Opposition Continues to Swell Against Utilization of the AMA Guides 6th ed

Resistance continues to mount against adoption of the AMA Guides to Impairment 6th edition. Joining the growing chorus of opposition are John Burton, a leading expert in workers' compensation, and the Attorney General of Tennessee who issued an opinion against adoption of the 6th Edition.

Workers’ compensation expert, John Burton, at a presentation to the NY State Workers’ Compensation Board expressed his disfavor in adoption to the AMA Guides 6h edition to determine disability. He recommended that all 40 US State jurisdictions and Canada abandon the AMA Guides altogether.

Burton said, "My concern about the AMA guide ... is that it's simply not evidence-based. It's ignoring the evidence that's available to do it right," "I think the AMA has now shown it's incapable of doing it right and this thing ought to be referred to the Institute of Medicine to look at this issue and figure out how to do a decent rating system."

Additionally, the automatic adoption of the AMA Guides 6th Ed. is unconstitutional states Attorney General of the State of Tennessee. “While there is not any controlling authority in Tennessee on this issue, and while Tenn. Code Ann. § 50-6-102(2) is defensible, this provision is vulnerable to attack as an unconstitutional delegation of legislative authority in violation of Tenn. Const. art. II, § 3, because by making the “most recent” edition of the AMA Guides that is in effect on the date of the employee’s compensable injury the applicable edition, § 50-6-102(2) may be construed as incorporating future changes of the AMA Guides to Tennessee’s statutory scheme.”

As the debate continues concerning the adoption of the AMA Guides to Impairment 6th Ed. the issue continues to focus on whether the AMA Guides to Impairment should be utilized at all to determine disability in at all in a workers’ compensation claim.

AMA Urges Trump Administration to Clarify Immigration Executive Order

A major element of workers' compensation benefits is medical treatment and that will be impacted the Donald Trump's recent ban on immigration. An adequate number of physicians must be available to provide medical care to cure and relieve  a work related medical condition. The American Medical Association (AMA) sent the following letter today to the U.S. Department of Homeland Security regarding the Administration’s executive order issued last week,“Protecting the Nation from Foreign Terrorist Entry into the United States:”

Governmental Opposition Swells Against Implementation of the 6th Edition of the AMA Guides

State governments throughout the United States are now delaying implementation of the 6th Edition of the AMA guides as a standard to determine permanent disability. The governmental officials are heeding warnings that the guides do not carry out the legislative intent of the workers’ compensation acts which is to provide a remedial social insurance benefit to injured workers.

In 1911 workers bargained away the right to seek redress in the civil litigation system for a more limited benefit structure called workers’ compensation. Workers’ compensation was the original “no fault system” that was to provide limited benefits in a summary and efficient fashion to disabled workers.

Soon there was an attempt by Industry to modify the system in the 1970’s to create a standardized system of measuring disability and reduce even the meager benenfits offered. The AMA guides were drafted and adopted in several state to measure permanent disability. Presently many jurisdictions utilize the 5th Edition to determine disability.

The 6th edition were published in late 2007s under the guidance of Christopher R. Brigham M. D. whose company, Brigham and Associates conducts medical evaluations. Dr. Brigham contends that only 40% of those totally disabled are really unable to perform meaningful work. It has been reported that if the new guides are adopted then permanent disability will no longer be recognized in 70% of the present claims.

At a recent meeting of the IAIABC (The International Association of Industrial Accident Boards and Commissions) , an organization composed of industrial boards and commissions throughout the United States, but open to membership from dues paying members, which include many of the workers’ compensation insurance carriers in the United States, there was “a lively discussion” concerning use of the new Guides.

"Dr. Russell Travis, Medical Director for the Kentucky Office of Workers’ Claims, suggested the 6th Edition makes improvements in guiding impairment rating, particularly in consistency of ratings across organ systems. However, Dr. Travis highlighted some of the perceived weaknesses he found in the AMA Guides; his presentation pointed to issues of apportionment, pain, and the qualifications required to perform a rating as still unresolved. The strong debate among the rating physicians demonstrated the lack of consensus on techniques for impairment rating and the role of the AMA Guides."

