AIMS Worker's Compensation Report

Welcome AIMS!

The AAOM welcomes to its Association Membership, the Acupuncture and Integrated Medicine Specialists (AIMS). As a California based association, AIMS is a non-profit business association dedicated to the protection, promotion, and advancement of acupuncture and traditional Oriental medicine and the integration of these practices into the American health care system.

Greetings,

Attached is the latest from "workcomp central" re: W/C Guidelines

AIMS insurance committee felt that the entire profession should be informed on the latest development as soon as possible. We hope you will read it and pass it on to others.

AIMS web site and communication operation is currently under reconstruction. We are asking you to please forward information to individuals, associations, and educational institutions.

This is an election year. It is an important year to be involved in the political process, and especially as it impacts our profession and our abilities to help patients. Look for AIMS bi-monthly updates scheduled to start sometime this summer.

AIMS is currently looking for a location for our State Legislative Town hall meeting tentatively scheduled for Sept/Oct. The subject of workers comp, education and  many other statutory and regulatory issues will be discussed and debated. We are currently asking the profession for suggestions for topic of discussion. We will be sending out a survey to further identify areas of  concern and then prioritize them for our State Legislative Town hall.

If the State adopts the proposal following this letter, it will be important to have the right person representing the profession. We believe we need to start that discussion as soon as possible.

In the past we have had great representation from Robin Hayes and Kenny Cherman in the W/C arena. Ken is an AIMS board member who has worked well with Robin when she was with c.a.a. and Ken was with C.S.O.M.

Ken and or Robin would be great choices. Another excellent choice would be former AIMS board member and current advisor to the President Shane Buras. Shane has a background of a million years or so of experience in the insurance industry before being reborn as an Acupuncturist. He is also co-chair of the AAOM CPT committee and AAOM board member. He testified before two committees in support of AB-3014 Koretz and proved himself to be extremely knowledgeable, respectable and a very cool head when asked questions under pressure. Alex Katz is another AIMS board member that is highly qualified to represent the profession in the W/C arena. He has made himself an expert on policy and procedures on W/C and has built a very successful career practicing in W/C. In addition, he has been working as a case review expert for several insurance companies as are Kenny and Shane.

AIMS is opening up the subject for discussion and debate. Who would be the best person and a back up to represent the Acupuncture profession should the W/C administrative director choose to have each of the physicians in W/C have such a representative?

I would like to thank Fred Lerner DC of Lerner Education for sending AIMS the latest update from "workcomp central." If ever you want to know the latest on W/C and how to get the most out of ethical billing, you need to attend one of Fred and Shane Burras' ethical billing seminars. The next one is in N. California in the Bay Area next week.

Separate issue.

Thanks to all who have been in support of AB-3014. Please tell others to join you in support. Please contact your State Senator and request their vote. CAOMA and their lobbyist are working hard to defeat this important legislation that the rest of the profession is supporting. CAOMA and the chiropractors and the physical therapists lobby are all working hard to defeat AB-3014 Koretz.

PLEASE HELP.

Neal S. Miller L. Ac., D.N.B.A.O
13735 Ventura Blvd.
Sherman Oaks, CA 91423

(818) 789-2468
(818) 981-2766 FAX

California -- Calif. Regs Would Keep ACOEM as Sole Guidelines: Regulatory [07/10/06]

The American College of Occupational and Environmental Medicine (ACOEM) would remain the source of treatment guidelines in California's workers' compensation system, under proposed rules posted Friday by the Division of Workers' Compensation.

The draft rules, while leaving ACOEM in place, would also establish a medical evidence evaluation advisory committee that will include an orthopedist, a chiropractor, an occupational medicine physician, an acupuncturist, a physical or occupational therapist, a psychologist or psychiatrist, a pain specialist and three other members to be appointed at the administrative director's discretion.

The agency scheduled an Aug. 23 public hearing in Oakland to take testimony on the proposed rules.

Susan Gard, spokeswoman for the Division of Workers' Compensation, said that the proposed regulations represent a step toward filing the gaps in ACOEM, most notably for spinal injuries, chronic pain and carpal tunnel syndrome.

