Health Care Provider Advisory Committee
Meeting Minutes
Aurora Medical Center in Summit
August 12, 2016

DRAFT

Members present: Mary Jo Capodice, DO; BJ Dernbach(Chair); Amanda Gilliland; Richard Golderg, MD ; Maja Jurisic, MD:Jeff Lyne,DC : Michael McNett, MD; James O'Malley(acting chair): Peter Schubbe, DC; Jennifer Seidl, PT; Ron Stark, MD; Sri Vasudevan,MD

Excused:  Ted Gertel, MD; Barbara Janusiak, RN; Stephen Klos, MD;  and .Jim Nelson

Other Attendees:  John Murray, Wisconsin Chiropractic Association

  1. Call to Order/ Introductions: Mr. O'Malley convened the Health Care Provider Advisory Committee (HCPAC) meeting at approximately 10:05 a.m., in accordance with Wisconsin's open meetings law. HCPAC members, Worker's Compensation Division staff and other attendees introduced themselves. Mr. Michael McNett was introduced as the newest member of the HCPAC. Dr. McNett is a pain medicine physician with Aurora Health Care.
  2. Acceptance of the May 6, 2016 Meeting Minutes:  Dr. Vasudevan moved to approve the minutes of the May 6, 2016 meeting. Dr Capodice seconded the motion. The minutes were unanimously approved.
  3. Future meeting dates: The HCPAC members agreed they will meet on October 7, 2016, with January 20, 2017 or February 3, 2017 set as alternative meeting date in the event of inclement weather. A tentative meeting date of May 6, 2017 was also set.
  4. Correspondence:  An email message dated June 9, 2016 from Doctor James Lincer, President of the American Board of Pain Medicine(ABPM), was received about the paper Chronic Opioid Clinical Management Guidelines for Wisconsin Worker's Compensation Patient Care not defining the qualifications for pain specialists. Dr. Lincer recommended that worker's compensation guidelines clearly stipulate that a pain medicine physician should hold certification from the ABPM, or subspecialty certification from the American Board of Medical Specialties. Literature about the ABPM was also distributed. Following some background information about the ABPM from Dr. Vasudevan, the members of the HCPAC discussed Dr. Lincer's recommendation.  It was a consensus of the members that determining who is a pain medicine specialist is not within the authority of the HCPAC and this should be addressed by the State of Wisconsin Medical Examining Board. The members agrees they should send a letter to Dr. Lincer thanking him for his input and explaining that determining who is a pain medicine specialist is a topic for the State of Wisconsin Medical Examining Board.
  5. Review of ch. DWD 81 of the Wisconsin Administrative Code: The HCPAC continued its review of the worker's compensation treatment guidelines in ch. DWD 81 of the Wisconsin Administrative Code from where it left off at the last meeting, beginning at DWD 81.06 (3) (b).

    1. 81.06 (3) (b) 2., rewrite the subdivision as follows: "The treatment is not given on a regularly scheduled basis, but only after a documented assessment of response to treatment and ongoing or persistent need,"
    2. 81.06 (3) (b) 5. Amend the subdivision as follows: "The additional 12 visits for treatment does not delay  the required surgical or chronic pain evaluation required by this chapter
    3. 81.06 (3) (b)  6 Rewrite the subdivision as follows. "Passive care is not necessary or  while the recommended for patients has chronic pain syndrome".
    4. The members discussed what should be included in the definition of "chronic pain syndrome." Dr. Jurisic and Dr. McNett will serve on a workgroup to draft a suitable definition of " chronic pain syndrome",

    5. 81.06 (3) (c) Amend the subdivision as follows: " Adjustment or manipulation of joints. For purposes of this paragraph, "adjustment or manipulation of joints" includes, but is not limited to, chiropractic and osteopathic adjustments or manipulations. All of the following guidelines apply to adjustment or manipulation of joints."
    6.   The members discussed including language from recent changes at the State of Wisconsin Medical Examining Board regarding the definition of manipulation of joints.

    7. 81.06 (3) (d) c. 2. Amend the subdivision as follows: "Home use of thermal modalities may be prescribed at any time during the course of treatment. Home use may only involve hot packs, hot soaks, hot water bottles, hydrocollaters, heating pads, ice packs and cold soaks, and other durable medical equipment that can be applied by the patient without health care provider assistance. Home use of thermal modalities doe not require any special training or monitoring, other that  usually provided by the health care provider during a office visit.."
    8. 81.06 (3) (e) Amend the paragraph as follows: Electrical muscle stimulation. For purposes of this paragraph, "electrical muscle stimulation" includes galvanic stimulation, trancutaneous electrical nerve stimulation, inferential, and microcurrent techniques. All of the following guidelines apply to electrical muscle stimulation.

      1. Electrical muscle stimulation given in a clinical setting.

          a. Time given for treatment response is 2 to 4 treatments.
          b. Maximum treatment frequency is up to 5 times per week for the first one to three weeks decreasing in frequency until the end of the maximum treatment duration period in sub d, 1. c. Time given for treatment response is 2 to 4 treatments.
          c. Maximum treatment duration is 12 weeks of treatment in a clinical setting but only if given in conjunction with other therapies. .
      2. Home use of an electrical stimulation device may be prescribed at any time during a course of treatment. Initial use of an electrical stimulation device shall be in a supervised setting in order to ensure proper electrode placement and patient education.  All of following guidelines apply to home use of an electrical muscle stimulation device.

        1. a. The time for patient education and training is 1 to 3 treatments.

          b. Patient may use the electrical stimulation device for one month, at which time effectiveness of the treatment shall be reevaluated by a health care provider before continuing home use of the device.
    9. 81.06 (3) (f) 1. b.;  Amend the subdivision paragraph to provide for maximum frequency duration up to 5 times per week. " "Maximum treatment frequency is up to 3 5 times per week for the the first 1 to 3 weeks, decreasing in frequency until the end of the maximum treatment duration period in subd. 1. c."
    10. 81.06 (3) (g): Amend this paragraph to include "dry needling" in the definition of acupuncture treatments. " Acupuncture treatments. For the purposes of the paragraph, " acupuncture treatments" include endorphin-mediated analgesic therapy that includes classic acupuncture, and acupressure, and dry needling.  All of the following guidelines apply to acupuncture treatments.

      1. 1. The Members discussed the definition of manual therapy. Ms. Seidl will e-mail suggestions for a definition of manual therapy to the members.

        2. The members discussed the definition of "phoresis" and the fact the current 81.06 (3) (i), does not contain a reference to laser treatments, Dr. Lynn, Dr. Schubbe and Ms. Seidl will serve on a workgroup that will draft a definition of laser therapy to be included on the treatment guidelines.

    11. 80.06 (3) (j). Amend this paragraph to not prescribe bedrest for more than 2 days, "Bedrest: Prolonged restriction of activity and immobilization are detrimental to a patient's recovery. Bedrest shall not be prescribed for more than 7 2 days."
      80.06 (3) (j) (k) 4. Rewrite the subdivision as follows: "Maximum continuous duration is 3 weeks unless patient is status post fusion post lumbar spine surgery."
  6. Adjournment: There was no new business. There was a motion to adjourn by Dr. Schubbe, seconded by Dr. Goldberg. The motion carried unanimously. The meeting was adjourned at approximately 12:20 p.m.