systematic review assessing the clinical significance of outcomes involving pain relief and functional improvement does not support the routine use of intra-articular HA. In contrast to previous reviews, we found no significant evidence of publication bias in the studies that we selected for analysis. The patient benefit of intra-articular HA was not clinically important when compared with intra-articular saline solution injections used as a placebo. Subdividing HA preparations by molecular weight did not change the results of the analyses. Selecting the best evidence resulted in significantly reduced heterogeneity but did not change the outcome; no clinically important improvement in pain and other outcomes from a patient’s perspective was found.”

 

 

How effective are platelet rich plasma injections in treating musculoskeletal soft tissue injuries?

 

“Platelet-rich plasma (PRP) has become increasingly popular in sports medicine and orthopaedic practice as treatment for muscle, tendon, and ligament injuries, and has received media attention because of its promise as a regenerative therapy.

 

We argue that patients should only be offered PRP for musculoskeletal soft tissue injuries within the context of well-designed clinical trials, with informed consent, high quality verbal explanations, and supporting written information. Advise patients that there is currently insufficient evidence to show that it is effective treatment for musculoskeletal soft tissue injuries. Clinicians offering PRP should ask manufacturers for the evidence of the platelet and growth factor concentrations, the constitution, and the viability of their PRP product (platelet activation levels).”

 

 

Efficacy of Autologous Platelet-Rich Plasma Use for Orthopaedic Indications: A Meta-Analysis4

 

“The recent emergence of autologous blood concentrates, such as platelet-rich plasma, as a treatment option for patients with orthopaedic injuries has led to an extensive debate about their clinical benefit. We conducted a systematic review and meta-analysis to determine the efficacy of autologous blood concentrates in decreasing pain and improving healing and function in patients with orthopaedic bone and soft-tissue injuries.

 

The current literature is complicated by a lack of standardization of study protocols, platelet- separation techniques, and outcome measures. As a result, there is uncertainty about the evidence to support the increasing clinical use of platelet-rich plasma and autologous blood concentrates as a treatment modality for orthopaedic bone and soft-tissue injuries.”

 

 

****************

REFERENCES:

  

  1. “More Insurance Companies Now Paying for Fibromyalgia Blood Test”, Donna Gregory Burch, http://nationalpainreport.com.
  2. “Viscosupplementation for Osteoarthritis of the Knee”, David Jevsevar, MD, MBA, et al, J Bone Joint Surg Am. 2015;97:2057-60.
  3. “How effective are platelet rich plasma injections in treating musculoskeletal soft tissue injuries?”, David Keene, et al, BMJ 2016;352:i517 doi: 10.1136/bmj.i517 (Published 17 February 2016).
  4. “Efficacy of Autologous Platelet-Rich Plasma Use for Orthopaedic Indications: A Meta-Analysis”, Ujash Sheth, et al, J Bone Joint Surg Am. 2012;94:298-307.

 


 

About Broadspire®

 

Broadspire (www.choosebroadspire.com), a global third party administrator, offers casualty claim, medical management, disability and absence management solutions, and risk management information services, helping increase employee productivity and reducing the cost of risk through early  intervention, professional expertise and data analytics. As a Crawford Company, Broadspire is based in Atlanta; Ga. Services are offered by Crawford & Company under the Broadspire brand in countries outside the U.S.

 


 

Leverage Physical Therapy Checklist To Return Employees To Work

When an employee suffers an injury to musculoskeletal system, the medical provider will frequently recommend a course of physical therapy for the employee. Self-insured employers who self handled their workers’ compensation claims need to know how to manage the physical therapy (PT). All employers can benefit from knowing how to manage PT.

 

 

Adjuster Physical Therapy Checklist

 

When the medical provider determines there is a need for physical therapy, the medical provider will advise the adjuster of the diagnosis, the modalities needed and the time frame. The adjuster, in the states where the employer/insurer controls the selection of medical providers, in turn assigns the physical therapy to a therapist provider. In states where the employee selects the medical provider, the medical provider will refer the employee to a therapy clinic of the medical provider’s choice.

