2. Worker's Compensation
3. Councils and Committees
4. Health Care Provider Advisory Committee

Health Care Provider Advisory Council Minutes January 22, 2016

Aurora Medical Center in Summit

January 22, 2016

Members Present: Mary Jo Capodice, DO; Amanda Gilliland; Richard Goldberg, MD; Barb Janusiak, RN; BJ Dernbach (chair); Jeff Lyne, DC; James O'Malley (acting chair); Jennifer Seidl, PT; and Ron Stark, MD.

Excused: Theodore Gertel, MD; Maja Jurisic, MD; Stephen Klos, MD; Peter Schubbe, DC; Jennifer Seidl, PT; and Sri Vasudevan, MD.

Staff Present: Mary Lynn Endter.

Observers: None

1. Call to Order/Introductions: Mr. O'Malley convened the Health Care Provider Advisory Committee (HCPAC) meeting at approximately 10:05 a.m., in accordance with Wisconsin's open meetings law. Mr. O'Malley informed the members that the new Worker's Compensation Division Administrator, BJ Dernbach, will attend the meeting and would arrive late. Mr. O'Malley also stated that Marlin Nelson resigned from the HCPAC and that Dr. Michael Lishak had moved out of state.
2. Future meeting dates: The members agreed that they will meet on May 6, 2016, and August 12, 2016. A tentative meeting date of October 7, 2016, was also set.
3. Update on the WCAC Agreed Bill: Mr. O'Malley advised the members the Worker's Compensation Advisory Council (WCAC) reached an agreed upon bill and the bill was pending in the Wisconsin State Senate and Assembly. A plain language summary of the agreed upon bill was distributed and Mr. O'Malley discussed this with the members. He further stated the bill was introduced as a companion bill in both houses and the Worker's Compensation Division did not expect there would be any problems with its passage.
4. Acceptance of the October 19 Meeting Minutes: Dr. Capodice moved to approve the minutes of the October 19, 2015 meeting without correction. Dr. Stark seconded the motion. The minutes were unanimously approved.
5. Other Legislation: Mr. O'Malley advised the members that other legislation of interest was introduced and passed, including 2015 Wis. Act 115, relating to prescription, dispensing, and delivery of opioid antagonists; 2015 AB-364, relating to reporting, disclosure, and practitioner review requirements under the prescription drug monitoring program; providing an exemption from emergency rule procedures; and granting rule-making authority; 2015 AB-365, relating to duty of law enforcement officers to report to the Prescription Drug Monitoring Program controlled-substance violations, opioid-related drug overdoses or deaths, and reports of stolen prescription drugs; 2015 AB-366, relating to pain clinic certification and requirements, granting rule-making authority, and providing a penalty; 2015 AB-367, relating to reporting by treatment programs using methadone and requiring review of prescription drug monitoring database; and 2015 AB-659, relating to opioid treatment programs. Mr. Dernbach stated that all of these bills were passed by both the Senate and Assembly.
6. Update on the Wisconsin Medical Society's medical education and training modules: Dr. Capodice said that she reviewed the training modules but they were of poor quality and written from the point of view of defense attorneys. She stated that the modules will be redone as case studies of real patients, one non-surgical and one surgical. The modules will be separated into 30 to 45 minute sections covering each case from beginning to end. The case studies will include information for the practitioner on issues of return to work, work restrictions, rehabilitation, chiropractic, permanent disability, and communicating with the insurers and employers. The modules will be available free of charge for members of the Wisconsin Medical Society and $25 for nonmembers. The goal is to have the modules ready by the summer of 2016.
7. Review of ch. DWD 81 of the Wisconsin Administrative Code: At the last meeting, several changes to s. DWD 81.03 were discussed by the HCPAC. Ms. Seidl requested the members to consider some additional changes to those sections already reviewed, as follows:

1. 81.03 (1): add the words "neuromuscular control and movement" after the phrase "proper body mechanics; and add the word "manual." The section would read as follows:
   
   "Active treatment" means treatment specified in ss. DWD 81.06 (4), 81.07 (4), 81.08 (4), 81.09 (4), and 81.010 (2) that requires active patient participation in a manual therapeutic program to increase flexibility, strength, endurance, awareness of proper body mechanics, or neuromuscular control and movement.

2. 81.03 (11): add the words "vestibular function." The section would read as follows:
   
   "Neurologic deficit" means a loss of function secondary to involvement of the central or peripheral nervous system. This includes motor loss, spasticity, loss of reflex; radicular or anatomic sensory loss; loss of bowel, bladder or erectile function; impairment of special senses, including vision, hearing, taste, or smell; or deficits in balance, propioperception, vestibular, cognitive, or memory function.

3. 81.03 (13) add the words "thermoelectric and phototherapy" and remove "muscle electric stimulation" and "manual." The section would read as follows:
   
   "Passive treatment" is any treatment modality specified in ss. DWD 81.06 (3), 81.07 (3), 81.08 (3), 81.09 (3), and 81.10 (2). Passive treatment modalities include bedrest, thermal treatment, traction, acupuncture, thermoelectric treatment, phototherapy, braces, manual and mechanical therapy, massage, kinesiology taping, and adjustments.

The HCPAC continued its review of the worker's compensation treatment guidelines in ch. DWD 81 from where it left off at the last meeting, beginning at DWD 81.05 (1) (f), guidelines for alternative imaging. Since most of the following sections required expertise from a surgeon or other specialist, the members recommended that Dr. Gertel be requested to review these sections in preparation for the next meeting. Dr. Capodice suggested that a surgeon be appointed to the HCPAC on an ad hoc basis to help with the review of these sections.

1. 81.05 (2) (g), create the following subdivision 6., "For patients where an MRI is contraindicated, and where further detail of the anatomy is required by CT and a plain CT of the spine is inadequate to provide further detail of the anatomy."
2. 81.05 2 (j) concerning discography. Dr. Goldberg offered to research the question of how often discography is used. The members agreed to leave this section in the treatment guidelines if there are patients for whom this procedure is still used.
3. 81.05 (2) (n), add a new subdivision 7., "In patients with known preexisting surgery or structural abnoralities with significant low back pain symptoms where there is a need to view these lumbar structures in a more timely fashion. In those cases in which clinical presentation is atypical, unusual, or showing significant impairment, lumbar spine films before 8 weeks may be done, on a case-by-case basis."
4. 81.05 (2) (p), add a new subdivision 4., "Oblique films may be indicated if a clinician suspects bony structural abnormalities that are only visible in oblique views."
5. 81.05 (2) (q), delete this paragraph as the prior section describes when oblique x-rays may be ordered.
6. 81.06 Low Back Pain. Mr. O'Malley stated that the next sections will refer to the ICD-9-CM codes and that the HCPAC will need to determine whether to remove the references to the ICD-9 codes or to replace them with the current ICD-10 codes. The consensus of the members is to remove all references to the ICD codes and not replace them.
7. 81.06 (1) (h), rewrite the section as follows:

"During the period of initial nonsurgical management, computerized range of motion or strength testing may be performed but shall be done in conjunction with an office visit with a health care provider's evaluation or treatment, or physical or occupational therapy evaluation or treatment. A health care provider may order computerized range of motion or strength measuring test during a period of chronic management when used in conjunction with a computerized exercise program, work hardening program, or work conditioning program."

8. Adjournment: There was no new business. There was a motion to adjourn by Dr. Stark, seconded by Dr. Goldberg. The motion carried unanimously. The meeting was adjourned at approximately 12:30 p.m.