Critics Say ACOEM Doesn't Address Chronic Care

[Guest guest]

Critics Say ACOEM Doesn't Address Chronic Care: Top [08/24/06]

OAKLAND, Calif.-- The failure of American College of Occupational and

Environmental Medicine treatment guidelines to address chronic conditions

emerged

Wednesday as the leading criticism of proposed regulations that would make

ACOEM the permanent standard in California.

Representatives for most of the major specialty groups in workers'

compensation protested the Division of Workers' Compensation's proposal to

stick with

ACOEM, and ACOEM alone, during a hearing at DWC headquarters. Neurosurgeons,

osteopaths, orthopedic surgeons, medical equipment manufacturers, physical

therapists, occupational therapists, chiropractors and acupuncturists said

ACOEM doesn't offer guidance on how to treat long-lasting ailments, especially

for patients who suffer multiple injuries.

Carey, a lobbyist for the Council of Acupuncture and Oriental

Medicine Associations, said the DWC missed by two years the legislative

deadline for

adopting a more comprehensive set of treatment guidelines.

" Now the (administrative director) has proposed status quo for injured

workers, leaving ACOEM the sole and exclusive guidelines, " Carey said. " If this

weren't so astonishing it would be amusing. Are we saying that we provide only

traditional Western medicine for injured workers because anything else would

just be too confusing? "

A representative for ACOEM said the organization's guidelines are a work in

progress and will be improved to address more conditions. Dr.

Schumann, second vice president to ACOEM's western chapter, said the college

plans

to issue " rolling updates " over the next three years to fill in gaps pointed

out by medical professionals.

Schumann also said that much of the criticism directed at ACOEM was not

really a fault of the guidelines themselves, but the alleged misinterpretation

of

the guidelines by insurance claims adjusters.

Even though speakers were limited to 10 minutes, DWC Medical Director Ann

Searcy and other officials heard four hours of testimony during the public

hearing. Administrative Director Nevans did not attend, disappointing

some

injured worker advocates who were waiting for a chance to give her an earful.

A moderator directed the meeting to keep speakers on point. Comments ranged

from the detailed to the broad. For example, an equipment manufacturer

suggested that the DWC accept U.S. Food and Drug Administration approval of

medical

devices as proof that they are safe and effective. On the other end of the

spectrum, an injured worker advocate charged that ACOEM guidelines are the

product of a conspiracy by drug companies and company doctors to divert the

cost

of injured workers' health care to taxpayer-supported programs.

For the most part, speakers kept closely to the question at hand: What set

of guidelines (technically called a medical treatment utilization schedule)

should California use to decide what type of medical care is appropriate and

what is not.

The answer from most specialty groups ranged from anything but ACOEM, to

ACOEM plus something else.

" We just don't see the science of ACOEM applying to chronic conditions, "

said Diane Przepiorski, executive director of the California Orthopaedic

Association. " After hearing the testimony this morning, I wonder if they are

even

suitable for acute conditions. "

Przepiorski pointed out that the introductory paragraphs of several chapters

in the ACOEM guidelines state that they are applicable only for care in the

first three months after injury.

Nileen Verbeten of the California Medical Association said not only does

ACOEM fail to address certain medical conditions, it does not include all the

available treatment options available for the medical conditions it does

address.

Peggy Sugarman, a consultant for Voters Injured at Work, said ACOEM was

given only a " lackluster " endorsement from the Rand Corp., which was hired to

evaluate the various treatment guidelines. The think tank issued a report in

2004 that recommended the state adopt ACOEM as a stop-gap measure only until it

develops its own set of comprehensive guidelines.

DWC spokeswoman Gard said the agency plans to do just that by adopting

the " rolling updates " mentioned by Schumann, the ACOEM representative. She

also said the agency plans to address abuses in utilization review from claims

adjusters who use ACOEM as an excuse to turn down necessary care.

" No one set of guidelines is going to be able to cover everything, " Gard

said. " That's why we've been so vocal about utilization review and the proper

application of guidelines. Utilization review does not have to be done on every

single case and insurers need to do a better job of figuring out how to use

the program effectively. The point of UR is to eliminate the use of expensive

procedures that don't work -- not to deny medically necessary treatment

that's helping someone recover. "

--By Jim Sams, WorkCompCentral Senior Editor

jim@...