Health Care Provider Advisory Council Minutes October 16, 2015

Aurora Medical Center in Summit

October 16, 2015

Members present: Mary Jo Capodice, DO; Theodore Gertel, MD; Amanda Gilliland; Richard Golderg, MD; Barb Janusiak, RN; Delora Newton(Chair); Jennifer Seidl, PT; Peter Schubbe, DC; Ron Stark, MD;

Member Excused: Maja Jurisic, MD; Jeff Lyne, DC; Stephen Klos, MD; Michael Lischak, MD; Marlin Nelson; Sri Vasudevan, MD

Staff present: Mary Lynn. Endter, James O'Malley

Observer: None

Call to Order/Introductions: Mrs. Newton convened the Health Care Provider Advisory Committee (HCPAC) meeting at approximately 10:05 a.m., in accordance with Wisconsin's open meetings law. HCPAC members, Worker's Compensation Division Staff, introduced themselves.
Acceptance of the August 14, 2015 Meeting Minutes: Dr. Schubbe moved to approve the minutes of the August 14, 2015 meeting without correction. Dr. Gertel seconded the motion. The minutes of each meeting were unanimously approved as corrected.
Future Meeting Dates: The members agreed the next meeting will be scheduled on January 22, 2016, with February 5, 2016 as an alternative meeting date in the event of inclement weather conditions. May 6, 2016, was selected as a future meeting date. August 12, 2016 was also selected as a tentative future meeting date.
Update on the WCAC Agreed Bill: Mr. O'Malley advised the members that the Worker's Compensation Advisory Council (WCAC) had not yet reached an agreed upon bill but the next meeting was scheduled on October 21, 2015, with a follow-up meeting on November 10, 2016. Mr. O'Malley said that there were some other bills of interest that were recently introduced in the Legislature not specifically related to worker's compensation. These bills pertained to narcotic prescriptions and the PDMP reporting system.
Amendments to ch. 80 of the Wisconsin Administrative Code approved by the WCAC have been in process for several years and will become effective November 1, 2015. One of the rules changes is an amendment to s. DWD 80.73 (3) (a) 5 of the Wisconsin Administrative Code. This amendment provides that worker's compensation insurance carriers and self-insured employers shall provide a copy of their reviewing doctor's report to providers with the notice when the necessity of treatment is denied.
Update on the Wisconsin Medical Society's medical education and training modules: Dr. Capodice provided the members with a status update on the Wisconsin Medical Society's medical and training modules. She advised the training modules were completed but that she had not yet reviewed them. She recommended the modules be available for free but the Wisconsin Medical Society was charging a $25.00 fee for members of that organization. Dr. Stark pointed out the modules should be focused on patient care and they should be available free of charge. Dr. Gertel commented the modules should be available free of charge and provide CMEs for dues paying members of the Wisconsin Medical Society.
Review of ch. DWD 81: Mr. O'Malley reminded the members that s. 81.14 (2) of the Wisconsin Administrative Code provides that the HCPAC is charged with modifying clarifying, updating, and expanding the treatment guidelines every four (4) years. The members began reviewing the worker's compensation treatment guidelines contained in ch. 81 of the Wisconsin Administrative Code. The details of the recommendations from the members of the HCPAC are as follows:
1. 81.02: the reference to ICD-9-CM is outdated and should either be changed to ICD-10-CM or eliminated since the description of the condition is more important than the diagnostic code.
2. 81.03 (1): add the phrase "restore or preserve" after the words "therapeutic program."
3. 81.03 (2): either to remove the phrase, "that exceed the identifiable pathology and medical condition" or to remove the entire second sentence.
4. 81.03 (11): add the following language at the end of the second sentence "… or deficits in balance, propioperception, cognitive or memory function."
5. 81.03 (13): add additional types of passive treatments such as iontophoresis, cold laser, electric stimulation, thermal laser, kinesiology taping, and bracing. This change should be made in any section of the rule where passive treatment is described.
6. 81.03 (15): change" Therapeutic injections" to "Joint injections" as a more inclusive term.
7. 81.04 (1) (b): add "lower extremities" before "upper extremities." Lower extremities are covered later in the chapter, in section 81.12.
8. 81.04 (1) (c): there are criteria for "improvement" but none for term or length of treatment.
9. 81.05 (1) (b): imaging may not always be the most "effective" and the language should be changed to the most "appropriate".
10. 81.05 (1) (e): refers to the "same imaging." A new section for when different imaging is appropriate may be needed.
11. 81.05 (1) (e) 2: the word "appropriate" should be deleted from the last part of the sentence and "necessary" substituted.
12. 81.05 (1) (e) 6: Change the language in the subdivision to the following," When the treating health care provider and a radiologist from a different practice have reviewed a previous imaging study and agree finds that it is a technically inadequate study."
13. 81.05 (1) (f) 3. Remove the phrase "an inconclusive finding" and replace it with "or."
14. 81.05 (1) (f) 4: Create the following subdivision: " Alternative imaging is appropriate in a case where an x-ray is negative but there is a high index of suspicion that a structural change is present that was not visible on a plain x-ray."

Adjournment: There was no new business. There was a motion to adjourn by Dr. Schubbe, seconded by Ms. Janusiak. The motion carried unanimously and the meeting was adjourned at approximately 12:45 p.m. The meeting was adjourned at approximately 12:40 p.m.