 

Regardless who selects the therapy clinic, the adjuster for the employer needs to do the following:

 

  • Confirm the therapy clinic has the medical provider’s diagnosis and the amount of therapy recommended by the medical provider

 

  • Require the therapy clinic to do an initial physical therapy evaluation during the first visit by the employee and to provide a physical therapy evaluation and treatment plan following the first visit and prior to the second physical therapy visit

 

  • Provide the therapy clinic with billing information and obtain an agreement on whether each individual physical therapy session will be billed or if physical therapy sessions will be billed weekly or monthly

 

  • Discuss with the therapist the estimated time frame until the employee will increase his/her functionality

 

  • Obtain the therapist’s opinion on the possibility of the employee returning to work either full duty or modified duty

 

  • Provide the therapist with a copy of the employee’s job description

 

  • Set up with the therapist a timetable for the adjuster to follow up with the therapist

 

  • The therapy clinic should be instructed to advise the adjuster immediately if the employee cancels a physical therapy session for any reason, or is a no-show

 

 

 

Categories That Should Be Included in Physical Therapy Treatment Plan

 

When the adjuster receives the physical therapy evaluation and treatment plan following the first visit by the employee, the evaluation and treatment plan should be carefully reviewed. The following information categories should be in the treatment plan:

 

  • The diagnosis of the therapist – it should match the diagnosis of the medical provider. If not, this needs to be addressed right away.

 

  • The employee’s current physical limitations due to the injury

 

  • The employee’s prior medical history and if it will impact the physical therapy, how so?

 

  • The type of modalities the employee will receive

 

  • The frequency of the physical therapy visits per week, and the number of weeks the PT is projected to continue

 

  • The treatment goals and what is expected

 

  • The frequency the therapy clinic will report the employee’s progress to the medical provider

 

  • The self-care guidelines provided to the employee

 

 

If any of these categories are missing from the evaluation and treatment plan, the adjuster should discuss with the therapist the need for an addendum to the evaluation and treatment plan that discusses the missed categories.

 

The initial projections by the medical provider as to how long the employee will need physical therapy are not set in stone. Occasionally the employee will recover faster than expected from the injury and the physical therapy will be discontinued early.

 

 

If Additional Treatment is Requested, Consider Utilization Review

 

Sometimes the employee will recover slower than average resulting in the medical provider extending the requested physical therapy. When extended PT is requested, the adjuster needs to consider the effectiveness of the treatment. If the adjuster has any doubts about the need to continue the physical therapy treatments, the adjuster should arrange for a Utilization Review (UR). If the UR nurse rejects the need for additional physical therapy, the adjuster should ask the Utilization Review nurse to discuss the physical therapy request with the medical provider. If the UR nurse and the medical provider do not reach an agreement on the physical therapy requested, an Independent Medical Examination can assist the adjuster in determining whether to approve additional physical therapy or not.

 

Managing physical therapy is not difficult. It does take time, however when properly managed the employee’s recovery time is minimized. The PT clinic is an excellent source of information to assist the employer in returning the employee to work on modified duty, or full duty. By working with the therapist, the amount of time the employee is off work is limited to what is necessary.

 

 

 

Author Michael Stack, Principal, COMPClub, Amaxx LLC. He is an expert in workers compensation cost containment systems and helps employers reduce their work comp costs by 20% to 50%.  He works as a consultant to large and mid-market clients, is co-author of Your Ultimate Guide To Mastering Workers Comp Costs, a comprehensive step-by-step manual of cost containment strategies based on hands-on field experience, and is founder of COMPClub, an exclusive member training program on workers compensation cost containment best practices. Through these platforms he is in the trenches on a working together with clients to implement and define best practices, which allows him to continuously be at the forefront of innovation and thought leadership in workers’ compensation cost containment. Contact: mstack@reduceyourworkerscomp.com.

 

 

©2016 Amaxx LLC. All rights reserved under International Copyright Law.

 

Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker, attorney, or qualified professional.

 

Humanize Work Comp To Realize Medical Savings

Medical costs continue to account for a significant portion of every workers’ compensation claims.  In order to address this matter, innovative teams are seeking improvements in the way they direct medical care and treatment in their claims.

 

 

Barriers in Directing Medical Care

 

All workers’ compensation programs are subject to a rigid statutory and regulatory framework that impacts the medical portion of every claim.  Notwithstanding the use of treatment parameters and fee schedules, the medical component in every jurisdiction can create challenges.  Some common barriers faced by the claim management team include:

 

  • Choice of medical providers and the ability of the employee to switch providers during the course of medical treatment;
  • Failure to use correctly an independent medical examination (IME) to mitigate exposure on a claim. This can often include selecting a doctor who lacks the correct credentials or familiarity with the injury in the claim; and
  • Problems dealing with medical care that enables the injured worker to malinger.

