AMA Guides® Newsletter - Issue Archive

Articles

1. AMA Guides to the Evaluation of Permanent Impairment, Sixth Edition: A Response to the NCCI Study

   Robert D. Rondinelli, Marjorie Eskay-Auerbach, Mohammed I. Ranavaya, Christopher R. Brigham

   Pages 1–9

   DOI: 10.1001/amaguidesnewsletters.2012.NovDec01

   Abstract

   The AMA Guides to the Evaluation of Permanent Impairment, (AMA Guides), Sixth Edition, is the recognized international standard for assessing impairment. The National Council on Compensation Insurance (NCCI) conducted a comparative study to examine the effects on impairment ratings in three states that have switched from the fifth to the sixth edition. The purpose and objectives of this article are as follows: 1) to provide a brief review of the conceptual framework and terminology of disablement and of the current model of disability in the AMA Guides and also to underscore the importance of the construct of medical impairment to compensation schemes within workers' compensation and other disability systems; 2) to examine the AMA Guides in terms of its origin, purpose, distribution, applications, and misapplications; 3) to examine the changes in the sixth edition in terms of efforts to direct change and improve upon the AMA Guides; 4) to examine the merits and shortcomings of the NCCI study and its conclusions within a broader context of inherent sources of variance in impairment ratings, as well as the content validity, reliability, and reproducibility of the ratings themselves; 5) to provide recommendations regarding the implications of this study for the use of the sixth and earlier editions of the AMA Guides, and to suggest new directions for much needed critical research.
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2. Question and Answer

   Christopher R. Brigham, J. Mark Melhorn, James B. Talmage

   Pages 9–10

   DOI: 10.1001/amaguidesnewsletters.2012.NovDec02

   Abstract

   Following successful surgical treatment of an inguinal hernia (ie, preparing the defect), there should be no ratable impairment unless there is clearly recognized nerve injury or a complication such as infection. The AMA Guides to the Evaluation of Permanent Impairment, (AMA Guides), Fifth and Sixth Editions, provide guides to the rating of permanent impairment for hernias. Both stress that impairment evaluation is predicated on the existence of a causal relationship between the individual's condition and an event or exposure. If a patient has an appropriate repair, then the defect should be resolved; that is, there should be no physical examination findings of a palpable deficit nor of a protrusion. If a palpable defect is present and the hernia is causally related to an injury, then the hernia is ratable. As with all ratings, the underlying basis must be reliable; that is, the history, including reported activities of daily living (ADL), must be supportable. In the AMA Guides, Fifth Edition, three examples show ratings, all of which depend on objective findings of palpable defects (protrusions). The sixth edition outlines the assignment of one of four classes of findings and interferences with ADLs. Impairment is based on objective findings when the individual is at maximum medical improvement.
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3. Rating Inguinal Hernias

   Christopher R. Brigham, Lee Ensalada, James B. Talmage

   Pages 10–11

   DOI: 10.1001/amaguidesnewsletters.2012.NovDec03