The Texas Department of Insurance, Division of
Workers’ Compensation (TDI-DWC) is accepting comments on informally proposed rule
28 Texas Administrative Code (TAC) §130.1 regarding Certification of Maximum
Medical Improvement and Evaluation of Permanent Impairment.The informal working draft rule can be
viewed on the TDI website at http://www.tdi.state.tx.us/wc/rules/drafts.html.The comment period closes Monday, March
1, 2010 at 5p.m. (Central Standard Time).
This informal working draft rule is not a formal
rule proposal.Accordingly, your
response will not be treated as a formal public comment for the purposes of the
Administrative Procedure Act.In
addition, you will also have the opportunity to make formal comments after the
rules are formally proposed and officially published in the Texas Register.The TDI-DWC anticipates formal
publication of the rule in calendar year 2010.The informal working draft may contain drafting notes and
formatting which will be changed as necessary to comply with the Texas Register formatting.
Comments may be submitted to TDI-DWC by e-mailing InformalRuleComments@tdi.state.tx.usor by mailing or delivering the comments to Maria Jimenez at:
Texas Department of
Insurance, Division of Workers’ Compensation
Workers’ Compensation Counsel,
MS - 4D
7551 Metro Center Drive,
Suite 100
Austin, Texas 78744 -1645
The purpose of the informal working draft rule is
to request input from workers’ compensation system participants regarding the
4th, 5th, and 6th edition of the American
Medical Association (AMA) Guides to
the Evaluation of Permanent Impairment.The TDI-DWC plans to propose this rule in order to reflect
changes made by the AMA to the guides for evaluating and determining permanent
impairment.
The TDI-DWC asks that the following be considered
when reviewing the informal working draft rule and when providing comments:
oImpact on the adequacy of income benefits:
oWhich edition produces impairment ratings that
adequately compensate injured employees for permanent impairments resulting
from a compensable injury under the current statutory income benefit structure
in Texas (i.e., which edition more accurately compensates injured employees for
economic duress that occurs or may occur as a result of the permanent
impairment)?
oWhat impact, if any, will a change in the AMA Guides have on the average
impairment rating?
oAre there categories of injuries that will be
overcompensated or under-compensated when using a certain edition of the AMA Guides?
oWhat impact, if any, will a change in the AMA
Guides have on the number of injured employees who qualify for Supplemental
Income Benefits?What are the pros
and cons of that impact, if any?
oWhat impact, if any, will a change in the AMA Guides have on Maximum Medical Improvement
(MMI) determinations?Will a
different edition of the AMA Guides
result in earlier determinations of MMI for injured employees?
oWill the impact, if any, on the adequacy of
income benefits be immediate or will there be a graduated impact over time?
oImpact on return-to-work outcomes:
oWould a change in the AMA Guides have a positive, negative or
no impact on return-to-work outcomes overall?
oIf a positive or negative
impact, would this impact be significant and sustaining or temporary?
oIf a positive or negative
impact, what categories of injuries or industries will be impacted the most?
oImpact on cost:
oWhat cost impact, if any,
would a change in the AMA Guides have
on:
ØTemporary Income Benefits
(TIBs)
ØImpairment Income Benefits
(IIBs)
ØSupplemental Income
Benefits (SIBs)
ØMedical costs (e.g.,
diagnostic tests)
ØInsurance rates and
premiums
oWill the cost impact, if
any, be immediate or will there be a graduated impact over time?
oImpact on disputes:
oWhich edition of the AMA Guides produces better inter-rater
consistency?
oWhat impact, if any, will a
change in the AMA Guides have on the
number of requests for designated doctor examinations?
oWhat impact, if any, will a
change in the AMA Guides have on the
number of impairment rating and MMI disputes seen in the workers’ compensation
system?
oWill the dispute impact, if
any, be immediate or will there be a graduated impact over time?
oImpact on health care providers:
oIf a change to the AMA Guides was enacted, what training
and testing requirements are needed for evaluating health care providers?
oIf a change to the AMA Guides was enacted, what effective
date should be considered to provide adequate time for health care providers to
be trained and tested?
oGeneral impact:
oOverall, what are the
advantages and drawbacks to: 1) staying with the 4th edition; 2) using the 5th
edition; or 3) using the 6th edition of the AMA
Guides?
oWhich edition of the AMA Guides most accurately represents
“evidence-based medicine?”
oDoes the 5th or 6th edition
of the AMA Guides represent the most
modern medical science in terms of disability evaluation?Why or why not?