"This sets the hierarchy of evidence," Gard said. "In other words, what's the best way to look at evidence? The Legislature made (ACOEM) the foundation of evidence-based medicine in California's workers' comp system and now we're going to build on that and add to it. That's the good news here."

The regulations, however, do not put in place any treatment guidelines other than ACOEM. The creation of an advisory panel at best will keep alive hopes by specialty groups that eventually California will adopt something they believe is more suitable for their disciplines.

Senate Bill 899, signed into law on April 19, 2004, called for the DWC to adopt a "medical treatment utilization schedule" by Dec. 31, 2004. Unable to complete an exhaustive analysis of the myriad treatment guidelines in existence by that deadline, the DWC adopted ACOEM as the utilization schedule.

"We're happy the process is going to be vetted," said Steve Cattolica, government affairs director for the California Society of Occupational Medicine and Surgery. "These regulations are months behind, and from that perspective we are glad to see that the DWC is stepping up and coming forward."

Orthopedic surgeons, chiropractors, acupuncturists and other practitioners have pleaded that the DWC to augment ACOEM's Occupational Medicine Practice Guidelines with guidelines from their specialties. What's more, the state's labor-management advisory panel, the Commission on Health and Safety and Workers' Compensation, recommended that the DWC adopt guidelines written by the American Academy of Orthopedic Surgery (AAOS) for spinal surgery and ACOEM for all other treatments.

But acting Administrative Director Carrie Nevans decided to stick with a single source, at least for now.

"The system and rigor of scientific review used in the development of evidence-based guidelines varies significantly from one group to another," the DWC said in a statement of reasons that accompanied the proposed regulations. "Should the administrative director adopt multiple guidelines, more disputes will arise as the lack of agreement between guidelines would negate the presumption of correctness under some circumstances."

Diane Przepiorski, Executive Director of the California Orthopedic Association, said she was disappointed that the DWC once again rejected guidelines that most spine surgeons consider superior to ACOEM for their specialty. CHSWC had recommended the orthopedic surgeon's AAOS guidelines because a study by RAND Corp. had deemed them more suitable for back surgery. RAND said ACOEM was superior to AAOS and other treatment guidelines for all other types of treatment, although it didn't find ACOEM or any other set of guidelines particularly comprehensive.

Przepiorski said her group will fight to improve California's treatment guidelines on two fronts: It will push for changes during the rule making process for the current draft regulations and before the medical advisory committee once it is established. Secondly, the American Academy of Orthopedic Surgery is holding discussions with ACOEM to create better guidelines for back surgery.

Przepiorski said ACOEM guidelines are good for treatment of acute back pain conditions, but not so good in recommending treatments for chronic conditions -- typically the type of disorders that surgeons are called in to cure and relieve.

"Ultimately we believe that specialists themselves have the most at stake in developing appropriate treatment guidelines," Przepiorski said. "Unfortunately, orthopedics was one of the specialties that was just not involved" in the drafting of ACOEM guidelines.

The DWC, in its statement of reasons, gave very specific reasons not to replace the spinal surgery section of ACOEM with AAOS. Mainly, the two guidelines give different direction to physicians on how to treat chronic cases. For instance, ACOEM says that X-rays should not be performed on patients suffering low back pain -- even if pain persists more than six weeks -- unless there are red flags that point to serious spinal pathology, while AAOS says X-rays should be considered if pain persists for four to six weeks.

The DWC found similar problems with recommendations to consider separate guidelines for podiatry, chiropractic, physical therapy, occupational therapy, acupuncture and biofeedback.

"... Conflicting recommendations such as those illustrated above will be confusing to the provider, employer, or claims administrator who are required to provide requisite services for an industrial injury and who may incur liability for failing to do so according to the statute," the DWC said in its statement of reasons.

To view the proposed regulations, the DWC's statement of reasons and the notice of public hearing, go here:

http://www.dir.ca.gov/dwc/DWCPropRegs/
MedicalTreatmentUtilizationSchedule/MTUS_regulations.htm

By Jim Sams, Senior Editor

Editor Rob McCarthy contributed to this report.