Many of the independent medical and impairment evaluation reports we review are of inadequate quality. Standards for independent medical examinations were published in the November / December 2005 issue of the Guides Newsletter. The report should reflect the quality of the evaluation and the skills of the expert. A well-written, supportable and clear report which fully addresses the issues posed by the client is essential. We have had numerous requests for an exemplary report. To view this report Click Here.

If you are a physician, we can assist you with the resources needed to prepare a high quality report. Click Here for a list of our physician resources. One of the best approaches is to learn from the examples of others who have authored exemplary reports. If you are a client in Hawaii, we are pleased to announce that we can provide you with the finest quality IME Services.

We are dedicated to always providing you with excellence.

by Christopher R. Brigham, MD

Ganglia, fluid filled cysts, are common about the wrist, representing 50% to 70% of all hand masses. Thick, clear, fluid leaks through a tear in the joint capsule or tendon sheath to form a ganglion cyst. It is typically filled from the joint via a tortuous duct, or "stalk," which functions as a valve directing the flow of fluid. Common locations include the dorsum of the wrist directly over the scapholunate joint, and the volar radial aspect. By far, the most common location for a ganglion is the dorsal wrist, with the pedicle arising from the scapholunate ligament in virtually all cases.

Ganglion cysts occur more commonly in women, usually between the ages of 20 and 30 years. However, they can develop in either sex at any age. Ganglion cysts may or may not be painful. Typically there is no history of wrist trauma. If pain or limitation of function mandates, the ganglion can be aspirated or excised. The ganglion may spontaneously rupture, providing relief. Typically they are not associated with any ratable impairment.

The best practices and most cost-effective claims management approach to impairment ratings is our Impairment Rating Integrated Solution (IRIS), which includes low cost screen of all ratings (Impairment Screen), detailed critique of erroneous ratings (Impairment Review), Impairment Analysis System data analysis (your cases and overall data, including impairments for specific diagnoses and physician performance analysis), and access to GuidesIQ.

• Impairment Screen - all ratings
• Impairment Review - detailed reports for ratings with significant error
• Impairment Analysis System - complimentary*
• GuidesIQ - complimentary*

The fee for this solution is nominal and the savings may be profound. For most impairment screens the cost is only $95 if the rating is correct or $195 if incorrect - a fraction of the cost of even a single percentage error. The fee for detailed critiques is based on the time involved for that case.

We will develop with you a process that is most effective for your organization. Ratings are reviewed typically within five days and invoices are sent for each case. The fee for the professional service is typically billed to the file. *If we review all of your ratings, we provide you on a complimentary basis our data analysis (otherwise quarterly licensing fee of $9500) and also access to GuidesIQ for your staff (otherwise annual membership fee of $897 per person). You also receive priority status. Most importantly you have a cost-effective mechanism to assure accurate impairment ratings.

We recommend a three month trial with this intervention. At the end of that time you assess the impact of this strategy and determine whether to continue and if any modifications are needed. Every client implementing this has continued with the screens and the return on investment has been several-fold.

Contact Mindy Brigham today and solve the challenge of erroneous impairment ratings.

We love getting out to see our clients and meet new folks in our industry! Here's a look at where we've been recently:

October

We sponsored the ICA Golf Tournament for the first time. Mindy & Leslie had a blast meeting new people and putting some faces to names we work with.

Early November

Mindy attended the WCRI Conference in Boston and we also exhibited at the National WC & Disability Conference in Chicago. Not only was the conference incredible, but StrataCare put on a great party at the House of Blues again!

Thanks to all of you who've stopped by our booth to introduce yourselves and thank us for our informative ezines! We enjoy meeting you all and love hearing success stories with our services being of such great assistance with your cases!

Coming up:

Late November

Dr. Brigham & Mindy will be heading to Australia where he will be teaching on the 4th and 5th Editions of the Guides.

December

Mindy will flying over to Hawaii to meet with clients regarding our services. Please send her an email if you are interested in meeting with her. Contact Mindy Brigham

Leslie will be attending the PIWC Holiday Party in Fresno. She will be flying up a day in advance to meet with clients interested in a one-hour Q & A session with her on the Guides. Please contact her if you are in the area and interested (limited amount of time here so please send your inquiry asap). Contact Leslie Dilbeck

We look forward to seeing you all soon!