Benchmark Client Newsletter Oct 03.pub

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Vital Resource Vital Resource for Medical-Legal for Medical SOLUTIONS M EDICAL C ONSULTANTS October 2003 Volume 4, Issue 5 THE CURRENT BUZZWORD…”EVIDENCE-BASED” Mark Your Calendar Medical-Legal Seminar calgalminar This may seem states, is trying to control the escalat-a strange topic ing Workers’ Compensation costs to for an orthopedic improve the business environment. In Saturday- November 8 8 surgeon to dis- that I have been a prior member of Sacramento amencuss but, after the Industrial Medical Council, the Convention Center nterall, the majority UCSD Orthopedic Department was of the treatment awarded the contract to develop a test for muscu- documenting medical findings. loskeletal disor- This test eventually emerged as the Vert Mooney, M.D. ders is non- CAL-FCP (Functional Capacity Proto-surgical. Thus, it col) test. This was a series of draw-is useful to inquire if the treatment is ra- ings of individuals doing normal activi-tional, especially when it is being com- ties of daily living with increasing pensated by the medical health care sys- physical demands and a physical test tem. as to capacity for lifting and grasping. The test was criticized for not measur- Our assumption in this modern age is ing pain but defended in that dimin-that medical care is being provided on ished function should reflect impair-the basis of scientific information. The INSIDE THIS ISSUE: ments caused by pain. Actually, there current buzzword ...

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• Publié par: Phuem
• Nombre de lectures: 34
• Langue: English

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VitalResource forMedical-Legal SOLUTIONS

October 2003 Volume 4, Issue5

T H E  C U R R E N T  B U Z Z WO R D … ” E V I D E N C E - B A S E D ” Mark Your Calendar  Thismay seemstates, is trying to control the escalat- Medical-LegalSeminar a strange topicing Workers’ Compensation costs to Saturday- November8 for an orthopedicimprove the business environment.In surgeon to dis-that I have been a prior member of Sacramento cuss but, after theIndustrial Medical Council, the ConventionCenter all, the majorityUCSD Orthopedic Department was of the treatmentawarded the contract to develop a test f o rm u s c u -documenting medical findings. loskeletal disor-  Thistest eventually emerged as the Vert Mooney, M.D. ders is non- CAL-FCP (Functional Capacity Proto- surgical. Thus,it col) test.This was a series of draw- is useful to inquire if the treatment is ra- ings of individuals doing normal activi- tional, especially when it is being com- ties of daily living with increasing pensated by the medical health care sys- physical demands and a physical test tem. as to capacity for lifting and grasping. The test was criticized for not measur-  Ourassumption in this modern age is ing pain but defended in that dimin- that medical care is being provided on ished function should reflect impair- the basis of scientific information.The INSIDE THIS ISSUE: ments caused by pain.Actually, there current buzzword is “evidence-based.”A is no accepted way of measuring documentation of this concern was Cali- pain. Forpolitical reasons, the test 2 fornia legislation in 1995, wherein the “Evidence Based” was not accepted at that time.None- State Legislature instructed the Industrial theless, the concept resonates in the Medical Council to evaluate “the feasibil- CME/MCLE Seminar 2 current California Work Comp crisis, ity of using objective medical findings for wherein California SB354 has been the treatment of soft tissue injuries.”Of 3 introduced, which would “require the Consultant Profiles course, soft tissue injuries in this context use of evidence-based clinical prac- means those indefinable problems such tice guidelines to determine what as back pain, whiplash and overuse syn- Chiropractic RED Flags 3 treatments and procedures are appro- drome. Noone who reads this newsletter priate.” Thetest developed in the on medical-legal consulting needs an 4 mid-1990s has emerged as a comput- New Consultants education as to the spiraling cost of the erized test called the MTAP treatment of these disorders in Workers’ (Multidimensional Task Ability Profile). Insert Compensation and personal injury. Consultant Then, as once again, California, as many ►BUZZ, Page 2 Availability