Within the last few weeks, several states have paid attention to warnings and taken action to resist immediate implementation of the 6th Edition of the AMA Guides. Kentucky legislatively voted to adopt the prior 5th Edition of the AMA guides to permanent impairment rather than the current 6th edition. Vermont issued an administrative directive barring use of the new 6th Edition. Iowa has joined the growing chorus of those who will not follow the adoption of the 6th Edition. Opposition to implementation in New York is at a fever pitch.

Joining the chorus of growing opposition is The Workplace Injury Law And Advocacy Group. In an article authored by Todd McFarrin, the President-Elect of CAAA, he cautions that:

“By using impairment ratings from the Guides, essentially as a proxy for disability, permanent disability benefits are being slashed. The use of impairment and the eclipse of disability as the relevant permanent consequence of an injury in workers’ compensation is a dangerous trend for injured workers. The latest [6th] edition of the Guides accelerates this decline.”

How to determine permanent disability has always been an agonizing proposition to all who participate in the system. While State legislatures and the Federal government would be pleased to adopt an objective standard, such a goal is illusionary. One cannot be substituted for subjective nature of pain and restrictions of movement in the human environment.

While the economy may be struggling, it is anticipate that the outrage of Labor to the implementation of the restrictive 6th Edition to determine permanent disability will only increase. The objections will become louder and stronger as Industry tries to renege on its 1911 bargain called workers’ compensation.

AMA Guides Tossed Aside in California

The California Workers Compensation Appeals Board has ruled that the 2005 version of the AMA Guides to Impairment need not be followed. The Court ruled:

(1) the AMA Guides portion of the 2005 Schedule is rebuttable;
(2) the AMA Guides portion of the 2005 Schedule is rebutted by showing that an impairment rating based on the AMA Guides would result in a permanent disability award that would be inequitable, disproportionate, and not a fair and accurate measure of the employee’s permanent disability; and
(3) when an impairment rating based on the AMA Guides has been rebutted, the WCAB may make an impairment determination that considers medical opinions that are not based or are only partially based on the AMA Guides.

Almarz v Environmental Recovery, et al
Case No. ADJ1078163 (BAK 0145426) Decided Feb. 3, 2009

Iowa Joins Other States Not Adopting the AMA Guides 6th Edition

The State of Iowa joins many other States who will not implement the 6th Edition of the AMA Guides. This follows mounting criticism against the use of the 6th Ed. of the AMA Guides to determine workers’ compensation disability.

Under emergency rule making authority The Iowa Commission promulgated the following rule.
“AMA GUIDES – Rule 876—2.4 has been amended as follows:
876—2.4(85,86) Guides to evaluation of permanent impairment. The Guides to the Evaluation of Permanent Impairment, Fifth Edition, published by the American Medical Association are adopted as a guide for determining permanent partial disabilities under Iowa Code section 85.34(2)“a” to “s.” The extent of loss or percentage of permanent impairment may be determined by use of this guide the Fifth Edition of the guides and payment of weekly compensation for permanent partial scheduled injuries made accordingly. Payment so made shall be recognized by the workers’ compensation commissioner as a prima facie showing of compliance by the employer or insurance carrier with the foregoing sections of the Iowa workers’ compensation Act. Nothing in this rule shall be construed to prevent the presentations of other medical opinions or guides or other material evidence for the purpose of establishing that the degree of permanent disability to which the claimant would be entitled would be more or less than the entitlement indicated in the Fifth Edition of the AMA guide guides.”

Do the AMA Guides Have Any Place in the Workers’ Compensation System?

The great debate continues over whether the AMA Guides have any place in the workers’ compensation system. During a recent interview with Dr. Christopher Brigham, Senior contributing editor of the AMA Guides 6th Edition and Todd McFarren, past President of the Work Injury Law and Advocacy Group and president-elect of CAAA, the issues were crystallized.

The AMA Guides measure “impairment” and most if not all workers’ compensation acts provide benefits for “disability.” Additionally there are many other negative changes in Guides including lower values and the elimination of pain as a factor.

There has been a national uproar created over the adoption and use of the AMA Guides 6th Edition. A question has now been raised as to whether they should be relied upon at all in the workers’ compensation area.

