Have you ever needed to talk to someone immediately about an impairment issue? We are pleased to announce our new service "Ask An Expert". Our very experienced AMA Guides experts are ready to take your call. Perhaps you are an evaluator and you are stumped on an issue which impedes you from completing your evaluation. Or you are an attorney or adjuster who needs a quick answer so you can move forward on your file.

Ask An Expert is your unique solution. Gain from our experience reviewing thousands of impairment evaluations and being recognized leaders in this field.

• Give us a call at 888-GUIDES5 (888-484-3375)
• The fee for this service is $65 per 15 minutes of consultation

We are pleased to announce a new low cost prepaid option for Impairment Screens. It is essential to assure that an impairment rating is correct or not. Appropriateness of care and medical bills are routinely reviewed by external expert resources, the same needs to occur with impairment evaluations. In fact, our data supports it is even more likely that impairment ratings will be wrong. Thus, more of our clients are having us review all assessments.

An excellent first step is our Impairment Screen. It is applicable to anyone who wants to determine if a rating is reliable; 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.

With the prepaid option, the flat fee is $147. Payment is made online as explained at http://www.impairment.com/impairment_screen. htm (Please note the 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).

Impairment Profiling System

Impairment Profiling System (IPS) is a powerful relational database of impairment reviews that helps you manage ratings and project probable impairments. This blended data is very valuable to you, including:

• Projecting probable impairments for specific diagnoses (used in reserving, defining settlement value, and negotiation)
• Identifying cases that are at higher risk for error and therefore require further intervention
• Insight to individual physician performance. (We report our observed data of cases reviewed, recognizing that this may not be reflective of all ratings performed by that physician nor predictive of future performance. Clients report such data is useful in identifying more experienced and skilled providers, and offering assistance to those who appear to have more difficulty in rating impairment).

Please contact us at Brigham & Associates for more information on this unique offering providing you with data essential to your organization.

Please view our New Client presentation where you will learn how to maximize the benefits from our unique impairment review and consultative services and the extensive resources at www.impairment.com. This presentation is essential for claims professionals and attorneys who deal with AMA Guides impairment ratings.

You will learn how to:

1. Read our reports and to extract all of the value provided - both in the narrative report and the summary analysis.
2. Use our reports to assure accurate, reliable ratings, including for case management, as constructive feedback to physicians (the majority of the time our clients report physicians will correct their ratings based on our feedback) evidence, negotiation, and preparation for cross examination.
3. Benefit from the data we collect (including information on impairments for specific diagnoses and physician profiling).
4. Select the most cost-effective service (ranging from our low cost screening reviews to our detailed physician critiques).
5. Make online referrals that are efficient and clearly define your needs.
6. Access other consultative resources that will assist you greatly with case management.
7. Use the many free, beneficial resources at www.impairment.com (including our impairment tools, tip and ezine archives, downloads, and links).

Click Here to View

On Wednesday May 9th from 11 a.m.-12 p.m. (PST) please join us for a teleconference call where you can ask any questions you may have about our services.

To participate in this complimentary and not to be missed event, call in at 1-218-486-1300 and enter '605808' when prompted for the bridge number.

The Guides Newsletter - Important Clinical Concepts from Past Issues
by Craig M. Uejo MD, MPH, QME, CIME, CIR

This is the eleventh in a series of articles written to assist evaluators in their use and interpretation of The AMA Guides to the Evaluation of Permanent Impairment, Fifth Edition (Cocchiarella L, Anderson G, AMA Guides to the Evaluation of Permanent Impairment, Fifth Edition, AMA Press, 2001). It will be used to help summarize key points of clarification documented in past issues of The Guides Newsletter. References to specific issues will be provided to allow anyone the opportunity to review the entire issue/article for assistance in understanding and accuracy of reporting.

This particular article will discuss the issues of rating upper extremity motion impairments. This issue was discussed in the May/June 2003 edition of The Guides Newsletter - Questions and Answers section. Christopher Brigham, MD was the author.

"Normal" Values of the Opposite Extremity

Upper extremity motion impairment as per Chapter 16, The Upper Extremities of the AMA Guides to the Evaluation of Permanent Impairment, Fifth Edition allows for apportionment of the uninjured "normal" extremity motion from any impairment calculated for the injured extremity.

Dr. Brigham writes in his answer to a question in the The Guides Newsletter issue reviewed:

New to the Fifth Edition are instructions permitting apportionment of diminished joint motion.

If a contralateral "normal" joint has a less than average mobility, the impairment value(s) corresponding to the uninvolved joint can serve as a baseline and are subtracted from the calculated impairment for the involved joint. (5th Ed, 453)

Therefore, you should also measure the opposite extremity. The Fifth Edition provides more direction on how to measure motion, but the values for motion deficits remain the same as in the Fourth Edition. Motion measurements falling between those shown in a pie chart may be adjusted or interpolated.

In summary:

The Guides 5th Ed. recommends apportioning away any "baseline" impairment that an individual may have as their "normal." Therefore, if an individual is measured as having decreased motion as their "normal" baseline measurement, any level of impairment for this baseline, pre-injury motion is accounted for in the final rating for the injured extremity.

• Look for additional articles in this series, The Guides Newsletter - Important Clinical Concepts from Past Issues, coming in upcoming issues of this Brigham and Associates Ezine.

Chapter Eight: The Skin
by Aimee Topping, CIR, WCCP

This article will discuss important points of reference for Chapter Eight of the AMA Guides, which addresses the skin. Skin disorders may develop from exposure to physical, biological agents. Simple avoidance of these agents may prevent ongoing irritation. Physicians examining patients for skin disorders must use their clinical expertise to determine the clinical course and anticipated permanency of a skin disorder. Section 8.1 Principles of Assessment explain how to use this chapter.

• Clinical Evaluation: this requires a detailed medical history, thorough physical examination. Possible use of ancillary diagnostic or laboratory testing including but not limited to skin patch testing, prick, intracutaneous and serologic allergy test, etc.
• Determine the correct impairment class: the physician will need to use clinical judgment to determine the severity of the condition and evaluate the impact on the patient's activities of daily living.
• Determine the appropriate percentage within any impairment class by considering the frequency, intensity and complexity of the condition and treatment required.

Consideration is made for disfigurement. Skin disfigurement "is an altered or abnormal appearance that may be an alteration of color shape or structure". Usually, this has no impact on the functional capacity of the body as a whole but may impact a patient's ADLs within socializing. For an example a hypertrophic scar on a face could result in some changes in socialization for a patient.

Section 8.7 contains the Criteria for Rating Permanent Impairment Due to Skin Disorders in Table 8-2 (5th Ed., 178).

It is imperative to note that within each Class of impairment there are three criteria each of which must be met in order for a patient's condition to be considered ratable within the class. There is a range of possible impairment values in each class. The physician must use clinical judgment and consider how the condition impacts the patient's ADLs to determine where in the range the patient is best classified.

Watch for the next article in the series, which will highlight sections of Chapter 9 The Hematopoietic System.