ITS ABOUT TIME

The California Division of Workers’ Compensation has now announced free online access to medical evidence-based treatment guidelines for medical providers (see link to the press release below).

It’s about time.

Over a decade ago, California began adopting medical treatment protocols for work injury treatment, largely based on the ACOEM guidelines from the American College of Occupational and Environmental Medicine. This became the set of protocols known as MTUS. Though rebuttable, they are the bible of workers’ comp medical treatment.

 

But for over a decade many of the doctors treating workers’ comp patients have not had access to the guidelines unless they paid for access. Many medical providers have not paid to subscribe to the guidelines. This is one of the factors that has led to an odd situation where we frequently see requested treatments denied by “Utilization Review” (UR) and “Independent Medical Review” (IMR) on the basis that the reviewer claims that the treatments do not comport with the guidelines.

In some instances the UR and IMR reviewer may not have the relevant medical records or sufficient information to determine whether the requested treatment is guideline compliant.

 

But in some cases the treatment probably isn’t guideline compliant. And physician lack of awareness of the guidelines may be a factor. How much of a factor is hard to quantify, but if a big swath of the treating community doesn’t have easy access to the treatment guidelines, it is clearly a problem.

This is a problem that in truth should have been a priority years ago.

But now it appears to be moving toward resolution. Providers will be able to register to get free access to the site, maintained by the Reed Group which maintains the guidelines. This will include access to online web-based training.

 

Ultimately it would be a welcome step if adjusters, injured workers and attorneys all had free access as well. We’re not there yet, but if treatment is going to depend on guideline compliance, those affected should have easy access as well.

 

Here is the link to the DWC announcement:

https://www.dir.ca.gov/DIRNews/2019/2019-14.pdf

Stay tuned.

Julius Young

www.boxerlaw.com


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