If there are any questions regarding the
information in this memo, contact Amy Lee at 512-804-4410 or by e-mail at Amy.Lee@tdi.state.tx.us or Dr.
Bill Defoyd at 512-804-4875 or by e-mail at Bill.Defoyd@tdi.state.tx.us.
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Working-age adults who use two or more prescription medications may be at
risk for becoming seriously injured after falling in the home,
researchers found.
In a study of young and middle-age adults,
using at least two medications was associated with an increased
likelihood of dying from or being hospitalized for a falling injury ….
Antihypertensives and cholesterol-lowering drugs were the most common
medications involved.
"The risk
of falls may be increased as a result of both the intentional and
unintentional effects of pharmacological therapy such as orthostatic
hypotension, psychomotor impairment, extra-pyramidal symptoms, and
dizziness."
Overuse of therapeutic procedures, diagnostic tests, and medications is
an understudied problem that may account for as much as 30% of
healthcare spending in the United States and result in harm to patients.
The 4 most common health services examined in the studies included in the
review were antibiotics for upper respiratory infections, coronary
angiography, carotid endarterectomy, and coronary artery bypass grafting
and revascularization.
Ratings agency Standard & Poor's warned it may downgrade "a
number of highly rated" Group of 20 countries from 2015 if their
governments fail to enact reforms to curb rising healthcare spending and
other costs related to ageing populations.
"If governments do not change their social protection systems, they will likely become unsustainable."
"If no reforms are adopted, healthcare-related credit
downgrades would likely start within three years..."
"... developed nations will eventually become the victims of their
social safety nets."
"S&P said it was not too late for G20 countries to
tackle the problem, but reforms to contain age-related spending needed
be coupled with efforts to balance budgets by 2016, which would be
enough to offset rising healthcare costs by 2050."
ACA needs your help! Over the course of the past several years, ACA has been examining the
practices of chiropractic networks. Recently, concerns about these
networks has increased dramatically to the point of additional
investigative efforts being put forth by ACA.
In order to
effectively capture the voice of DCs regarding these issues, a
questionnaire has been developed to give both members and non-members
the opportunity to share their experiences about chiropractic networks.
Responding to this questionnaire will help ACA understand the effects
these networks have on profession, and will also help the association
better position itself for future efforts.
Concussions are getting much-needed attention in the press, especially
given the short- and long-term cognitive loss, early-onset dementia,
physical disability and even death resulting from traumatic brain injury
(TBI).
This study suggests that the addition of an adjunct therapeutic mirthful
laughter Rx (a potential modulator of positive mood state) to standard
diabetes care may lower stress and inflammatory response and increase
“good” cholesterol levels.
The authors conclude that mirthful laughter
may thus lower the risk of cardiovascular disease associated with
diabetes mellitus and metabolic syndrome.
An FDA proposal to require dietary supplement manufacturers to submit
data proving their product is safe doesn't go far enough, according to a
physician writing in the New England Journal of Medicine.
A survey has suggested that most dentists tend to overprescribe
antibiotics in children. The study found that adherence to
professional prescribing guidelines ranged from 10% to 42%.
US dentists write between 200 million and 300 million antibiotic
prescriptions each year, accounting for about 10% of all such
prescriptions in the United States.
The Centers for Medicare and Medicaid Services (CMS) recently ruled that
providers not successfully/satisfactorily participating in PQRS by the
2013 reporting period (Jan. 1 - Dec. 31, 2013), will have their Medicare
reimbursement decreased by 1.5 percent beginning in 2015, and 2 percent
in 2016.