 

 

Dealing with Common Pitfalls in Medical Care

 

The claim handler in charge of the claim is on the front lines when it comes to dealing with injured workers and making sure they receive the benefits, care and treatment they are entitled to post-injury.  This requires that member of the claim management team to take a proactive approach to dealing with these issues and reducing future exposures.

 

Here are some important things to consider:

 

  • Educate the employer/clients regarding injury prevention;
  • Be proactive when it comes to reporting claims. Time is of the essence.  A promote injury response can also buy good will from the employee and their attorney;
  • Have good lines of communication with the medical representatives of the employer. This should include having a coordinated response immediately post-injury and continue throughout the course of care; and
  • Gain the trust of all medical providers outside the scope of the preferred employer medical team’s network. This includes conducting yourself in a professional manner at all times.  By gaining their trust, you will more likely than not gain their cooperation.

 

 

The Human Element of Workers’ Compensation

 

To the injured workers, members of the claim management team are often faceless individuals that are guardians of the insurance carrier’s financial interests.  This perception leads to the false conclusion by injured parties and their family members that the claim handler does not consider the interests of the injured employee.  Personalizing the services you provide can pay dividends during the course of managing the claim.

 

Various steps can be taken to gain the trust and cooperation and “humanize” the workers’ compensation process:

 

  • Provide accurate information whenever dealing with the injured party or their legal representatives;
  • Be responsive to their communications. Set realistic and reasonable expectations from the outset of the claim.  Develop the relationship as you would any other professional interaction.  Personalizing the response is helpful; and
  • Empathize with the position of the injured party. Although workers’ compensation wage loss benefits are tax free, they are being paid at a reduced rate.  When the injured person is off work, it is important to remember their bills do not have a similar reduction.

 

 

Conclusions

 

Reducing the medical costs in workers’ compensation claims requires an active role by all members of the claim management team.  Part of this requires individual claim handlers to make the extra effort in their file load.  It is also necessary for the claim handlers to bring a sense of humanity to their claims when dealing with injured employees.

 

 

 

Author Michael Stack, Principal, COMPClub, Amaxx LLC. He is an expert in workers compensation cost containment systems and helps employers reduce their work comp costs by 20% to 50%.  He works as a consultant to large and mid-market clients, is co-author of Your Ultimate Guide To Mastering Workers Comp Costs, a comprehensive step-by-step manual of cost containment strategies based on hands-on field experience, and is founder of COMPClub, an exclusive member training program on workers compensation cost containment best practices. Through these platforms he is in the trenches on a working together with clients to implement and define best practices, which allows him to continuously be at the forefront of innovation and thought leadership in workers’ compensation cost containment. Contact: mstack@reduceyourworkerscomp.com.

 

 

©2016 Amaxx LLC. All rights reserved under International Copyright Law.

 

Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker, attorney, or qualified professional.

 

7 Considerations For Selecting Your Work Comp Doctor

Hello. Michael Stack. Principal of Amaxx, founder for COMPClub and co-author of Your Ultimate Guide to Mastering Workers’ Comp Cost. I want to give you a success tip that actually comes out of the 2016 version of Your Ultimate Guide to Mastering Workers’ Comp Cost, it is the fifth step of the five-step system to reduce your cost by 20 to 50%. That step is in regards to medical and pharmacy cost containment.

 

 

7 Considerations To Use in Doctor Selection:

 

When we talk about managing workers’ comp claims and reducing workers’ comp cost, one of the things that we often forget is that these are medical injuries, and they need the expertise of medical providers for the healing and recovery of those injuries. I want to give you seven considerations to use as a reference point for the selection criteria of the medical providers that you work with at your organization.

 

Now, when it comes to doctor selection the laws are going to vary by states. You’re going to want to definitely check with your jurisdiction. It’s either going to be an employee-directed state, an employer-directed state, or often times a blend of those two. There are some states where the employer can have zero input whatsoever, so be sure to check with your state laws. Often times even in an employee-directed state, you can do what’s called soft channeling by setting up relationships with high quality providers and giving a recommendation to your employees to go to see them if they chose.