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C U R R E N T  B U Z Z WO R D …

Is there really a problem in rational physical therapy?The only form of noninvasive physical treatment which has documented, scientific information as to benefit for soft tissue injuries is a pro- gressive active exercise program.There is no documentation for benefit from various passive modalities such as electrical stimula- tion, hot packs, cold packs, etc.For chronic recurrent problems, there is scientific documentation for the benefit of manipulation associated with exercise.When I became involved with the busi- ness of physical therapy, however, I was astonished to find that regulations for physical therapy treatment under Workers’ Com- pensation require that most of the treatment be passive in nature. This is reflected in the reality of a report provided by the California Workers’ Compensation Institute, which indicated in the year 2002, for physical medicine modalities, which include all physical therapy and chiropractic care, only 10% of the billings were for active exer- cise. Thus,even insurance regulations hinder the acceptance of rational care. How do we define rational care?The only mechanism of which I am aware is one in which function is measured at baseline, and the same tests are used later on after treatment to note if there has been improvement.If no improvement occurs, the strategy of treatment currently being employed cannot be considered effec- tive. Ifa medication provided by a doctor is found not to benefit the entity being treated, usually different pharmaceutical agents are tried. Is such a concept feasible?In 1997, the medical director of the Labor Commission in Utah established new rules wherein physical therapy treatments would not be continued if there was not im- provement in at least three out of ten simple measures of function. The regulation considerably reduced the use of modalities and increased the use of active treatment. What is the point of this discussion?Certainly there is an un-

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solved problem.Back pain is now the single most expensive category of industrial injury, responsible for 31% of total industrial expenses. Thisis representative of a lack of consistency in evaluation and treatment of this very common disorder. Yet, in scientific circles at the medical school and specialty board level, the problem tends to be ignored.Last year at the Orthope- dic Surgeons annual meeting, out of 540 presentations, four re- lated to non-operative physical care.In a recent survey of Ameri- can fourth year medical students as to the area in which they felt most competent, where all phases of medical care from obstetrics to dermatology were queried, the area where most felt they were incompetent was in rehabilitation.The second most incompetent area was in nutrition.Yet, the Latin word for “teacher” is “doctor.” Is there a model to document the benefits of an active pro- gram? Lookat what happens to the injured professional athlete. This is probably the most expensive workers’ comp injury.The time off required for recovery of the injured athlete is costly to the business interests of the team.Is the athlete sent for a home program? Ishe sent to a physical therapist?No. Heis sent to the athletic trainer employed by the organization, who takes him to the training room, where his injury is gradually worked out with the use of various forms of training equipment.He may have the adjunctive use of modalities for pain control, but the goal is to measure his or her performance with the benefit of equipment so that all involved can be assured that his physical performance when recovered from the injury is close to where it was before the injury. Ifonly the usual injured worker or personal injury victim could be coached in such a similar manner.Physicians (in Cali- fornia, chiropractors are also physicians) have to take responsibil- ity for searching for effective care.Requests for documentation of improved function, not just an adjective as to whether the individ- ual is “better,” will ultimately become a necessary requirement for effective care.

N E E DC M EO RM C L EC R E D I T S ? B R I N G I N GT O G E T H E RT H E  M E D I C A L , L E G A L , A N D  I N S U R A N C EI N D U S T R Y Mark your calendars for Saturday, November 8th!W orkshop,Causation Register by It's Benchmark Medical Consultants' Annual Meet-Analysis, Chronic Pain ing. A CME and MCLE accredited seminar on issueDisorders, Breakthroughs fax, mail, or of interestto doctors, attorneys and insurancein Obesity Treatment, and professionals in the medical-legal industry.The ourkeynote speaker, on-line seminar will be held from 8:00 AM to 5:00 PM at theChris Brigham, MD, Sacramento Convention Center- 1400 ’J’ Street,speaking on The Disabling of America. Sacramento. Topicswill include a Testimony Call1.800.458.1261 today for early registration!

