Health Care Provider Advisory Committee
Meeting Minutes

Aurora Medical Center in Summit - Gifford Room

October 11, 2013

Present: Mary Jo Capodice DO, MPH-Occ Med; Amanda Gilliland;  Maja Jurisic MD-Occ Med; James O'Malley(sitting in for John Metcalf); Jennifer Seidl PT; Sri Vasudevan MD-PM&R.

Staff present: Tracy Aiello; Ana Lopera

Observers: None present at meeting.

  1. Call to Order: Mr. O'Malley convened the Health Care Provider Advisory Council(HCPAC) at approximately 10:05 AM in accordance with Wisconsin's open meeting law.  HCPAC members and staff introduced themselves.

  2. Acceptance of October 29, 2010 and May 11, 2012 Meeting Minutes: Mr. O'Malley advised that since there is no quorum in attendance at the meeting, minutes of previous meetings cannot be approved.

  3. Committee Membership: Mr. O'Malley raised the issue of committee membership and reappointment.  It was decided that a letter asking current committee members if they wanted to be reappointed or leave the committee would go out under John Metcalf's signature. The division would start the process of replacing those current members who no longer wanted to stay on the committee. Members present at the meeting asked to be reappointed, except for Dr. Jurisic. She informed the members that she had a replacement in mind. It was decided that it would be good to have physicians from around the state as well an orthopedic and back surgeons, family practitioners or internists on the committee.

  4. Future Meetings: It was agreed that having regularly scheduled meetings would be a good thing. The third Friday of every quarter was discussed as a possible date for future meetings. All agrees that the Aurora Medical Center in Summit was a convenient location.

  5. Unfinished Business: Ms. Seidl suggested that the committee work on revising the functional capacity language in s. DWD 81.06(1) (k) 4 of the Wisconsin Administrative Code. Mr. O'Malley mentioned that this was discussed before and that the current language does not reflect the difference between functional capacity assessments and functional capacity evaluations. He agreed to help with the legal language after the committee came up with a draft.

    A discussion ensued about including language related to the two or three most disputed areas and Dr. Vasudevan requested the Worker's Compensation Division provide the committee with the top 10 most disputed CPT codes and Mr. O'Malley agreed to provide this information at a future meeting.

    The issue of ensuring quality care of patients and that physicians do a good job was discussed, and Mr. O'Malley mentioned there is currently a proposal being considered by the Worker's Compensation Advisory Council (WCAC) to change the current DWD 81 of the Wisconsin Administrative Code treatment guidelines to treatment parameters to be used for utilization review. This lead to a conversation centered on There was a consensus of the committee that guidelines should be used to assist physicians in doing a good and effective job of treating worker's compensation patients. It was mentioned that some states require their physicians to take certain training before they can treat worker's compensation patients. It was brought to the committee's attention, however, that the Wisconsin worker's compensation system has a history of not intruding on the medical practice. Some states that offer training, it was noted, actually give those physicians who complete the training a small increase in their medical payment.

    There was a discussion about elevating the DWD 81 of the Wisconsin Administrative Code guidelines to a standard level that encourages best practices without in any way impacting access, although it was noted that keeping up guidelines takes a great deal of time and resources. The committee members present expressed their desire to move the guidelines up to the status of a proactive utilization review, i.e. moving the guidelines "up front". Doing so could result in better care, less overtreatment, help with return to work and better treatment of minor injuries (which can become expensive if not treated properly), thus benefiting both the quality of life of patients and lowering the cost to employers. It was noted that the current guidelines should include language addressing return to work and causation.

  6. New Business: Dr. Vasudevan inquired about advance practice nurse prescribers and physician assistants being allowed to opine about causation or give PPD ratings in Wisconsin. Mr. O'Malley stated that advance practice nurse prescribers, physician assistants and dentists cannot but some insurance carriers accept their opinions on causation and on the extent of disability

  7. Update DWD 81, Wis. Admin. Code: Dr. Capodice suggested that DWD 81 contain language addressing return to work, causation determination and exposure. Dr. Jurisic also suggested publishing something on the DWD WC website related to the return to work process and the role played by the physician

  8. Opioid Use Standards: The committee looked at the New Mexico Administrative Code, Title 16, Chapter 10 Part 14 on Management of Pain with Controlled Substances and discussed the language used. The possibility of putting this language into DWD 81, as a good base upon which to build, was discussed

  9. Update DWD 80.32 Wis. Admin. Code Schedule of Injuries: Minimum ratings have not been reviewed in about 20 years. Updating DWD 80.32 is on the Worker's Compensation Division's list of things to do.

  10. Adjournment: The meeting was adjourned at approximately 1:30pm
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