After the original post (below) I had a chance to review more carefully the recent releases from Texas re the adoption of medical treatment and guidelines and to gain more insight into the guideline selection process.
First, a clarification. ODG guidelines WILL be used for management of physical medicine, including physical therapy.
That said, if physicians or other stakeholders want to provide any type of treatment that differs from that recommended by ODG (surgery, therapy, etc), they can provide information to the payer/state justifying their position. And if their treatment plan is supported by other evidence-based medical guidelines, my sense is it will be approved.
Sources also indicate that MDA’s disability duration guidelines were selected primarily due to their accessibility; they are easier to comprehend and more “usable” for laypeople, while still backed by solid research and data. This accessibility may well make conversations among the stakeholders more productive and reduce confusion and mis-interpretation.
That’s good, as it allows providers and payers to have a discussion about treatment options with science-based guidelines as the ultimate test of appropriateness.
The latest state to adopt clinical guidelines for the treatment of workers comp injuries is Texas. While the adoption of guidelines is a good thing, Texas is clearly marching to its own mariachi band.
The state’s Workers Comp Commissioner, Albert Betts, actually selected guidelines from two sources – ODG and MDA. ODG will provide the medical treatment guidelines, while MDA will be the source for disability duration information.
This is a little unusual, as both guideline purveyors incorporate both medical and return-to-work information in their products, and they are designed to work in concert – you have this condition, you need this treatment, and you should be out of work for this long if your job requires this level of activity.
ODG will be used for management of rehabilitation, defined as physical therapy and chiropractic. Texas has a big big problem with overutilization of physical therapy and chiropractic services; this may well help.
LIke every other state, Texas suffers from widely varying medical practice patterns. The adoption of these well-regarded tools should help add a little more consistency by bringing a bit more science to the art of medicine.
Perhaps most importantly, the guidelines will establish a benchmark against which treating providers can be assessed. This is a breakthrough that is long overdue.
