Website - Division of Worker's Compensation
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Health Care Provider Advisory
Aurora Medical Center in Summit
October 7, 2016
Members present: Mary Jo Capodice, DO; BJ
Dernbach(Chair); Amanda Gilliland; Richard Goldberg, MD ;Barbara Janusiak,
RN, Maja Jurisic, MD, Jeff Lyne,DC : Jim Nelson, James O'Malley (acting
chair): Peter Schubbe, DC; Jennifer Seidl, PT; Ron Stark, MD; Sri Vasudevan,MD
Excused: Ted Gertel, MD; Stephen Klos, MD;
and .Michael McNett, MD
Other Attendees: Forbes McIntosh, Government
Policy Solutions LLC, H.J. Waukau, Wisconsin Medical Society (by telephone
- 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.
- Acceptance of the August 12, 2016 Meeting Minutes:
Dr. Vasudevan moved to approve the minutes of the August 12, 2016 meeting.
Dr Capodice seconded the motion. The minutes were unanimously approved
- Future meeting dates: The HCPAC members agreed they will meet on
January 20, 2017, with February 3, 2017 set as
an alternative meeting date in the event of inclement weather. A future meeting date of
May 7, 2017 was also set. August 11,2017 was set as a tentative future
At the last meeting the HCPAC discussed
message dated June 9, 2016 from Dr. James Lincer,
President of the American Board of Pain Medicine (ABPM)
about the paper Chronic Opioid Clinical Management
Guidelines for Wisconsin Worker's Compensation Patient
Care not defining the qualifications for pain specialist
and that these guidelines should clearly stipulate that
pain medicine specialist should hold certification from
the ABPM or subspecialty certification from the American
Board of Medical Specialties. The HCPAC reviewed the
language of a letter responding to Dr. Lincer. Mr.
Dernbach will send the letter containing the finalized
language to Dr. Lincer.
- Update on education and training modules from the Wisconsin
Dr. Capodice explained the education and training
modules that were previously completed were not patient centric enough.
Mr. H. J. Waukau was recently
hired to work on completing the education and training modules and
appeared at the meeting by telephone conference call. Mr. Waukau updated
the HCPAC about his activities and the current status of the project. It
was the consensus of the HCPAC the members would review the modules
before they were finalized. Mr. O'Malley agreed to provide assistance
with completing this project. Dr. Capodice and Dr. Stark commented there
is currently no useful resource for physicians to consult about giving
permanent partial disability ratings and the modules could cover
permanent disability ratings.
- 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.
The definition of chronic pain syndrome that was
drafted by Dr. Jurisic and Dr. McNett should be included in DWD 81.03 (2).
The HCPAC resumed its review of the treatment
guidelines beginning at DWD 81.06 (4).
81.06 (4) Amend the title of the
subdivision for the correct spelling of Modalities.
81.06 (4)(a) Amend the paragraph as follows:
"Active treatment modalities shall be used as set forth in pars.
(f). A health care
provider's use of
active treatment modalities may extend
past the 12-week limitation as with
on passive treatment
modalities as long as acceptable reasons, as set forth in s. 81.04 (5), are
documented. so long as the maximum durations for the active treatment
modalities are not exceeded."
c. 81.06 (4) (b) Amend the paragraph as follows: "
Education shall teach the patient about pertinent anatomy and physiology as it
relates to spinal function for the purpose of injury prevention. Education
includes training on posture, biomechanics, and relaxation.
number of treatments is 3 visits, which include an initial education and
training session and 2 follow-up visits. Education
is provided continuously and reflected through active treatment
d. 81.06 (4) (c) Amend the paragraph as follows:"
Posture and work method training shall instruct the patient in the proper
performance of job activities based on essential job duties as reported by
the employer. Topics include proper positioning of the trunk, neck and arms,
use of optimum biomechanics in performing job tasks, and appropriate pacing of
activities. Methods include didactic sessions, demonstrations, exercises, and
simulated work tasks.
The maximum number of treatments is 3 visits.
This is an ongoing part of
treatment and is reflected through active treatment modalities." e.
