Website - Division of Worker's Compensation
Email - WC
Health Care Provider Advisory
Aurora Medical Center in Summit
August 12, 2016
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
- 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.
- 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.
- 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.
- 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.
- 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).
- 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,"
- 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
- 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". 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",
- 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." The members discussed including language
from recent changes at the State of Wisconsin Medical Examining
Board regarding the definition of manipulation of joints.
- 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.."
- 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
- Electrical muscle stimulation given in a clinical setting.
a. Time given for treatment response is 2 to 4
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
c. Maximum treatment duration is 12 weeks of treatment in a clinical setting but only if given in conjunction with other therapies.
- 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.
a. The time for patient education and training is 1 to 3
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.
- 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."
- 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
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.
- 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."
- 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.