Therefore, the 2012 reporting period is the last opportunity
providers have to voluntarily participate in PQRS and learn how to
report successfully/satisfactorily while incentives are still offered
and their Medicare reimbursement is not subject to penalties.
The federal government on Friday refused to let Texas ease a requirement
that health insurers devote at least 80 percent of premium revenue to
medical care.
Officials of the U.S. Department of Health and Human Services said Texas
insurance regulators did not convincingly back up their claim that
immediate enforcement of the medical-spending minimums would disrupt the
state's "individual market."
Health reform will increase the number of uninsured adults with diabetes
who will be covered by Medicaid, researchers found. That will expand
access and increase the use of healthcare in a population that has many
unmet healthcare needs.
In 2010, Medicaid covered about 60 million Americans, and in 2014 that
figure will expand by about 16 million as more uninsured patients become
eligible for the program as a result of the Affordable Care Act; about a
million of these patients will have diabetes.
Sen. Charles Grassley (R-Iowa) has demanded that 33 states and the
District of Columbia explain what they plan to do about physicians who
hand out huge numbers of painkiller and psychiatric drug prescriptions
paid for by Medicaid.
Each of the letters said, "I have concerns about the oversight and
enforcement of Medicaid abuse in your state. ... the numbers
themselves are quite shocking. One ... doctor, for
example, had written 18,890 scrips for quetiapine (Seroquel) in 2009 --
'nearly 73 prescriptions per weekday or nine prescriptions per hour .... [another] physician who had
written 2,522 scrips for oxycodone (OxyContin) in 2009, and another with
more than 2,800 prescriptions for alprazolam (Xanax)."
Some of Grassley's letters highlighted a single Wyoming
doctor who wrote prescriptions for aripiprazole (Abilify) that cost the
state nearly $300,000.
The Surgeon General's Division of the Civilian Medical Reserve Corps
(MRC) is looking for doctors of chiropractic who want to make a
meaningful contribution to America's health structure and their
community.
The Indian Health Service (IHS), an agency of the U.S. Department of
Health and Human Services (HHS), issued a public notice Monday in the
Federal Register that details the requirements for qualified health
professionals who may apply for funds available under the student loan
repayment program of IHS.
DCs are now
eligible to apply through this program.
Parker Seminars awarded some of the most influential leaders in the
profession during 2012 Parker Seminars Las Vegas. Erchonia Medical, a
leader in low level laser health care applications, was honored with the
coveted Philanthropy Award.
The Parker Lifetime Achievement Award was presented to Dr. Terry Yochum
for enhancing the profession with his substantial contributions. Dr.
Yochum, director of Rocky Mountain Chiropractic Radiological Center in
Denver, Colorado, and adjunct professor of radiology at Southern
California University of Health Sciences, is well-known for his work in
radiology.
The World Congress of Women Chiropractors (WCWC) named Dr. Janette
Kurban as the Woman Chiropractor of the Year for her exemplary service
to the profession. A 2009, Parker graduate, Dr. Kurban is actively
involved in the profession and is a leader in chiropractic. She
maintains a practice in Arlington, Texas. In 2008, Dr. Kurban made
history as the first Parker graduate appointed to serve on the Board of
Chiropractic Examiners (TBCE).
More than 5,300 Parker Seminar attendees flocked to the fresh and
exciting line-up of courses designed to improve chiropractors,
chiropractic assistants, and chiropractic students.
Texas Chiropractic College is honored to announce that Dr. Howard
Wasdin, best-selling co-author of his memoir SEAL Team Six and
practicing chiropractor from Georgia, will be speaking at the College’s
Russell Auditorium on Wednesday, Feb. 8, 2012 at 11 a.m.