The Future of Spitzer’s NY Workers’ Compensation Reform Effort and the AMA Guides 6th ed.

With Governor Spitzer now embroiled in a major scandal that may end in his resignation as Governor of the State of New York, all eyes in the workers’ compensation arena are now focused on his reform efforts. On February 27, 2007 shortly after taking office he signed landmark legislation to overhaul the NY system.

The legislation mirrors the concerns of Labor and Industry throughout the country about a workers’ compensation system bogged down in administrative bureaucracy and failing to meet the medical and permanent disability needs of injured workers. The new NY act is a skeleton on a program that will be reconstructed by regulations and administrative memos.

Injured workers in NY, as in other parts of the country, are concerned of the implantation of the new AMA Guidelines as the criteria for determining disability. It has been remarked that the new AMA Guidelines 6th edition will eliminate at 60% of all findings of disability resulting in no benefits for those injured workers. The Business Council on NY has been advocating for their implementation.

It is doubtful that there will be a change of course in NY. The NY legislation was originally drafted under the Republication Administration of Governor Pataki and merely passed in the Democratic Administration of Spitzer in about 45 days after he took office. The political deal was struck NY long before the Spitzer Administration, but the legislation is only a skeleton that will require additional crafting and implementation.

NY mirrors the same issues of other jurisdictions. Unfortunately implementing the AMA Guidelines 6th edition will not solve the problem in NY or elsewhere. It is like taking a wheel off a vehicle with 2 flat tires already. Yes the system needs reform, but one that will be crafted as the fathers of workers’ compensation legislation intended, which is a system that provides expeditious and adequate compensation for injured workers.

Congresswoman Woolsey Calls For A GAO Study of Workers Compensation-Cites Insurance Company Cost Shifting

Below are the prepared remarks of U.S. Rep. Lynn Woolsey (D-CA), chairwoman of the Workforce Protections Subcommittee, for a subcommittee hearing on “Developments in State Workers’ Compensation Systems” 11.17.2010

-
Thank you all for attending this hearing on “Developments in State Workers’ Compensation Systems.” Here in Congress, we don’t examine these state compensation programs very often because they are generally under the purview of state legislatures.

However, there have been some disturbing national trends that may compel a comprehensive reexamination of these state programs and their impact on injured workers.

As most of you are aware, workers’ compensation statutes were passed beginning in the early  20th century to establish a no fault system for providing efficient redress for injured workers.

Workers’ compensation was called the ‘grand bargain.’

Workers waived their rights to bring individual suits against their employers and in return receive compensation for work-related injuries regardless of fault.

Every state and the District of Columbia have workers’ compensation programs in place.

Most employers purchase private workers compensation policies, but others self-insure or purchase insurance from a state managed compensation fund.

Beginning in the 1990s, changes in state workers’ compensation laws--brought about by the lobbying efforts of employers and insurance companies---have resulted in stricter eligibility requirements and the reduction in both the amount and duration of benefits—particularly for those workers with permanent partial disabilities.

Unfortunately this ‘grand bargain’ of the 20th century is not so ‘grand’ any more, especially for injured workers.

In addition, there are two other recent developments that merit our attention

The first has to do with the American Medical Association’s (AMA) Guides to Permanent

Impairment.

And the second concerns a cost-shifting trend away from state workers compensation programs, where the employer is responsible for an employee’s injury, to the federal government’s medical and disability programs.

The AMA Guides have been in effect since 1971 and are now in widespread use.

Some states even require workers’ compensation programs to use the latest edition of the Guides.

These Guides were originally designed to be used by physicians in making a scientific assessment of a worker’s level of impairment---or loss of function---due to a work-related injury.

The determination of whether a worker is permanently disabled and entitled to workers compensation is based upon his or her impairment rating, which is then applied to the specific case of a given worker.

For example, a worker who loses a hand may not suffer permanent disability if he or she is a teacher, but that same worker would be permanently disabled if he or she works in construction.

In 2007, the AMA published the 6th edition of the Guides, and witnesses today will describe how this new edition has dramatically reduced impairment ratings for many types of conditions, without apparent medical evidence, and transparency.

