Fwd: [CSOMA] New Work Comp Acupuncture Guidelines Final

[Guest guest]

Look at the new guidelines in CA;

No visit-payment cap if functional improvement is demonstrated from 3-6

treatments.

 

" If functional improvement is demonstrated, there is no maximum duration of

treatment. "

 

 

---------- Forwarded message ----------

CSOMA <info

Jun 15, 2007 6:59 PM

[CSOMA] New Work Comp Acupuncture Guidelines Final

johnkokko

 

June 15, 2007

 

Work Comp Treatment Guidelines Now Official

 

New Acupuncture Guidelines Should Drastically Reduce Denials

 

On June 15, 2007, the Division of Workers' Compensation's (DWC) medical

treatment utilization schedule (MTUS) final regulations were approved by the

Office of Administrative Law (OAL). The MTUS regulations, commonly referred

to as " medical treatment guidelines, " are now finalized.

 

Most significantly, the new MTUS regulations adopt new treatment guidelines

for acupuncture. The new guidelines are based upon existing guidelines for

acupuncture in the Colorado Work Comp system.

 

The final acupuncture treatment guidelines explicitly allow the use of

acupuncture and electro-acupuncture for a wide range of musculoskeletal

conditions, specifically:

 

- Neck and Upper Back Complaints

- Elbow Complaints

- Forearm, Wrist, and Hand Complaints

- Low Back Complaints

- Knee Complaints

- Ankle and Foot Complaints

- Pain, Suffering, and the Restoration of Function

 

The frequency and duration of treatment is delimited as follows:

 

- Time to produce functional improvement: 3 to 6 treatments

- Frequency: 1 to 3 times per week

- Optimum duration: 1 to 2 months

 

The new guidelines omit " shoulder complaints " on the grounds that the ACOEM

guidelines address acupuncture as it relates to such complaints.

 

Comments submitted by CSOMA resulted in the removal of a proposed

14-treatment cap from the final regulation. If functional improvement is

demonstrated, there is no maximum duration of treatment.

 

Other changes introduced by the new MTUS regulations include:

 

- Adoption and incorporation of the American College of Occupational

and Environmental Medicine's Occupational Medicine Practice Guidelines

(ACOEM Practice Guidelines) into the MTUS;

- Establishment of the presumption of correctness of the MTUS, the

burden of proof, and the strength of evidence rating methodology to evaluate

specific medical treatment or diagnostic services; and

- Creation of a medical evidence evaluation advisory committee which

will advise the DWC medical director on matters concerning the MTUS for

purposes of revising, updating, and supplementing the MTUS as necessary.

 

What The New Guidelines Mean

 

In short, the new acupuncture treatment guidelines supersede the ACOEM

treatment guidelines. There is no longer a basis for denying acupuncture

treatment on the basis of disputed efficacy. For all of the complaints

listed above, acupuncture claims should be accepted for a minimum of three

to six treatments.

 

Treatment duration may be extended beyond this minimum as long as functional

improvement is demonstrated. For this reason, it is now more important than

ever to clearly and accurately document functional improvement of an injured

worker at each visit.

 

Regarding shoulder complaints, the ACOEM guidelines (2nd edition, p.204)

state, " Some small studies have supported using acupuncture, but referral is

dependent on the availability of experienced providers with consistently

good outcomes. " Because the new MTUS omits shoulder complaints, this section

of the ACOEM guidelines remains presumptively correct and may be used to

justify acupuncture treatment of the shoulder when medically necessary.

 

Head, eye, and stress-related injuries are not addressed in the new

acupuncture guideline. It is safe to assume that acupuncture treatment will

be routinely denied for such claims.

 

In our analysis, the new acupuncture guidelines should greatly reduce the

widespread denials of acupuncture treatment based upon disputed efficacy. If

you treat within the California Work Comp system, we want to hear about your

experiences with the new guidelines. CSOMA has established a web feedback

form <http://www.csomaonline.org/i4a/pages/index.cfm?pageid=3398> for

reporting difficulties with the new guidelines.

 

For more information on the new guidelines and what they mean, visit the CSOMA

website <http://www.csomaonline.org/i4a/pages/index.cfm?pageid=3384>.

 

The full text of the approved regulations, as filed with the California

Secretary of State, can be found on the DWC

website<http://www.dir.ca.gov/dwc/DWCPropRegs/MedicalTreatmentUtilizationSchedul\

e/MTUS_regulations.htm>.

 

 

Comments & Feedback

 

As always, we welcome and appreciate feedback from members on these issues.

You may send comments to advocacy.

 

 

 

CSOMA. Your Partner in Practice.

 

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aka Mu bong Lim

Father of Bhakti

 

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aka Mu bong Lim

Father of Bhakti

 

 

--

 

aka Mu bong Lim

Father of Bhakti