Last week Chris Brigham, MD and Phil Walker, JD shared unique insights to the AMA Guides during a one hour preview call for next week's seminar "AMA Guides: The Next Step – Advanced Skills and Practical Application”. The feedback was so positive we are sharing the recording with you.

Please click on the link at the end of this article to hear the recording.

Dr. Brigham and Mr. Walker discussed challenging areas of the Guides and provided a preview of some of the content for the upcoming seminar. Details are below... If you have not yet registered, there is still time. This advanced seminar will provide attendees with the knowledge to assess impairment in complex areas such as multiple upper & lower extremity injuries and corticospinal tract injuries. There will also be discussion on common areas of misuse and abuse of the Guides along with current trends seen with erroneous ratings.

Physicians, attorneys and claims staff are encouraged to attend.

• August 2, 2006 - Irvine Marriott
• August 4, 2006 - San Francisco Airport Marriott
• Time: 7:30am- 4:30pm
• Register On-Line or Call 619-299-7377 or 888-262-1202
• 7 Hours Credit: CME, MCLE, WCCP

Would you make an investment if you knew you would receive a return on that investment? Of course!

How can one resist gaining more than they invested? Training is an area that our clients have proven to themselves be an area of great returns, when they have invested the time and money on educating their staff on the Guides.

What type of return best fits your group?

• Physician - Gain on their investment by increasing the value of their reports and the demand for their services by providing correct ratings. They also decreasing the time in preparing a quality impairment rating and are able to support their ratings.
• Insurers and Claims Management - Gain by decreasing claims costs due to erroneous impairment ratings.
• Attorney - Gain the ability to better serve their clients and to win cases by learning how to evaluate and manage ratings and be effective with cross-examination.

Which group are you?

Think about how this can improve your success and that of your organization by enhancing quality, increasing your revenue and decreasing your costs. The calculations are specific to your volume and organization, but are undoubtedly result in a great return on investment.

Our firm can provide training on the Guides for your organization. We can tailor training to the needs of your organization. Training can be done on-site or web based. For more information call Mindy Brigham (888) 262-1202.

The Range of Motion (ROM) method should be used for rating cases with multiple level (or bilateral) radiculopathy, recurrent radiculopathy, and for multilevel fusions. It is not used merely for the presence of degenerative disk disease (including findings of disk herniations or protusions.) As explained in Section 15.2 Determining the Appropriate Method for Assessment (5th ed., 379-381) the Range of Motion Method is used in certain situations. On page 380, at the top left, item 2 states “when there is multilevel involvement in the same spinal region (eg, fractures at multiple levels, disk herniations, or stenosis with radiculopathy at multiple levels or bilaterally). On the same page at the bottom right item 4 provides further clarity stating “use the ROM method if . . .there is radiculopathy bilaterally or at multiple levels in the same spinal region.” In the May/June 2001 Guides Newsletter Robert Haralson, III, MD, the Spine Chapter Chair, and I clarified this point in stating “This refers to disk herniations with radiculopathy at multiple levels or bilaterally or spinal stenosis with radiculopathy at multiple levels or bilaterally. Findings of disk herniations are commonly seen among asymptomatic individuals, and these findings alone may not significant.” Thus the key feature is the presence or absence of radiculopathy. Radiculopathy is the presence of pain, with sensory loss, motor weakness, and/or muscle stretch reflex alteration in a limb. Without radiculopathy, imaging changes other than fracture, are not sufficient to produce an impairment. The common prevalence of degenerative changes, including disk herniations, is discussed on page 378 in Section 15.1b Description of Clinical Studies.

The Guides state on page 379 “When the cause of the impairment is not easily determined and if the impairment can be well characterized by the DRE method, the evaluator should use the DRE method.” Page 383 discusses common imaging findings, such as herniated disk without radiculopathy and aging changes and states “the presence of these abnormalities on imaging studies does not necessarily mean the individual has an impairment due to an injury.” It is preferable to use the DRE method. However, the examiner should state that “cumulative trauma” is not a proven cause of back pain, and thus, while the examinee’s spinal impairment can be estimated by the DRE method, the impairment would not be due to “cumulative trauma”.

We appreciate the very favorable feedback on our impairment review services, and the superb value that this brings to our clients. Our goal is to assure accurate ratings; unfortunately, most ratings are erroneous - therefore our review services are essential.

We have several exciting developments to share with you. This week we implemented our new online referral process - even better than our state-of-art approach we have used for years. You can now provide more specific information about your referral and upload multiple records. Our detailed reports will now include a summary page providing you with essential data. We are now collecting more data on every case we review - we have the nation's largest database on impairment assessments. To best service our clients, our San Diego office is managing California and Hawaii referrals and our Portland, Maine office is serving our clients for the rest of the United States and internationally.

In the next issue we will share information about the most exciting development ever in AMA Guides training - an online solution with high quality presentations, video and publications - immediately available. This is the result of two years of effort - we are finalizing the website and will share with you the link in the next issue, and provide you with a free video on impairment assessment of carpal tunnel syndrome. You are going to be awed by this resource.

We will always be on the cutting edge - providing you with unique resources that are of tremendous value to you and your organization.