 

 

Care & Credentials

 

Let’s talk about these considerations and some of these criteria that you should use. Of these seven considerations, there’s really two main categories that they’re going to fall under. The first is care and the second is credentials. The first category is care, how much those providers care, and the second is what are their credentials. Let’s talk about some specifics here.

 

 

Be responsive to employees’ needs and willing to return them to work

 

The first thing that you want to look at in regards to care is you want to talk about how much responsiveness do they have to your employees? Responsive to your employees’ needs and a willingness to return them to work. Responsive to your employees’ needs and a willingness to return those employees to work.

 

 

Visit your organization

 

Second criteria here is that they visit your company. They actually go to your job site to visit your employees and find out what type of work they’re doing on a regular basis, get to know your organization, and at the same time be willing to use your forms in your return-to-work program in order to get the medical restrictions and get them back to work to work within your system. Their responsiveness, their willingness to return them to work, and then also visiting and understanding what those job descriptions are understanding what type of work your employees are doing, and using your forms to feed right into your system.

 

 

Be available to schedule employee’s appointments without delay

 

Selection criteria number three is scheduling appointments. You want to make sure that your employees can get in to see these providers easily. One of the studies that WCRI just recently came out with was in regards to worker outcomes, and the ability for the employees to get the care that they needed was one of the biggest factors in determining whether they would ever come back to work. The ability to get the care that they needed was one of the biggest factors in determining whether they would ever come back to work, so being able to get in to see those providers is a key selection criteria.

 

 

Spend extra time with your employees as needed

 

The last criteria here is time. How much time are those providers able and willing to spend with your employees? If you’ve ever studied human relations, you know that one of those principles is people don’t care how much you know, until they know how much you care. People don’t care how much you know, until they know how much you care. That’s what this first set of criteria (is about), this first selection criteria, is making sure those providers care to work with your organization and they care about your employees and what’s best for them, which is getting them back to work.

 

 

Possess outstanding medical credentials and an excellent reputation

 

Let’s talk about these credentials, because if you have this down, then of course, the quality of those providers is an extremely important piece as well. The first thing you want to look at is their credentials, their actual medical credentials and their reputation in the community. What is their background? What is their expertise? What is their specialty, and then what is their reputation in the community? You obviously want to work with a very high quality provider to provide your employees with the highest level of medical service that’s available.

 

 

Provide medical records and reports timely, be available for consultation with claims team

 

Number two then. In regards to working with your claims management team, you need to be able to get the reports and any records and any communications and conversations that need to be had with your adjuster, with your nurse case manager, and with your claims management team, providing reports, providing records, and having conversations. Their ability to provide that information to ensure your employee is getting the best medical treatment, to get the best medical outcome, getting them back to work, and by the way, that will lead to the lowest amount of workers’ compensation cost.

 

 

Provide detailed medical restrictions for return to work

 

A final point then, and probably most important from an employer standpoint, is be able to get restrictions for return to work. To be able to get restrictions, the medical restrictions, to understand what that employee can do safely and productively at your organization in a return-to-work program. You need to have them sign off that they’re able to go back to work and understand what those restrictions are. For example, they have a 10-pound, a 20-pound, a 30-pound weight-lifting limitation, they can only stand for a certain number of time, etc, so understand what those restrictions are, have it written out in your form, and get those employees back to work as soon as possible.

 

 

That’s the selection criteria for your medical providers. Remember, your success in workers’ compensation will be determined and defined by your integrity, so be great.

 

 

Author Michael Stack, Principal, COMPClub, Amaxx LLC. He is an expert in workers compensation cost containment systems and helps employers reduce their work comp costs by 20% to 50%.  He works as a consultant to large and mid-market clients, is co-author of Your Ultimate Guide To Mastering Workers Comp Costs, a comprehensive step-by-step manual of cost containment strategies based on hands-on field experience, and is founder of COMPClub, an exclusive member training program on workers compensation cost containment best practices. Through these platforms he is in the trenches on a working together with clients to implement and define best practices, which allows him to continuously be at the forefront of innovation and thought leadership in workers’ compensation cost containment. Contact: mstack@reduceyourworkerscomp.com.

 

 

©2016 Amaxx LLC. All rights reserved under International Copyright Law.

 

Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker, attorney, or qualified professional.

 

How Much Time Are Doctors Spending On Your IME?

doctor tabletThe independent medical examination is one of the most important components of a successful workers’ compensation claim.  This is because in most jurisdictions, the defense gets one opportunity to see and examine the injured employee by a medical expert of their choice.  One of the most important factors to consider in selecting the correct service provider is seeking out only those that add value to your claim.

