Health Care Provider Advisory Committee

Minutes for September 8, 2006
Crowne Plaza
Madison, WI

Present: David Bryce MD, Mary Jo Capodice DO, Eric Carlsen MD, Amanda Gilliland, Frances Huntley-Cooper, Barbara Janusiak RN, Maja Jurisic MD, Steven Kirkhorn MD, Jennifer Pollak, Peter Schubbe DC, Sri Vasudevan MD

Excused: Gina Buono MD, Mike Lischak MD, Jeff Lyne DC, Timothy Waldoch

Staff present: Jim O'Malley, Mike Topp

Observers: Margie LaBarge, RN-Ministry Health Care; Ron Kuehn-WI Biotech & Medical Device Assoc; Russ Leonard, Wisconsin Chiropractic Association

10:12 AM meeting called to order by Chair Frances Huntley Cooper

Quorum is not met with 10 in attendance.

Members of the committee went around the room and introduced themselves.

Sri Vasudevan moved to approve the meeting minutes for August 4, 2006
Seconded by Peter Schubbe
Motion carried

Mike Topp reported out that MetaStar/Promed does not publicize their list of reviewers.

Mike Topp presented an overview of the reasonableness of fee dispute resolution request process. (Handout was provided)

Sri Vasudevan distributed handouts of interest:
Preventing Needless Work Disability by Helping People Stay Employed
Guidelines for the Assessment and Management of Chronic Pain

Mary Jo Capodice continues to work on rule alignment with current International Classification of Diseases (ICD) coding

Rule 81.00 discussion

  1. Steve Kirkhorn moved to accept the majority rule on any vote to make a rule change today, September 8, 2006, contingent on absentee members voting, “Yes”, “No”, or “Object” to the change in the committee rule regarding 12 members needed for a vote on rule changes.
    Second by Barb Janusiak
    Unanimous consent
    Motion needed in order to vote on rule changes in light of the absence of a quorum
  2. Sri Vasudevan moved to change the definition of Chronic Pain in 81.03(3) by deleting “means any of the following set of verbal or nonverbal behaviors that:” and sections (a)-(d) and replacing it with, “Complaint of persistent pain beyond 12 weeks of appropriate treatment per DWD 81.03 to 81.12. It is persistent with verbal and nonverbal pain behaviors that exceed the identifiable pathology/medical condition.”
    Second by Maja Jurisic
    Unanimous consent
  3. Sri Vasudevan moved to change 81.13 from “Chronic Management” to “Chronic Pain Management”
    Second by Eric Carlsen
    Unanimous consent
  4. Sri Vasudevan moved to change 81.10(1)(a) with
    Know the categories of clinical signs and symptoms that are important for diagnosis, know the interpretation of these diagnostic criteria for clinical use and the sensitivity and specificity (sensitivity 0.85, specificity 0.60).
    1. Positive sensory abnormalities: spontaneous pain, mechanical hyperalgesia, thermal hyperalgesia, deep somatic hyperalgesia.
    2. Vascular abnormalities: vasodilation, vasoconstriction, skin temperature asymmetries, skin color changes.
    3. Edema, sweating abnormalities: swelling, hyperhidrosis, hypohidrosis.
    4. Motor, trophic changes: motor weakness, tremor, dystonia, coordination deficits, nail changes, hair changes, skin atrophy, joint stiffness, soft tissue changes.
    5. Interpretation. One or more symptoms of three or more categories each AND one or more signs of two or more categories each.
    Second by Peter Schubbe
    Motion carried; 10 Yes, 1 No (David Bryce)
  5. Maja Jurisic moved to change 81.06(4)(a)(4)(c)(1)(a) to read, “the maximum treatment frequency is 5 times for the first week, decreasing to 3 times per week for the next two weeks, and should decrease further thereafter”
    Second by Sri Vasudevan
    Unanimous consent
  6. Maja Jurisic moved to change 81.06(3)(c)
    Second by Jennifer Pollack
    Motion withdraw as end range thrust would be included
  7. Maja Jurisic moved to change 81.11
    Discussed and withdrawn
  8. Amanda Gilliland moved to add to 81.11(1)(a), “There may be patients recovering from surgical, diagnostic, or other medical procedures or in Observation status who occupy inpatient beds for one or more nights but do not meet clinical criteria for inpatient status and therefore are not considered inpatients or billed as such.“
    Second by EricCarlsen
    Unanimous consent
  9. David Bryce moved to add section 6 to 81.04
    Second by Mary Jo Capodice
    Discussed and withdrawn

  10. David Bryce moved to add to 81.03(10)
  11. David Bryce moved to change 81.06(6)(d)(2); 81.07(7)(c)(2); and 81.08(6)(d)(2) to use the phrase “intrathecal drug pump” instead of “morphine pump” and change “somatic pain” to somatic or neuropathic pain.”
    Second by Steve Kirkhorn
    Tabled for future discussion
  12. David Bryce moved to have “morphine pump” changed to “intrathecal drug pump”
    Second by EricCarlsen
    Unanimous consent
  13. David Bryce moved to amend sections 81.06(6)(b)1.; 81.06(11)(b)6.; 81.07(6)(a)1.a.; 81.07(11)(b)6.; 81.07(12)(b); 81.07(13)(a)2.; 81.07(14)(a)2.; 81.08(6)(b)1.; 81.08(11)(b)6.; 81.08(12)(b); and 81.08(13)(a)2. to change “morphine pump” to “intrathecal drug pump” and “dorsal column stimulator” to “spinal cord stimulator.”
    Second by EricCarlsen
    Unanimous consent
  14. David Bryce made a motion stating if a person has a motion that involves expansion, he or she should provide pertinent information by email or mail or reference websites, prior to next meeting for all committee members to review.
    Second by EricCarlsen
    Unanimous consent
  15. David Bryce made a motion to amend section 81.10(3)(b)
    Second by Mary Jo Capodice
    Tabled for future discussion

Motion to adjourn – Peter Schubbe
Second – Amanda Gilliland
Motion carried
Meeting adjourned at 2:25 PM

October 13, 2006
10:00 am – 3:00 pm
Crowne Plaza
4402 E. Washington Avenue
Madison, WI