Workers Comp Committee made no recommendation reinterferential electrotherapy at today's meeting

[Guest guest]

Doctors, others

Yesterday the OBCE addressed the pending petition regarding interferential

therapy and communicated with the WC department in response to their request for

OBCE's opinion. Supporting letters from WSCC were also provided.

This morning I attended the Workers Comp Department Medical Advisory Committee

meeting at the Labor & Industries building in Salem. They were discussing the

RS-4i device. The committee learned (for the first time it seems) this is a

bi-model device performing, first interferential electrotherapy & then electro

muscle stim, as a combination therapy. The device is provided for home use by

patients and includes a data card that can track actual usage.

(RS Medical said they charge $250 rent/lease per month to patients for use of

this device, which costs up to $2,495, with a 30% discount provided in some

situations. A company rep assists the doctor to fit the patient with the device

-- either on a belt or a vest -- and the company rep also programs the doctor's

instructions into the device. My understanding is the company bills directly to

payers for this therapy.)

After much discussion, the committee took no action towards a recommendation

regarding this specific device. They addressed the confusion caused by the

Liberty NW Insurance Company petitions, first requesting the RS-4i device be

rendered non-compensable, and then last week's 2nd petition requesting all

interferential therapy be rendered non-compensable. Instead, WC dep staff is

contacting Liberty to seek clarification regarding their petitions, and what

exactly they are requesting. At one point a committee member (Liberty's Med

Director I think) said it was just the home interferential therapy they were

concerned with. The chiropractic representative on this committee,

Prideaux DC, questioned the scope of these petitions as lacking clarity so the

committee could not know exactly what they are being asked to address. It was

also pointed out that interferential is one of several electrotherapies in

common use. Certainly no one was questioning TENs, and it was suggested that

interferential should be compared in effectiveness to TENs.

The committee's chair emphasized the Advisory Committee's role is not to get

involved in reimbursement issues or cost of device, but to review the supporting

evidence that validates the technique or treatment, with an emphasis on RCTs,

followed by retrospective and case studies, that all meet criteria of valid,

well done (free of bias and flaws), and of sufficient size.

They listened to an extended presentation by RS Medical, the Vancouver WA based

company that provides the RS-4i device to clinics across the country, including

a bibliography of evidence on both interferential current and muscle

stimulation. Two medical doctors provided supporting testimony based on their

clinical and anecdotal experience. They claimed use of this device in some cases

obviated need for other modalities & pain control drugs, thus justifying the

cost. Committee members asked both if they had documented their positive outcome

claims in any way, neither had. Both said that RS Medical was paying them their

lost earnings for this morning's testimony.

No one from Liberty NW Insurance Company appeared to formally testify regarding

their petitions.

Discussion ensued regarding the quality of the evidence before the panel, with

several panel members stating it is known there is a lack of RCTs for these and

many other modalities, yet they are in common use and known to have many

clinical benefits.

Likewise the Liberty petition included multiple references to clinical studies

which they say cause doubt about the clinical effectiveness of interferential

therapy.

Should the process go forward, (it may not) no doubt the chiropractic profession

will wish to identify, review, and present the available clinical evidence

supporting interferential therapy in some coherent fashion. That's what the

Committee clearly is requesting.

The WC department did not initiate this proceeding, but has to review the

petition requesting administrative rulemaking. They may deny the petition/s or

subsequently enter into rulemaking with a further public comment & public

hearing process.

Dave McTeague, Ex. Dir.

Oregon Board of Chiropractic Examiners

503-378-5816 ext. 23