by Christopher R. Brigham, MD
There are many challenges associated with the use of the
Guides, including criticisms of the Guides
themselves, the use of impairment rating numbers, and a high
error rate. The Guides remain the internationally
recognized standard for defining the impact of injury and
illness, being superior to outdated and less reliable rating
schedules. Previous criticisms, referenced in the Sixth
Edition, include:
- Failure to provide a comprehensive, valid, reliable,
unbiased, and evidence-based rating system.
- Impairment ratings did not adequately or accurately
reflect loss of function.
- Numerical ratings were more the representation of "legal
fiction than medical reality."
Studies have
demonstrated poor inter-rater reliability and revealed that
many impairment ratings are incorrect, more often rated
significantly higher than appropriate. (Brigham CR, Uejo C,
Dilbeck L, Walker P. Errors in impairment rating: challenges
and opportunities. J Workers Compensation. 2006;15(4):19-42.)
While treating physicians, who by definition are advocates for
their patients, have been particularly prone to overrate
impairment, physicians who have not been adequately trained in
the use of the Guides also commonly provide erroneous ratings,
with it much more common for rating errors to increase rather
than decrease ratings. Therefore, many clients are having all
impairment ratings reviewed by experts to assure accuracy. (
http://www.impairment.com/impairment_screen.htm)
For further discussion of erroneous ratings
click
here.
The following changes were recommended with the Sixth
Edition and reflected in its design.
- Standardize assessment of Activities of Daily Living
(ADL) limitations associated with physical impairments.
- Apply functional assessment tools to validate impairment
rating scales.
- Include measures of functional loss in the impairment
rating.
- Improve overall intra-rater and inter-rater reliability
and internal consistency.
The process in the Sixth
Edition is still far from perfect with respect to defining
impairment or the complexities of human function; however the
authors' intention with the Sixth Edition was to simplify the
rating process, to improve inter-rater reliability and to
provide a solid basis for future editions of the
Guides.
To learn more about the use of the Sixth Edition visit www.sixthedition.com.
______________________________________________________
Teaming Up With WorkCompSchool For
More 6th Edition
Training!
Click Here for List of Live
Courses
WorkCompSchool has formed an educational partnership with
Brigham and Associates Inc. that will bring its president and
founder, Dr. Christopher R. Brigham, to present a live seminar
at its Camarillo, California headquarters in May.
Date and Time: May 3 (Claims Professionals,
Attorneys, Nurses, other Fact Finders & Physicians)
Location: WorkCompSchool Educational Learning
Facility
1320 Flynn Rd. #401, Camarillo, CA, 93012
Instructor: Christopher Brigham, MD
Topic: AMA Guides 6th Edition
Overview of Seminar: This unique one-day seminar
provides a solid orientation to the new Sixth Edition of the
AMA Guides to the Evaluation of Permanent Impairment.
If you are involved in performing or reviewing impairment
assessments - it is essential that you attend this seminar -
you need to learn the new Guides. Participants will
demonstrate the fundamental skills required to assess most
common impairments, based on new approaches.
Continuing Education Credits: 7.5 Claims
Professional, 7.5 MCLE, 7.5 Legal Specialization Credits and
7.5 CME Category I accredited by ACOEM.
This activity has been planned and implemented in
accordance with the Essential Areas and Policies of the
Accreditation Council for Continuing Medical Education through
the Joint Sponsorship of the American College of Occupational
and Environmental Medicine and Brigham & Associates, Inc.
The American College of Occupational and Environmental
Medicine is accredited by the ACCME to provide continuing
medical education for physicians. The American College of
Occupational and Environmental Medicine designates this
educational activity for a maximum of 7.5 AMA PRA Category 1
Credit(s). Physicians should only claim credit commensurate
with the extent of their participation in the activity.
Testimonials: I highly recommend Dr.
Brigham's Guides training seminars for anyone involved
in AMA Guide's impairment ratings. He has put on so many of
these over the years he knows how to present what is needed
smoothly and effectively in an easy to assimulate one day
package. I have been to quite a few of these myself. I left
each of these ready to provide accurate ratings. His input in
the writing of the new methods in the 6th edition
musculoskeletal chapters takes us to a new paradigm that
reflects his years in this field.
- Dr. Verne
Backus, Vermont
Cost: $495/person, Group Discounts available to 5 or
more attendees from same company, $50 off/attendee.
Register: Click
Here for more details or to enroll. Or call
1-866-975-2667.
_____________________________________________________
Low Cost Solution To Ensuring
Accurate Impairment
Ratings
Our Impairment Screen is a low-cost screening
of a permanent impairment report to determine if permanent
impairment rating is correct. We highly recommend the review
of all impairment rating reports.
This is a very cost effective screening method of
determining if an impairment evaluation was correct or not. It
is applicable to anyone who wants to determine if a rating is
reliable, i.e. clients include claims professionals, attorneys
(defense and plaintiff), and physicians. This screening report
presents our conclusions in this case, however does not
include the narrative discussion and explanations provided in
our standard Rating Review reports. (For cases where the
report is used to be used for feedback to the original rating
physician, evidence in the case, to prepare for
cross-examination, or negotiations we recommend our standard
reports.)
For the month of May we are offering a modest fee of $95
for a routine "Impairment Screen" (correct or incorrect). The
standard fee is $95 for correct and $195 for incorrect. This
low-cost option is most useful for screening purposes and
internal case management. After your review of the Rating
Screen we can provide a detailed narrative report at an
additional charge.
This screening service is restricted to impairment
assessment (without analysis of causation, apportionment or
disability rating), to the review of a single impairment
evaluation report, less than 30 pages of records, the
assessment of two body regions or less, and excludes complex
cases (such as hand impairment assessment, medical and
psychological issues).
Our time frame is 5 working days for most reviews although
complex or lengthy cases may require additional time. Rush
reviews are available in less than 5 working days at
additional fee.
Use our easy online referral www.impairment.com/referral
- once registered make a referral in less than a minute.
