Comment in Our Forum!

November 18, 2004
Source: WorkInjury.com
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The Commission on Health and Safety and Workers' Compensation (CHSWC) of the California Division of Industrial Relations has just released the much anticipated Rand report with recommendations regarding medical treatment guidelines.

Among the recommendations made by the CHSWC to the DWC:

* That the AD consider adopting an interim utilization schedule based on the ACOEM guidelines, but replaced with AAOS (American Association of Orthopedic Surgeons) guidelines specifically for spinal surgery.

* That the AAOS Guides evaluated favorably for spinal fusion surgery while the ACOEM guidelines did not.

* That both guidelines (ACOEM and AAOS) rated favorably for spinal decompression surgery, but that there would be less confusion if only one guideline were applied to all spinal surgery.

* That both the ACOEM and McKesson Guidelines have pros and cons; the former is better for utilization review while the latter is better for clinical work (since it's in narrative form). And that ACOEM is recommended as the primary reference.

* That the ACOEM is weak for occupational therapy, acupuncture and biofeedback.

* That there have been frequent reports of utilization review decisions withholding authorization for treatment solely because the treatment was not covered by ACOEM guidelines (no great shock to workers' comp. practitioners). That if true, these reports demonstrate that the fallback language of Section 4604.5 is insufficient to fill the gaps and that it's therefore recommended that the medical treatment utilization schedule require

"that a competent medical professional exercise expert judgment in determining whether treatment not covered by ACOEM and AAOS guidelines is medically appropriate, and that other guidelines relied upon by the treating physician or known to the medical professional should be considered in making that: determination."