The 6th edition has become so controversial that many states, including Iowa, Kentucky and Vermont have decided not to adopt them.

It also appears that the 6th edition was developed in near secrecy, without the transparency and consensus which should necessarily accompany the development of standards that will have widespread use by state governments.

In addition, it appears that the physicians who developed this latest edition may have ties to insurance companies, and are making a profit training doctors on the use of the 6th edition, which is complicated and very difficult to apply.

The National Technology Transfer Advancement Act of 1996 sets forth minimum criteria for the development of voluntary consensus standards: openness; balance of interests; due process protections; and consensus.

The process used for developing the 6th edition appears to significantly deviate from these standards and is a focus of testimony before us today.

Workers who are wholly dependent on this ‘grand bargain’ when they are injured on the job, are the ones paying the price.

The subcommittee invited the AMA to testify today, but unfortunately, it declined.

Another troubling policy issue is that as eligibility for workers’ compensation benefits have become more restrictive, there has been a cost shift to Medicare and Social Security Disability (SSDI), placing an additional burden on the taxpayer.

In addition, costs are being shifted to private health insurance that should be borne by workers’ compensation policies and employers.

This is particularly worrisome, especially during a time of record deficits.

Chairman Miller and I believe that this cost-shifting trend warrants further study.

Therefore, we will be asking the Government Accountability Office (GAO) to do a study and issue recommendations.

The testimony today will illuminate these problems facing injured workers and taxpayers, and I look forward to hearing from our witnesses.

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Iowa Workers' Compensation Commissioner Tells Congress AMA Guides Are Objectionable

The Commissioner of the Iowa Division of Workers' Compensation, Christopher James Godfrey, recently testified before Congress that AMA Guides 6 Ed. were problematic. The Commissioner cited the 2008 Iowa Task Force report that found multiple errors and cultural bais in the AMA Guides.

An additional objection made was that the Guides were in conflict with both Iowa statutory and case law. The Commissioner stated, "With all due respect to Dr. Brigham, the Iowa Workers’ Compensation system will evolve and improve when it is decided by the citizens of Iowa that it will evolve and improve. The system will not evolve at the whim or business opportunity of either one physician, one medical association, or a small consensus of the two."

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• Congresswoman Woolsey Calls For A GAO Study of Workers Compensation-Cites Insurance Company Cost Shifting (workers-compensation.blogspot.com)

AMA President Optimistic About A Fix For Medicare’s Doctor Payment Formula

Today's post was shared by Kaiser Health News and comes from capsules.kaiserhealthnews.org

Dr. Ardis Dee Hoven Debated and despised, the Medicare physician payment formula may finally be on the way out – at least that’s what AMA President Ardis Hoven believes. Known as the “sustainable growth rate” or SGR, the formula routinely threatens double-digit payment reduction to doctors until Congress steps in at the last minute to stop the cuts. Currently a 25 percent cut looms Jan. 1 unless Congress takes action again. An admitted optimist, Hoven says she sees plenty of evidence to support her view that Congress is prepared to pass a permanent SGR fix this year. The AMA president points to wide bipartisan support in both chambers. She notes that the House Energy and Commerce Committee passed SGR legislation before the August break — well before the usual end-of-the-year scramble that has been the usual path to a short- term SGR fix. The House Ways and Means and Senate Finance panels are also actively working on a solution. “This is different. This is palpably different,” Hoven says in an interview. According to the Congressional Budget Office, replacing the SGR would cost about $140 billion, down from earlier estimates as high as $300 billion.  But in this era of deficit reduction, it’s unclear where Congress can find that much cash for anything, let alone to pay for the doc fix. Expect a big battle if lawmakers, as they have in the past, turn to other Medicare providers, such as hospitals, home health...

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Dean Emily Spieler Requests Congress to Review The Workers' Compensation Disability Rating System

In recent testimony before the Subcommittee on Workforce Protections Committee on Education and Labor U.S. House of Representatives, Emily A. Spieler, Dean of the Northeastern University Law School, requested further investigation to develop a new rating system for workers compensation claims.