 

 

Selecting the Right Medical Expert

 

An important component when selecting an IME service provider is the panel of medical experts they offer.  In the modern workers’ compensation system, there are a whole host of injuries.  This gives rise to the need to work with a service provider that has a wide variety of medical experts.  This also includes connections with specialists in a number of fields.  Some of these areas include orthopedics, neurosurgery, psychology, and psychiatry.

 

Before selecting the right IME doctor, it is also important to know the background of the expert.  Part of this investigation includes and understanding of the doctors medical training, professional experience and other specialties.  It is also important to consider an expert who has written peer-reviewed articles for medical publications and/or hold distinguished lecturing credentials.

 

 

How Much Time Are Doctors Spending On Your IME?

 

It is also important to understand the physician’s perspective performing an IME. The demands on a physician’s day are well documented, and increasing administrative requirements and changes in health care have only made the job more difficult.  An important question to ask is how much time are doctors spending on your IME?  In many instances, providers will fill the doctor’s schedule with appointments, which does not allow the doctor adequate time to complete a thorough exam and determine a thoughtful conclusion.  This detracts from the final and most important product when defending a case—the IME report.

 

Best practice dictates the physician to be fairly compensated, and allowed additional time to complete the exam and IME report.  The end result is a thoughtful report in which the medical opinion becomes a material element in your claim.

 

A second necessity for adequate time from the IME doctor is providing and receiving additional information as required by the adjuster and/or nurse case manager.  A high quality physician that will render a high quality opinion needs to be fairly compensated for this additional time. However, the investment can often lead to a significant return as the opinion is based on adequate information and all parties are able to agree on the proper course of action on the claim.

 

 

Preparation and Turn-Around Time

 

The final element to consider in the relevance of time to your IME is in preparation and turn-around of the report.  There must be the ability for the IME providers to access medical records and reports for review by attorneys and claim handlers prior to the examination. It is also important to have a reliable point of contact to handle issues as they arise throughout the process.

 

Important matters to consider include:

 

  • Turnaround times for the completion of reports; quick turnaround time is important, however, not at the expense of report quality. Waiting a day or two extra for more a comprehensive report that substantiates all requested issues would most likely impact the potential exposure of a case then getting a report back a day sooner;

 

  • Quality assurance measures that include a review of the report for typographical errors; and

 

  • Superior customer service.

 

 

Conclusions

 

The independent medical examination is one of the most important parts of defending a workers’ compensation claim. The main question asked at the deposition or hearing is whether the medical expert has adequate foundation to issue their findings and opinions within a reasonable degree of medical certainty. Increasing demands on physician’s time, along with increased pressures on lower fees often creates a low quality IME report. Ensure your IME physicians are fairly compensated and have adequate time to complete a high-quality, meaningful report.

 

 

 

Author Michael Stack, Principal, COMPClub, Amaxx LLC. He is an expert in workers compensation cost containment systems and helps employers reduce their work comp costs by 20% to 50%.  He works as a consultant to large and mid-market clients, is co-author of Your Ultimate Guide To Mastering Workers Comp Costs, a comprehensive step-by-step manual of cost containment strategies based on hands-on field experience, and is founder of COMPClub, an exclusive member training program on workers compensation cost containment best practices. Through these platforms he is in the trenches on a working together with clients to implement and define best practices, which allows him to continuously be at the forefront of innovation and thought leadership in workers’ compensation cost containment. Contact: mstack@reduceyourworkerscomp.com.

 

 

©2016 Amaxx LLC. All rights reserved under International Copyright Law.

 

Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker, attorney, or qualified professional.

 

Professional Development Resource

Learn How to Reduce Workers Comp Costs 20% to 50%"Workers Compensation Management Program: Reduce Costs 20% to 50%"
Lower your workers compensation expense by using the
guidebook from Advisen and the Workers Comp Resource Center.
Perfect for promotional distribution by brokers and agents!
Learn More

Please don't print this Website

Unnecessary printing not only means unnecessary cost of paper and inks, but also avoidable environmental impact on producing and shipping these supplies. Reducing printing can make a small but a significant impact.

Instead use the PDF download option, provided on the page you tried to print.

Powered by "Unprintable Blog" for Wordpress - www.greencp.de