AMA Guides® Newsletter - Issue Archive

Articles

1. Erroneous Impairment Ratings

   Christopher R. Brigham

   Pages 1–5, 9-11

   DOI: 10.1001/amaguidesnewsletters.2006.MayJun01

   Abstract

   A nationwide study in 2005 of 2100 cases referred for impairment rating review found 80% to be erroneous, and 89% of these erroneous ratings were higher than appropriate. Among whole person erroneous ratings (839 of 1037 cases critiqued), the original physician's rating averaged 15.5% whole person permanent impairment, but following rerating by physician experts, the corrected rating averaged 5.6%; only 7% of the cases were underrated. All ratings were based on the AMA Guides to the Evaluation of Permanent Impairment, (AMA Guides), Fifth Edition. Tables and figures show error rates according to portion of the body affected, expert vs original rating, and other explanatory variables. Two physicians who use the AMA Guides should arrive at similar conclusions about impairment ratings, but most physicians have not received instruction about assessing impairment, disability, or causation and lack an adequate ability to assess these issues. Causation requires a given cause and a given effect that are associated with a reasonable degree of medical probability and also requires documentation with appropriate scientific evidence (not self-reports or historical time frames). Those who prepare and review assessments of impairment should ensure that clinical causation assessments were accurate, that the rating was performed at maximal medical improvement, that examination findings were consistent, and that the individual's normal state was determined.
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2. Impairment Tutorial: Rating Permanent Impairment for Artificial Disc Replacements

   James B. Talmage, Charles N. Brooks, Christopher R. Brigham

   Pages 6–8

   DOI: 10.1001/amaguidesnewsletters.2006.MayJun02

   Abstract

   In 2005, the Food and Drug Administration (FDA) approved an artificial disc replacement (ADR), and physicians likely will be called on to evaluate permanent impairment in some patients who have been treated using an ADR. The AMA Guides to the Evaluation of Permanent Impairment, (AMA Guides), Fifth Edition, was published in 2000, before the approval of ADRs, and thus is silent about evaluating ADR-associated impairment. FDA based its approval on the results of a study in which the indications were tightly limited and for which the list of relative contraindications was quite long. One review of 100 consecutive lumbar spine surgery patients found that 95% had at least 1 contraindication to ADR. The AMA Guides recommends using the Diagnosis-related estimates (DRE) method, but some situations (eg, multilevel involvement in the same spinal region) warrant use of the range-of-motion (ROM) method. Assuming a single injury and one level of loss of the activities of daily living, the DRE is the correct method to rate the permanent impairment, and the authors recommend that ADR be accepted as the equivalent to loss of motion segment integrity, warranting a rating from CRE Category IV. ADR is in its infancy, and until the AMA Guides, Sixth Edition, is available, evaluators can rate one level ADR from DRE Category IV.
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