Dean Spieler reviewed current difficulties with the current AMA Guides 6th ed. She stated, "I urge that you ask the National Academies of Science / Institute of Medicine to conduct a review. This review should include recommendations regarding the best way to develop a new system for rating workers’ injuries as measured by the impact of those injuries and diseases on the extent of permanent impairments, limitations in the activities of daily living, work disability and nonwork disability (or noneconomic losses)."


Click here for complete testimony.

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mHealth: A Potential Player for Workers' Compensation

Delivery of workers' compensation medical care is one of the most costly items on the landscape  of the social, remedial program. A recent article in the AMA Journal raises doubts that the delivery of medical care  utilizing electronic mobile technology will be an advantageous solution to spiraling costs.

"mHealth technologies have the potential to change every aspect of the health care environment and to do so while delivering better outcomes and substantially lowering costs. For consumers, mHealth offers the promise of improved convenience, more active engagement in their care, and greater personalization. For clinicians, mHealth could lead to reduced demands on their time and permit them to instead refocus on the art of medicine. Much remains to be done to drive this transformation. Most critically needed is real-world clinical trial evidence to provide a roadmap for implementation that confirms its benefits to consumers, clinicians, and payers alike."

Click here to read the entire article appearing in the AMA Journal

Administration in California Requests Judges to Vacate Their Decision Against AMA Guides

California Administration officials have written to the California Appellate Judges and requested that they vacate their decision setting aside the AMA Guides.  The letter, an unprecedented action, has not yet received a response from the California Workers' Compensation Appellate Court.

However, Todd McFarren, a California attorney and President of the California Applicants Attorneys Association, has remarked that the the Judges, will “...still be handcuffed by the administration’s inadequate permanent disability schedule.”  “The administration has not addressed the fundamental flaws in its disability rating schedule. We’ve been waiting more than a year for the governor to approve his own administration’s proposal to restore a small percentage of the permanent disability compensation he cut by 50% to 70%.”

Petition Filed to Re-Consider California AMA Guide Decision

The California Workers' Compensation Appeals Board (CAWCAB) has decided to review its prior decision of February 27, 2009, challenging the AMA Guidelines. The CAWCAB has issued an Order granting reconsideration and inviting mucus briefs to be filed.

"We also will give any interested person or entity until 5pm on Friday, May 1, 2009 to file an amicus curiae brief and to serve that brief on all counsel in both the Almaraz and Guzman cases."

Alvaraz v. Environmental Recovery Services, et al.

A 10 Step Guide To Your Independent Medical Examination

Follow these steps to ensure you get the most out of your independent medical examination.

Today's post comes from guest author Paul J. McAndrew, Jr. from Paul McAndrew Law Firm.

You will reach the stage in your worker’s compensation claim where you will be examined by a doctor of your choice. This exam may generate the most important evidence in your claim. I strongly recommend that you do the following:

1. Needless to say, always tell the truth. Never exaggerate or overstate your symptoms. On the other hand, do not understate your symptoms, either. This is your one chance to tell it all.
2. Be sure to write down the time and place of your independent medical examination (IME, for short). It is important that you make it to this appointment on time.
3. Before going to the IME, spend an hour or two writing down the history of your injury, your current complaints based on the injury, what things aggravate your injury, and what care and treatment you have been given for your injury. You will have only a limited amount of time to describe these things to the IME doctor. It is important that you have a well-organized statement to give to the doctor. Therefore, you should take your written statement to the IME and use it to make sure that you tell the doctor a complete statement of these things. Then, save the written statement and return it to me. If the things in your statement do not end up in the IME doctor’s record, this may be useful in the future.
4. Remember, although this is a doctor of our choosing who will be fair and impartial. The doctor is not in our pocket. He (or she) will be using the AMA Guides to the Evaluation of Permanent Impairment which has certain “tests” to determine if a patient is faking or exaggerating their symptoms.
5. The best way to go into the IME is to be alert, relaxed and polite. The IME is a fairly routine process. You are not being singled out. Don’t be defensive.
6. A major part of the IME will consist of you answering<!--more--> written or oral questions or giving a statement to the doctor. Answer all questions politely and truthfully. Don’t try to fake anything or unreasonably exaggerate any problem. Any experienced doctor will quickly discover this and it could ruin your case. Take your time in answering questions to make sure that you answer each question clearly and truthfully. Answer only the questions that are asked and don’t ramble on.
7. You will probably be asked to describe your pain. Paint is often difficult to describe. You might find it easiest to explain activities that worsen your pain. You should have a list of everyday activities that increase your pain.
8. When talking to the physician try to be as accurate as possible. Explain when and how you were hurt. Tell him your current symptoms in as neutral a way as possible.
9. Do not complain bitterly about your previous treatment. Don’t say things about the company doctor being in cahoots with the employer. The IME doctor’s evaluation won’t be made better by complaints.
10. After the IME, I am interested in knowing just what went on in the examination. Therefore, after the examination, take at least one half-hour to write down as much as you can remember of what the doctor said, what you answered, what the doctor did, and what, if anything, was dictated into a recorder. Note as accurately as possible the time that you arrived at the office, the time that you were placed in the examining room, when the doctor entered the room, and when the doctor left the room. It may be important to have an exact record of the time the doctor spent with you in the examination room.

