AMA Guides® Newsletter - Issue Archive

Articles

1. American Medical Association Impairment Ratings and Earnings Losses Due to Disability

   Seth A. Seabury, Frank Neuhauser, Teryl Nuckols

   Pages 1–6

   DOI: 10.1001/amaguidesnewsletters.2013.MarApr01

   Abstract

   The AMA Guides to the Evaluation of Permanent Impairment (AMA Guides) has been criticized because it was designed to measure the severity of impairment (loss of function of a body part) rather than disability (eg, inability to work), and the AMA Guides uses whole person impairment that accords higher priority to body regions that are deemed more important to functionality even though no objective evidence supports the relative importance of different body regions. This article reports on a study funded by the California Commission on Health and Safety and Workers’ Compensation (CHSWC) to address these concerns. The study found that the AMA Guides, Fifth Edition, is an effective tool for ranking the effect of physical impairments on the ability to work; people with higher physical impairment ratings, measured using the AMA Guides, consistently had higher earnings losses. The authors conclude that ratings based on the AMA Guides, Fifth Edition, probably are more accurate and consistent than ratings conducted under the previous system in California, the system used by the Veterans Administration, or systems used by Wisconsin and Florida in the 1960s. The authors also identified significant challenges to using ratings based on the AMA Guides to determine financial compensation, particularly across body regions, and some evidence suggests that the relationship between impairment ratings and losses was attenuated at higher ratings.
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2. The Historical Development of AMA Guides Impairment Ratings for Asthma

   Stephen L. Demeter

   Pages 6–10

   DOI: 10.1001/amaguidesnewsletters.2013.MarApr02

   Abstract

   In 1956, the Board of Trustees of the American Medical Association convened an ad hoc Committee on Medical Rating of Physical Impairment that published thirteen articles in JAMA between 1958 and 1970, including one on pulmonary impairment rating on November 22, 1965. That article rated pulmonary impairment by radiographic abnormalities, the historical description of the degree of shortness of breath, the results of at least two of three spirometric tests (forced vital capacity, forced expiratory flow in one second, and the maximal ventilatory volume), the maximal ventilatory volume, and oxygen saturation (if performed). Use of the examinee's history has come full circle from being part of the impairment rating process to being excluded to being reintroduced in the AMA Guides to the Evaluation of Permanent Impairment, Sixth Edition. The concept that asthma is not easily rated using methods applicable to other pulmonary diseases was introduced in the fifth edition and was modified for use in the sixth edition. Since the publication of the fifth edition, several medications have been approved for treatment of asthma. Future editions likely will refine the medication usage table to reflect medications in clinical use at the time and, one hopes, also will eliminate the clumsy reference to “beclomethasone equivalents” and are likely instead to reference low, medium, and high doses of the inhaled corticosteroids.
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