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Resources >
Discussions > Strategies
to Assure Accurate Ratings
Strategies to Assure
Accurate Ratings
There are several strategies to assure
accurate ratings, and to minimize misuse and abuse of
the Guides. These include obtaining an accurate,
unbiased rating, evaluating impairment ratings, managing
erroneous ratings, and discrediting erroneous ratings.
The first step is recognizing the high likelihood of
error and becoming knowledgeable about the Guides.
To achieve accurate ratings it
is necessary to utilize strategies that are
proven to reflect best practice. It is important
for both the rating physician and the party
requesting the rating to recognize the high
likelihood of error and to become knowledgeable
about the Guides.
Assuring Accurate
Impairment Evaluation
Proactive management of
impairment ratings starts by assuring the
initial impairment rating is correct and is
performed at maximal medical improvement. Claims
organizations may establish processes driven by
specific triggers. Physicians
performing impairment evaluations should be
experienced in the assessment of injuries or
illnesses being rated and in the use of the
Guides. Ideally, the physician should have had
formal training on the use of the AMA Guides and
demonstrated competency in the knowledge,
skills, and experience required to assess
impairment. Impairment evaluations should be
performed by a board-certified in an appropriate
medical or surgical specialty (www.abms.org),
experienced in the assessment of injuries and
the use of the AMA Guides to the Evaluation of
Permanent Impairment, Fifth Edition, who has
demonstrated competency in the performance of
independent medical examinations, either being a
Certified Independent Medical Examiner (American
Board of Independent Medical Examiners, www.abime.org),
a Fellow of the American Academy of Disability
Evaluating Physicians (www.aadep.org),
having obtained Certification in Evaluation of
Disability and Impairment Rating (www.aadep.org)
and/or a Certified
Impairment Rater. It is appropriate to
determine if the physician has attended
educational programs specifically on the use of
the AMA Guides. Training in impairment
evaluation is provided by American Academy of
Disability Evaluating Physicians (www.aadep.org),
American Academy of Orthopaedic Surgeons (www.aaos.org),
American Board of Independent Medical Examiners
(www.abime.org),
American College of Occupational and
Environmental Medicine (www.acoem.org ),
and other organizations. A careful review of
that physician’s curriculum vitae and sample
reports is often useful. The
client requesting an impairment rating by a
physician may want to work with an organization
that has identified, and credentialed,
physicians skilled in assessing impairment. The
client requesting the evaluation should provide
a cover letter describing the specifics of the
evaluation which should be carefully reviewed by
the physician. Providing guidance on the
assessment process and defining standards for
the evaluation and the report will improve the
probability of obtaining a correct rating. All
relevant medical records and any other
nonmedical documents that may be helpful in the
rating process should be provided.
Assessing and Managing
Impairment Ratings
Since there is a high error rate
with impairment ratings, impairment reports
should be critically reviewed to determine the
accuracy of the rating, i.e., was the rating
performed consistent with the AMA Guides and
does clinical data support the rating.
Impairment Resources has identified specific
triggers associated with erroneous ratings.
Please contact us
to discuss these triggers. The
reviewer of ratings should be experienced in the
use of the Guides and the process of auditing
reports. Clinical knowledge, skills, and
judgment are required to adequately analyze the
clinical data and to appropriately apply the AMA
Guides. Typically a nonphysician, working
independent of a physician, will be unable to
accurately determine the reliability of ratings,
since he/she will not have the skills to judge
the significance of specific clinical findings
upon which an impairment assessment is based.
The impairment review may be used to provide
feedback to the rating physician, and will
promote improvement in the rating process
(particularly if constructive, tactful feedback
is provided from a credible expert). Reviews may
also be used as a negotiation tool, as basis for
effective cross-examination, and for evidence.
It is important to track the return on
investment from an impairment management
program. Since the error rate is high, the
difference between the original rating and
corrected rating is often several rating
percentage points, and the dollar value per
percentage point is often more than a thousand
dollars, there are opportunities for significant
cost savings. Beyond the opportunities for
financial savings, there is the opportunity for
human savings by not portraying someone as
seriously impaired, i.e. damaged, when they are
not.
Conclusion
Impairment ratings should be reviewed for
accuracy. Inaccurate ratings often are the
result of bias, confusion, and misapplication of
the Guides. It is imperative that physicians
perform impairment evaluations according to the
processes defined in the Guides, in an effort to
avoid errors in rating. Strategies are available
to assist stakeholders in obtaining an accurate
rating at MMI initially, or to reduce or fix
errors in ratings that are received. Clients
requesting ratings should be aware of the high
incidence of error and take steps to drive
accurate impairment ratings. Impairment
Resources, LLC will assist you in
assuring
accurate impairment ratings.
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