If you follow these directions, you will provide the IME doctor with an accurate description of your work-injury condition. This will lead to a clear and reliable IME report that can held your claim. Of course, check with your attorney for more suggestions.

Professor John F Burton Jr: Illinois Proposed Changes Are Obectionable

The former chair of the 1972 National Commission on Workers' Compensation told the Illinois legislature yesterday that the proposed changes to the Illinois Workers' Compensation Act will degrade the system and reduce benefits to injured workers. Profession Emeritis John F. Burton, Jr., yesterday presented a statement to the Committee of the Whole before the Illinois House of Representatives.

Professor John F. Burton Jr.

Climate Change: A Factor Escalating Compensable Conditions

Global climate change is anticipated to cause an increase in adverse medical conditions and will ultimately impact work-related medical conditions and diseases. A recent report in the Journal of the American Medical Association (JAMA) discuses the anticipated escalation.

"Evidence over the past 20 years indicates that climate change can be associated with adverse health outcomes. Health professionals have an important role in understanding and communicating potential health concerns related to climate change, as well as the cobenefits from burning less fossil fuels."

"By 2050, many US cities may experience more frequent extreme heat days. For example, New York and Milwaukee may have 3 times their current average number of days hotter than 32°C (90°F). The adverse health aspects related to climate change may include heat-related disorders, such as heat stress and economic consequences of reduced work capacity; and respiratory disorders, including those exacerbated by fine particulate pollutants, such as asthma and allergic disorders; infectious diseases, including vectorborne diseases and water-borne diseases, such as childhood gastrointestinal diseases; food insecurity, including reduced crop yields and an increase in plant diseases; and mental health disorders, such as posttraumatic stress disorder and depression, that are associated with natural disasters. Substantial health and economic cobenefits could be associated with reductions in fossil fuel combustion. For example, the cost of greenhouse gas emission policies may yield net economic benefit, with health benefits from air quality improvements potentially offsetting the cost of US carbon policies.

Climate Change Challenges and Opportunities for Global Health, AMA. Published online September 22, 2014. doi:10.1001/jama.2014.13186

Click here to read the entire article.

….

Jon L. Gelman of Wayne NJ is the author of NJ Workers’ Compensation Law (West-Thompson-Reuters) and co-author of the national treatise, Modern Workers’ Compensation Law (West-Thompson-Reuters). For over 4 decades the Law Offices of Jon L Gelman  1.973.696.7900  jon@gelmans.com  have been representing injured workers and their families who have suffered occupational accidents and illnesses.

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Congress to Hear Experts on New State Workers' Compensation Limitations

A sub-committee of the Committee on Education and Labor, chaired by the Congressman George Miller, will be hearing testimony from national experts concerning the new limitations being imposed on State workers' compensation systems. The systemic problems to be examine include the delivery of medical benefits and the assessment of the nature of disability.

On Wednesday, November 17, the Workforce Protections Subcommittee of the House Education and Labor Committee will examine state workers’ compensations systems. Workers’ compensation traditionally provides financial assistance and job training to workers injured on the job and aid to the surviving family of a worker killed on the job.