81.06 (4) (d)Amend the paragraph as follows:
"Worksite analysis and modification shall examine the patient's work station,
tools, and job duties. A health care provider's recommendations may be made for
the alteration of the work station, selection of alternate tools, modification
of job duties, and provision of adaptive equipment. The maximum number of
treatments is 3 visits is 3 per individual injury."
81.06 (4) (e) Amend the paragraph as follows:"
Exercise, which is important to the success of an initial nonsurgical treatment
program and a return to normal activity, shall include active patient
participation in activities designed to increase flexibility, strength,
endurance, or muscle relaxation. Exercise shall, at least in part, be
specifically aimed at the musculature of
that impacts function of
the lumbosacral spine. Aerobic exercise and extremity strengthening may be
performed as adjunctive treatment, but may not be the primary focus of the
81.06 (5) (b) 3. Amend this subdivision as follows:
"All of the following guidelines apply to facet joint or nerve (medial branch
h. 81.05 (5) (b) 5. Create 81.05 (b) 5 a. and renumber the other subdivision
paragraphs as follows: "All of the following guidelines apply to epidural
a. Ideally the treatment is administered within the first 6 to 8 weeks
Time for treatment response is within one week.
c. Maximum treatment
frequency is once every 2 weeks if there is a positive response to the first
injection. If subsequent injections demonstrate diminishing control of symptoms
or fail to facilitate objective functional gains, then injections should be
discontinued. Only one injection per patient visit.
Maximum treatment is 3 injections."
Amend 81.06 (5) (c) Amend this paragraph as
follows: "For purposes of this paragraph, "lytic or sclerosing injections"
include radio frequency denervation (ablation) of the facet joints. These
injections may only be given in conjunction with active treatment modalities
directed to the same anatomical site. All of the following guidelines apply to
lytic or sclerosing injections:
1. Time for treatment response is up to 6 weeks.
2. Maximum treatment
frequency may repeat 4 times per year or once every 3 months for any site.
3. Maximum of 2 injections or ablations to any one site. "
The HCPAC discussed possible changes to
DWD 81.06 related to low back surgery including decompression procedures and
arthrodesis. It was the consensus of the members that no further discussion
should occur at this meeting and that any suggested changes should be made by
surgeons. Mr. O'Malley will send a message to Dr. Gertel and request him to
review and comment about the language contained in DWD 81.06 (6).
81.06 (8) (a) 2. Amend this subdivision
as follows: "For patients using electrical
stimulation or mechanical traction devices at home, the device and any required
supplies are necessary within the guidelines of sub.
(3) (e) and
The members discussed including the Wisconsin Medical Examining Board's Opioid
Prescribing Guideline in ch. DWD 81 of the Wisconsin Administrative Code.
Mr. O'Malley stated that the Attorney
General's Office is required to approve any document that is incorporated by
reference in the Wisconsin Administrative Code. Mr. O'Malley will contact the
Wisconsin Attorney General's Office for additional information about this and
report at the next meeting.
k. 81.06 (9) (e). Amend this subdivision as follows:
";(e) If there is not
in at least 2 criteria specified in pars. (b) to
(d), in par. (c) or (d), the modality shall be discontinued or
significantly modified or a health care provider shall reconsider the diagnosis.
The evaluation of the effectiveness of the treatment modality may be delegated
to another health care provider. "
l. 81.06 (10) (b) and (c). Repeal DWD 81.06 (10) (b) and renumber par. (c) as
par. (b) as follows:
"(b) Patients with radicular pain may require longer periods of treatment.
(c) A health care provider shall document the rationale for the use of
any scheduled medication. Treatment with nonnarcotic medication may be
appropriate during any phase of treatment and intermittently after all
other treatment has been discontinued. The prescribing health care
provider shall determine that ongoing medication is effective treatment
for the patient's
Adjournment: There was no new business. There was a motion to adjourn by
Dr. Lynn, seconded by Dr. Vasudevan. The motion carried unanimously. The meeting was adjourned at approximately 12:30 p.m.