Texas Picks ODG Over ACOEM

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September 1, 2006

Texas Picks ODG Over ACOEM

The Texas DWC proposed rules that would make Official Disability Guidelines,

not ACOEM, the standard for non-network care

Republished with permission from _WorkCompCentral.com_

(http://www.workcompcentral.com/)

The Texas Division of Workers' Compensation on Thursday proposed rules that

would mandate the use of the Work Loss Data Institute's Official Disability

Guidelines (ODG) for non-network medical care and the Group's Medical

Disability Guidelines (MDA) for disability management.

The decision dealt a blow to the American College of Occupational and

Environmental Medicine (ACOEM), which had been lobbying Texas officials to

follow

California 's lead in adopting its treatment guidelines. DWC spokesman

Greeley would not say why his agency had chosen ODG over ACOEM.

" We have no comment at this time other than to say we are letting the

rulemaking process work to produce the best treatment guidelines for the

workers'

compensation system and for the citizens of Texas , " Greeley said in an

e-mail. " As you know, we are accepting comments until Oct. 2, when a public

hearing

is scheduled here at DWC. "

The proposed Texas rules would require physicians to treat injured workers

according to ODG when not covered by a health care network. Networks in Texas

are allowed to adopt their own guidelines.

The MDA disability treatment guidelines would be used to guide insurers and

employers on expected recovery times for various industrial injuries.

Treatment and disability management guidelines were mandated by House Bill

7, a reform measure signed into law by Texas Gov. Rick in 2005.

" These proposed rules provide carriers with guidance to manage claims

through the use of consistent benchmarks established by the guidelines and

through

the treatment planning process when treatments and services or diagnoses are

not addressed in the guidelines, " the DWC said in an explanation of its

proposal. " Application of disability management tools should reduce indemnity

benefit costs through the efficient utilization of medical services with

resulting reduction in medical costs, and improved return-to-work outcomes. "

Phil Denniston, president of the Work Loss Data Institute, said the proposed

rules should make life easier for Texas physicians compared with their

counterparts in California . The Texas rules guarantee that physicians will be

paid for their work if they treat according to ODG, he said. In California ,

there is no guarantee of payment even if ACOEM is followed, he said.

" In California , they can go 14 days " without payment, Denniston said.

" That's terrible, no matter what the guidelines are. That's not the fault of

the

guidelines. Study after study has shown that workers should get early access

to treatment. "

As to why Texas is going with ODG treatment guidelines rather than ACOEM,

Denniston said he believes officials saw that the Work Loss Data Institute -- a

private company -- has the only set of guidelines that are adopted by the

federal government's medical guideline clearinghouse. ODG also regularly

updates its guidelines and has easy-to-find references to the latest research

on

the effectiveness of various treatment options.

But Denniston said ACOEM also publishes good guidelines and he wouldn't be

surprised if carriers used ODG, ACOEM and even other guidelines available to

them.

ACOEM Executive Director Barry Eisenberg said many of the health care

networks already approved in Texas , including Concentra and Liberty Mutual,

have

already adopted ACOEM. He said Texas ' proposal to establish a separate set of

guidelines for non-network care could cause unnecessary confusion. It's

possible, Eisenberg said, that physicians will be forced to use one set of

guidelines when they treat patients who are not covered by a network and a

different set of guidelines when they treat patients whose employers are

enrolled in

a network.

In a written statement issued after Texas posted its proposed rule, ACOEM

took a shot at the state's decision to go with a private company rather than a

recognized medical society whose guidelines are widely used across the

nation.

" We would hope that Texas would at a minimum allow physicians to use a set

of treatment guidelines developed by the medical profession rather than

mandating the exclusive use of guidelines developed for commercial purposes, "

ACOEM

said.

But in California , proposed rules that would make ACOEM the exclusive

source of treatment guidelines were widely criticized by medical specialists

during an Aug. 23 public hearing. They said ACOEM does not address chronic

conditions and has many other gaps that cause unnecessary disputes between

physicians and insurance carriers.

The California DWC proposed to adopt ACOEM along with future updates

promised by the medical society. It would also appoint an evaluation committee

that

could also broaden the guidelines later.

Steve Cattolica, government affairs director for the California Society of

Industrial Medicine and Surgery, said he does not have detailed knowledge of

ODG, but he knows that they are widely used by physicians and " it appears the

marketplace is speaking. " Cattolica said he hopes Texas ' decision will alert

California DWC officials that they should look beyond ACOEM.

" That's what we advocated at the public hearing -- not specifically about

ODG -- but that the division do what it can to broaden the available guidelines

now and not wait for their committee, " Catollica said. " We would like them

to look outside of California and see what's going on. "

The Texas rules have also caused some controversy.

The proposal released Thursday is similar to a draft version released in

February, despite complaints by business and insurer groups that using two

separate guidelines -- ODG and MDA -- would increase costs.

The division said in an explanation of the rules proposal that any extra

expense would be minor -- only $360 for users who subscribe to the Internet

versions of both guidelines. Large companies that need to provide access to

many

employees could save any more through group-user arrangements, the division

said.

The Texas DWC will hold a public hearing to take testimony on the proposed

rules on Oct. 2 in the Tippy Room, Division of Workers' Compensation,

7551 Metro Center Drive , Austin .

To view a copy of the proposed regulations, go to:

http://www.tdi.state.tx.us/wc/rules/planning/documents/pr137dismgmt.pdf.

By Jim Sams, WorkCompCentral Senior Editor

jim@...

[Guest guest]

So THATS what this is all about. Denying care to people on a ma$$ive $cale..

Some of the 'trust us, we're experts' language coming out of the ACOEM in

their response raises red flags for me, does it for other people?