Not only are the state systems drawing the attention of the US Congress, but also the federal programs are becoming problematic. The United States Postal Service announced last week that workers' compensation costs are so high that the quasi-governmental agency may have to declare bankruptcy.

With the newly elected Republican majority in Congress, the water ahead may be rough for workers' compensation. The last time the Republican's held the majority in Congress, Newt Gingrich , the former Speaker, was entertaining dramatic changes in the program. Those appear to have been refreshed in recent comments about a year ago.

These systems have undergone numerous changes in the past decade as many states have begun strictly limiting workers’ compensation benefits – changes that may be stressing the Social Security Disability Insurance (SSDI) program. Additionally, the American Medical Association’s (AMA) guide to assessing injured workers has undergone significant changes in its latest edition, which has made consequential changes to injured workers’ evaluation procedure.

Workforce Protections Subcommittee Hearing

2:00 PM, November 17, 2010

2175 Rayburn H.O.B.
Washington, DC

Additional witnesses TBA.

Witnesses:
Emily SpielerDeanNortheastern University School of LawBoston, MA
John BurtonProfessor Emeritus, School of Management and Labor Relations, Rutgers UniversityProfessor Emeritus, School of Industrial and Labor Relations, Cornell UniversityPrinceton, NJ
Christopher GodfreyIowa Workers Compensation CommissionerDes Moines, IA
Dr. John NimlosOccupational Medicine ConsultantShoreline, WA

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Computerized X-ray Interpretation to Evaluate Spinal Ligamentous Injuries

Diagnosing and quantifying spinal ligament pain in workers' compensation claims has historically been a challenge to both the medical and legal communities. Now a recently published study reports that through computer assisted analysis  a computerized measurement can be obtained that can assist in accurately diagnosing and grading of ligament injuries.

"Spinal Ligament injury is well documented to be one the most common injuries in a trauma. It is also well documented that, depending upon the grade (seriousness) of the injury, they can take up to 2 years to heal and have different treatment protocols. Yet it seems few doctors attempt to accurately grade the injury according to medical guidelines even where specific guidelines exist. The crude and varying methods to assess the injury provided little consensus. This study shows that precise accurate grading of spinal ligament injury can be best obtained by advanced computerized methods for measuring x-rays, while conforming to current AMA injury guidelines. One Hundred random cases of spinal injury were assessed by usual visual inspection of stress x-rays by radiologists, then re-assessed by computer measurement.  

"Significant spinal ligament injury was accurately revealed by computer measurement that was missed by the standard radiological reads. 

"Assessing spinal ligament injury by computer measurement significantly improves diagnosis and grading of ligament injury.

Click here to read Brownstein SP, Jefferey Cronk DC, Joseph Cioffi BA. Evaluation of Spinal Ligamentous Injuries using Computerized X-rayInterpretation. Orthop Rheumatol Open Access J. 2015;1(1): 555551. 

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Coverage for End-of-Life Talks Gaining Ground

Today's post is shared from nytimes.com

Five years after it exploded into a political conflagration over “death panels,” the issue of paying doctors to talk to patients about end-of-life care is making a comeback, and such sessions may be covered for the 50 million Americans on Medicare as early as next year. Bypassing the political process, private insurers have begun reimbursing doctors for these “advance care planning” conversations as interest in them rises along with the number of aging Americans. People are living longer with illnesses, and many want more input into how they will spend their final days, including whether they want to die at home or in the hospital, and whether they want full-fledged life-sustaining treatment, just pain relief or something in between. Some states, including Colorado and Oregon, recently began covering the sessions for Medicaid patients. But far more significant, Medicare may begin covering end-of-life discussions next year if it approves a recent request from the American Medical Association, the country’s largest association of physicians and medical students. One of the A.M.A.’s roles is to create billing codes for medical services, codes used by doctors, hospitals and insurers. It recently created codes for end-of-life conversations and submitted them to Medicare. The Centers for Medicare and Medicaid Services, which runs Medicare, would not discuss whether it will agree to cover end-of-life discussions; its...

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