AMA Guides® Newsletter - Issue Archive

Articles

1. Independent Medical Evaluations: The Client Perspective

   Jennifer Christian, David Siktberg, Christopher R. Brigham, Charles N. Brooks

   Pages 1–5

   DOI: 10.1001/amaguidesnewsletters.2002.JulAug01

   Abstract

   Independent medical evaluations (IMEs) are widely—and often, inappropriately—used in the claims management process. An IME includes a review of all pertinent medical records; an interview (history) and physical examination; a review of laboratory results and test results; and an edited and signed written report. The primary value of an IME is the report, because a credible medical opinion obtained at the right time can provide information necessary to initiate appropriate action in claims management, both for insurers, who will have a solid basis for acceptance or denial of a claim, and for claimant attorneys, who may use the evaluation to gain acceptance of a claim. A list of common problems in IMEs shows issues about which evaluators should be particularly careful, including questions of use, timing, choice of examiner, adequacy of questions asked and information received, expectations not defined, and framing the evaluation in a negative manner. From a client perspective, IMEs can be improved in several ways, and physicians should understand these opportunities for improving the quality, effectiveness, and value of evaluations. Because referral letters sometimes fail to ask detailed, focused, and probing questions, examiners who have any doubt about the conduct or objectives of the IME should contact the referral source. Detailed checklists and specifications can help ensure completeness and compliance. The article includes a box with definitions of frequently used IME terminology.
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2. Impairment Tutorial: Rating After IDET Procedures: Rating Permanent Impairment in Patients Who Have Already Had Intra-discal Electrothermal Annuloplasty (IDET) Procedures

   James B. Talmage, Robert H. Haralson

   Pages 6–7

   DOI: 10.1001/amaguidesnewsletters.2002.JulAug02

   Abstract

   Intra-discal electrothermal annuloplasty (IDET) is a relatively recently described surgical procedure for chronic low back pain that is caused by degenerative discs is unresponsive to nonoperative treatment. IDET involves percutaneously inserting a catheter into a disc(s) and then heating the catheter to 90 °C for 17 minutes. Randomized controlled trials are in progress but not yet reported, so the proper role of IDET in the care of chronic back pain is not yet known. Neither the Fourth nor the Fifth Edition of the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides) specifically addresses IDET. Evaluators who use the AMA Guides, Fifth Edition, apply the Diagnosis-related estimates (DRE) method to assess impairment when the patient is at maximum medical improvement (MMI). Because the long-term effects of IDET are not known and the patient's disc probably has been permanently changed by the procedure, evaluators should consult the AMA Guides, Fifth Edition, regarding categorization. This is because the injury and surgery have not resulted in a normal disc but rather one that may be prone to future problem episodes. If the evaluator chooses to use the range-of-motion method from the AMA Guides, Fourth Edition, in some scenarios the authors recommend considering IDET as if it were “surgical treatment” of the disc.
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3. Impairment Tutorial: Recurrent Radioculpathy: Recurrent Radioculpathy and Apportionment

   Christopher R. Brigham, Leon H. Ensalada

   Pages 8–10

   DOI: 10.1001/amaguidesnewsletters.2002.JulAug03

   Abstract

   Recurrent radiculopathy is evaluated by a different approach in the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), Fifth Edition, compared to that in the Fourth Edition. The AMA Guides, Fifth Edition, specifies several occasions on which the range-of-motion (ROM), not the Diagnosis-related estimates (DRE) method, is used to rate spinal impairments. For example, the AMA Guides, Fifth Edition, clarifies that ROM is used only for radiculopathy caused by a recurrent injury, including when there is new (recurrent) disk herniation or a recurrent injury in the same spinal region. In the AMA Guides, Fourth Edition, radiculopathy was rated using the Injury Model, which is termed the DRE method in the Fifth Edition. Also, in the Fourth Edition, for the lumbar spine all radiculopathies resulted in the same impairment (10% whole person permanent impairment), based on that edition's philosophy that radiculopathy is not quantifiable and, once present, is permanent. A rating of recurrent radiculopathy suggests the presence of a previous impairment rating and may require apportionment, which is the process of allocating causation among two or more factors that caused or significantly contributed to an injury and resulting impairment. A case example shows the divergent results following evaluation using the Injury Model (Fourth Edition) and the ROM Method (Fifth Edition) and concludes that revisions to the latter for rating permanent impairments of the spine often will lead to different results compared to using the Fourth Edition.
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4. Questions and Answers

   Pages 8–10

   DOI: 10.1001/amaguidesnewsletters.2002.JulAug04