Texas Department of Insurance, Division of Workers’ Compensation
(TDI-DWC) solicited and received input from workers’ compensation system
participants. All comments were carefully considered and discussed. The
Commissioner of Workers’ Compensation Rod Bordelon approved the revised
CY (Calendar Year) 2012 Annual Audit Plan (Annual Plan) on January 11,
2012.
The TBCE has passed a new fee structure in order to comply with recently passed laws. The currently proposed rule raises fees for initial applications, jurisprudence exams, initial license, and license and facility renewal and reinstatement.
The TBCE would add the definition that "on-call means that the licensee
must be available for consultation within 15 minutes either in person or
by other means of telecommunication" for the provision of any or all treatment provided under the licensee direction.
At this point in the history of mankind, we have been conditioned to
abhor symptoms of any kind. Headaches, sneezing, coughing, colds,
allergies, pain, infections, hypertension, etc., are no longer tolerated
as a part of the process of living. Rather than look into the
mechanisms that may be causing these symptoms, we are reaching for the
medicine that will suppress them. In so doing, we may feel better, but
we now have no motive to look at causes and correct for the issues that
may be impairing our health, thus increasing our "need" for more
medications over time.
Without the
"gold standard" double blind, placebo controlled study there can be no FDA approval of a new drug. So let's look at this approval process more closely.
In years gone by, many children were afflicted with polio, measles,
mumps, Rubella, influenza, small pox, diphtheria, whooping cough and
others. Of course, the majority of these children recovered without
incident (other than polio, which caused permanent nerve damage most of
the time), but there were some children who had serious sequelae and
even some who died from these diseases. Modern science discovered a way
to confer immunity on these children so that they would never become
afflicted with these diseases, and for the most part, it has been
successful. The question is, at what price?"
The Centers for Medicare and Medicaid Services (CMS) recently ruled that
providers not successfully/satisfactorily participating in PQRS by the
2013 reporting period (Jan. 1 - Dec. 31, 2013), will have their Medicare
reimbursement decreased by 1.5 percent beginning in 2015, and 2 percent
in 2016.
Therefore, the 2012 reporting period is the last opportunity
providers have to voluntarily participate in PQRS and learn how to
report successfully/satisfactorily while incentives are still offered
and their Medicare reimbursement is not subject to penalties.
ACA needs your help! Over the course of the past several years, ACA has been examining the
practices of chiropractic networks. Recently, concerns about these
networks has increased dramatically to the point of additional
investigative efforts being put forth by ACA.
In order to
effectively capture the voice of DCs regarding these issues, a
questionnaire has been developed to give both members and non-members
the opportunity to share their experiences about chiropractic networks.
Responding to this questionnaire will help ACA understand the effects
these networks have on profession, and will also help the association
better position itself for future efforts.
Concussions are getting much-needed attention in the press, especially
given the short- and long-term cognitive loss, early-onset dementia,
physical disability and even death resulting from traumatic brain injury
(TBI).
Smokers are no more likely to give up cigarettes for good by using
nicotine replacement products such as patches and gum than if they did
not use those quit-smoking aids, a prospective cohort study showed.
Working-age adults who use two or more prescription medications may be at
risk for becoming seriously injured after falling in the home,
researchers found.
In a study of young and middle-age adults,
using at least two medications was associated with an increased
likelihood of dying from or being hospitalized for a falling injury ….
Antihypertensives and cholesterol-lowering drugs were the most common
medications involved.
"The risk
of falls may be increased as a result of both the intentional and
unintentional effects of pharmacological therapy such as orthostatic
hypotension, psychomotor impairment, extra-pyramidal symptoms, and
dizziness."
This study suggests that the addition of an adjunct therapeutic mirthful
laughter Rx (a potential modulator of positive mood state) to standard
diabetes care may lower stress and inflammatory response and increase
“good” cholesterol levels.
The authors conclude that mirthful laughter
may thus lower the risk of cardiovascular disease associated with
diabetes mellitus and metabolic syndrome.
Copyright 2010 Texas Journal of Chiropractic. All Rights Reserved: Texas Chiropractic Association
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