AMA Guides® Newsletter - Issue Archive

Articles

1. Range of Motion: AMA Guides, Sixth Edition

   James B. Talmage, Jay Blaisdell

   Pages 3–5

   DOI: 10.1001/amaguidesnewsletters.2015.MayJun01

   Abstract

   In the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), Sixth Edition, range of motion (ROM) is used to calculate the physical examination modifier when the diagnosis-based impairment (DBI) method is used, ie, Table 15-8, Physical Examination Adjustment: Upper Extremities, and Table 16-7, Physical Examination Adjustment: Lower Extremities. The DBI method is preferable for calculating upper and lower extremity ratings, but in instances specified by the regional grid, the evaluator may choose to use the ROM method, typically because it yields a higher impairment rating. The article outlines the steps for measuring ROM. Invalid results on the day of testing are declared after three consecutive efforts if the three measurements for a given plane of motion vary by more than 10 degrees from the average (mean) of these three measurements. The process can be tried again another day, or the DBI method can be used. All ROM measurements should be rounded to the nearest number ending in zero, and a figure provides examples of suitable annotations. Adjustments for functional history can be made if ROM is the only method used for rating, if results are deemed reliable and consistent with results from an activities of daily living questionnaire or other valid functional report, and if the current ROM impairment does not adequately capture the full impairment.
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2. Social Security Disability and the AMA Guides

   E. Randolph Soo Hoo

   Pages 6–10

   DOI: 10.1001/amaguidesnewsletters.2015.MayJun02

   Abstract

   Two disability programs are administered by the US Social Security Administration (SSA): Disability under Title II of the Social Security Act is referred to as SDI, which is funded via contributions made by the individual worker, and disability under Title XVI of the Act commonly is referred to as SSI, which is funded through general funds from the US Treasury. Both SDI and SSI disability adjudication use the same five-step sequential evaluation process to determine if a claimant fulfills SSA's disability definition. The foundation for determining disability under SSA is medical evidence that establishes a medically determinable impairment based on defined evidentiary criteria. SSA determines disability, does not rate disability, and awards disability benefits only for total disability. Unlike SSA, the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides) does not determine (or rate) disability. The AMA Guides, Sixth Edition, emphasizes the use of evidence-based diagnosis for determining whole person impairments and contrasts with SSA disability for which a diagnosis is not a requirement and the focus is placed on determining «impairment» based on symptoms, clinical signs, and laboratory/diagnostic findings. SSA determines disability, does not rate disability, and awards disability benefits only for total disability. An impairment rating using the AMA Guides should not be equated to an SSA disability determination.
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3. GUEST EDITORIAL: In the Line of Fire: IME Burnout

   Tim Pinsky

   Pages 11–13

   DOI: 10.1001/amaguidesnewsletters.2015.MayJun03

   Abstract

   Physicians suffer more burnout than many other American workers and rank near the top of all professions in burnout. Physicians who perform independent medical evaluations (IME) face the usual challenges (too many bureaucratic tasks, too many hours of work, insufficient income, and loss of status) that contribute to burnout among all physicians. Both “innate personality traits” and external factors (circumstances, examinees, time, performance, and risk) contribute to burnout among physicians who perform IME. Stressed because of multilayered litigation, insurance, and bureaucratic processes, IME physicians face a high concentration of difficult patients who are disgruntled with their jobs and, often, their lives. Examinees’ negative attitudes and outlooks contribute to pessimism and depression that can be contagious to the examiner, and because IMEs are one-time evaluations with no longitudinal care, the opportunity to establish rapport is limited. Physicians who are coping with the pressures of the IME milieu may need to realize that they have a greater sphere of positive influence than they realize: By conducting oneself in a professional and ethical fashion, writing fair reports, relying on evidence-based medicine, and applying the AMA Guides to the Evaluation of Permanent Impairment in a proficient manner, physicians who conduct IMEs can recognize and, one hopes, avoid IME burnout.
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4. Q&A: Upper Limb Nerve Conduction Studies

   James B. Talmage, J. Mark Melhorn

   Pages 14–14

   DOI: 10.1001/amaguidesnewsletters.2015.MayJun04

5. Q&A: Apportioning Cervical Fusions

   Christopher R Brigham, James B. Talmage, Marjorie Eskay-Auerbach, Lorne Direnfeld

   Pages 15–16

   DOI: 10.1001/amaguidesnewsletters.2015.MayJun05