RE: LMSI

[Guest guest]

Greetings Listmates:

An adjuster with Country Mutual Insurance informed

me that every time she receives a report suggesting ligament laxity from a

digitally measured radiograph, she turns it over to their in-house chiropractic

specialist. She said that she has never

seen a digitally-measured study provide substantiation of a patient’s treatment

according to her specialist’s criteria! I guess the AMA guides are

meaningless, after all! I will no longer utilize Dr. McCoy’s Spinal-Logic

Diagnostic’s in Kirkland,

WA to digitally measure my films

for this reason, and am back to manually measuring the films using Penning’s

Analysis. That may help avoid raising any red flags, but does not address the

problem of uninformed and/or unscrupulous IMEs.

Our effort to provide objective measures

of patient’s injuries to justify treatment appears to be viewed by others

(even within our profession) as window dressing, and is currently treated as

such. My frustration is that for all practical purposes, I have been wasting my

time and money ($8,000 for a wireless dual inclinometer system, which also

utilizes the Neck Pain Disability Questionnaire, Revised Oswestry,

Roland-, Rand-36, and VAS, etc) in my efforts to provide the information

we are told is necessary to prove injury exists, and prove our treatments are

effective, when all it takes is an IME to suggest that a medical radiologist

who glances at a film can determine that no ligament injury exists, and that my

report is simply boilerplate, then cut off treatment. And I’m not talking

over-utilization here. One case was closed after only four visits, and another

after 47. Both patients suffered ligament injuries that the AMA Guides place at

a 25-percent, whole-person impairment. (And by the way, Croft guidelines suggest

an outside treatment number of 76 treatments over a 56-week period for such

cases. I have never had a treatment plan last that long before an IME steps in,

calls it a resolved sprain/strain, then closes the case.)

Either our documentation and objective

measures carries some weight, or it doesn’t. I am told by attorneys that

a jury would simply gloss over at the suggestion that a 3.5mm, or even 5mm

translation has any significance in the real world, yet those measures are

listed in the AMA Guides as the determinates of a 25-percent whole-person

impairment. If we are making the effort to measure and document it needs to

mean something, doesn’t it? It appears that treatment decisions are

increasingly being made by uneducated, unsubstantiated, purchased opinions. It

is a very sad state of affairs.

Can anyone tell me what it is going to

take? Will the Board ever be given the means necessary to protect such

violation of our patient’s trust? What is it going to take?

I’m tired, and I’m not going

to take it anymore!

Sincerely,

Glenn

Glenn F. Gumaer, B.S., D.C.

Chiropractic Physician

Northside Chiropractic Clinic

1240 N. Riverside Avenue

Medford, OR 97501-4619

541-770-1330 ofc

541-770-7090 fax