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M E D I C A L C O N S U L T A N T S C O N S U LT A N TP RO F I L E S E. Gary Starr, M.D.Gordon E. Lewis, M.D. Physical Medicine & RehabilitationOrthopedic Surgeon Dr. Starris a physiatrist.Physiat-Dr. Lewis received his medical rists undergo extensive specialty degree in 1972 from Loma Linda training including orthopedics, neu- University in Loma Linda, CA. rology, electro diagnostic testing, He undertook post-doctoral train- internal medicine, pulmonology, ing in Orthopaedic Surgery be- cardiology, kinetics, psychiatry, and tween 1972 and 1976 at Loma rehabilitation techniques.Many Linda University Medical Center. physiatrists devote their careers to In 1974 part of his training oc- treating individuals with spinal inju- curred at Rancho Los Amigos ries and paralysis due to wartime accidents or traumatic injuries, such Hospital in southern California, E.G. Starr, M.D.G.E. Lewis, M.D. as Christopher Reeve.Dr. Starr which is a renowned rehabilitation studied for many years at the University of Reno, Nevada facility where individuals with serious orthopaedic where he received his medical degree in 1984.He under- conditions are treated.Dr. Lewis has been in private took his internship and residency at the University of Cali- practice since 1976 in northern California.He earned fornia, Irvine Medical Center between 1985 and 1988 and his Board Certification in Orthopaedic Surgery in is licensed to practice medicine in both California and Ne- 1977. Heis an active member of the American Acad- vada. Heearned his Board Certification in 1989 and was emy of Orthopaedic Surgeons and is a Diplomat of the staff physiatrist and Medical Director of Rehabilitation the American Board of Orthopaedic Surgery.He is a at Northern Nevada Medical Center in Reno between 1990 member of the medical staff at Sutter Auburn Faith and 1998.He is currently in private practice in Reno.Dr. Starr is a certified member of the American Board of Inde- Hospital, Healthsouth of Auburn, and Sutter Rose- pendent Medical Examiners, the North American Spine ville Medical Center. Society and the American Academy of Physical Medicine and Rehabilitation. Available in Sacramento and NevadaAvailable in Sacramento and Auburn C H I RO P R A C T I C  R E D  F L A G S The following is a list of CPT CodesExplanation several CPT codes that 95860-95875 Invasive treatmentThese codes all refer to variations of needle EMGs. are commonly misused is prohibited under chiropractic guidelines.If used by a chiropractor, in chiropractic care and the study was surface only and therefore most likely not reimbursable. i d e n t i f i e dt h r o u g h 76120-76125 These codes refer to video fluoroscopy.Not a medically necessary Benchmark Bill Reviews. procedure in chiropractic care. Again, record review is the best de- 99090 Computer analysis of manual diagnostics.This is also not separately fense for abuse of these codes.This identifiable from E/M codes and usually clinically unnecessary in order to provide accurate diagnosis. information does not qualify the ad- juster as an authority. For additional 97010 Be aware of overuse of hot/cold packs.Most guidelines prohibit use information, regarding Benchmark’s for post-traumatic cases in the 1st week. Bill Review Service, please contact us 97024 and 97035 Diathermy and ultrasound do essentially the same thing, therefore at 800.458.1261. often is redundant.

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Campbell Lee….………..Chiropractic Evans Keith…...………. Chiropractic Koopmans John M……. Chiropractic McKechnie Brad………. Chiropractic Rabadi Ma'an…………..Chiropractic Schneider Frank………. Chiropractic Denning Jeffrey ………..Economist Salmi Gregory H……….Family Practice Whitley Careen………..Family Practice Disiere John…………...General Surgery Hertz Bruce Michael….. Internal Medicine Norwood Paul…………. Internal Medicine Thompson David……… Neurology Gennuso Rosemaria…..Neurosurgery Kohut James…………..Neurosurgery Saleh Jamshid………..Neurosurgery

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