Health Care Provider Advisory Committee

Meeting Minutes

 

Aurora Medical Center in Summit

October 17, 2014

Present: Mary Jo Capodice, DO(by teleconference) ; Amanda Gilliland ; Richard Goldberg, MD ; Stephen Klos, MD; Barbara Janusiak, RN ;  Maja Jurisic, MD; John Metcalf (Chair) ; Jennifer Seidl PT;   Ron Stark, MD; Sri Vasudevan MD. 

Excused: Theodore Gertel, MD; Michael Lischak, MD ; Jeff Lyne, DC ;  Marlin Nelson; Peter Schubbe , DC ;

Staff present: Ana Lopera; James O'Malley

Observers: Anna Legreid-Dopp, Pharmacy Society of Wisconsin; Jonathan Van Eyck , Briggs and Stratton

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

  2. Acceptance of  May 2, 2014  and July 25, 2014 Meeting Minutes:  The minutes of the May 2, 2014 meeting were not approved at the July 25, 2014 meeting to allow the HCPAC members additional time to review. Ms. Seidl moved to approve the minutes of the May 2, 2014 and July 25, 2014 meetings without correction, seconded by Dr. Stark. The minutes of these meetings were unanimously approved.

  3. Minnesota WC Treatment Parameters and New Mexico Administrative Rules related to use of Controlled Substances:  A copy of ch. 16.10.14 New Mexico Administrative Code covering management of pain with controlled substances was distributed to the HCPAC. This administrative rule has been in effect since January 20, 2003. This rule was not limited to the treatment of injured employees. These rules provide regulation for prescriptive practices of health care providers to be consistent  with the appropriate treatment of pain, requirments for prescription drug monitoring program (PMP) and pain management continuing legal education. Dr. Jurisic commented that PMPs were mandatory in 2-3 states  and voluntary in most states, including Wisconsin. Dr. Jurisic stated that regulations should use "Best Practices" that include following treatment agreements and non-punitive test to make sure that patients were actually taking prescribed medication.


  4. A copy of  the current Minnesota WC Treatment Parameters rule 5221.6105 Medications was also distributed to the HCPAC. These rules cover the use of non-steroidal anti-inflammatory drugs, opioid analgesics, and muscle relaxants for the treatment of injured employees.

  5. Modification of Paper on Chronic Opioid Guidelines: The members of the HCPAC discussed the most recent draft of the paper Chronic Opioid Clinical Management Guidelines for Wisconsin Worker's Compensation Patient Care by Dr. Scott Hardin from Aurora Health Care. . The revisions  include the five (5) "A"s and the four (4) "C"s previously  proposed by Dr. Vasudevan. Dr. Vasudevan briefly discussed the benefits of the revised paper, and that it was not evidence based, but contains a very good check list of what should be documented.


  6. Dr. Jurisic suggested a change on page 6, in No. 8, Tapering and Discontinuing Opioids, to delete  "not" in the fourth sentence to read. " Consider the following reasons to start to taper and discontinue chronic opioid therapy."

    Dr. Jurisic suggested changes to the language on page 5, No. 7, Addiction, Pseudoaddiction and Aberrant Behavior, fourth bullet point in the fourth sentence to the following, " For this patient, if he or she receives the proper does of Opioid, their aberrant behaviors cease."

    For the second paragraph on page one Dr. Goldberg commented that patients recovering from acute injuries may need opioid treatment for more than 30 days. The HCPAC discussed how "chronic" should be defined. This sentence also appears in No. 9, When Should Subspecialty Consultation be Considered? Dr. Stark suggested the following language to modify the sentence in both sections in the paper," For any worker's compensation patient who will need opioid treatment for a period of more than 90 days, the treating physician should follow these guidelines and or consider referral to a Pain Management specialist."

     

    Dr. Jurisic suggested including chiropractic treatment in No. 2, Non-Opioid Options Need to be presented to the Patient, in the third bullet point.


    Dr. Stark moved to approve all of these suggested language changes, seconded by Dr. Vasudevan. These language changes were unanimously approved.


    Dr. Capodice moved for the HCPAC to formally adopt the paper "Chronic Opioid Clinical Management Guidelines for Wisconsin Worker's Compensation Patient Care" with the changes approved at the meeting, second by Dr. Stark. The motion was unanimously approved.


    Dr. Vasudevan moved to refer the paper to the Worker's Compensation Advisory Council (WCAC) for adoption by the WCAC and to include in ch. DWD 81 of the Wisconsin Administrative Code, seconded by Dr. Capodice. The motion was unanimously approved.

    Dr. Capodice and Dr. Vasudevan will present the paper to the WCAC at a future meeting.

  7. Revised Language for FCA/FCE Guidelines:  Ms. Seidl discussed the proposed amendments to ss. 81.06 (1) (k), 81.07 (1) (k), 81.09 (1) (k) and 81.09 (1) (k) of the Wisconsin Administrative Code to reflect the difference between functional capacity assessments and functional capacity evaluations. Ms. Seidl worked with the Wisconsin Physical Therapy Association to draft the language for the proposed amendments. The differences between functional capacity assessments and evaluations are confusing. The proposed amendments do not apply to work hardening. The proposed language provides for a brief (2 hours or less) functional capacity evaluation to establish baseline performance and limits a health care provider to performing one to two comprehensive (up to 8 hours) functional capacity evaluation per injury, exacerbation or surgery. Several members of the HCPAC expressed concerns about the proposed amendments because the charges for an 8 hour functional capacity evaluations can range from $1,300 to $2,000 up to $4,000 and insurance companies will not agree to pay for more than one. The coding is the same for functional capacity testing to establish a patient's baseline at the beginning of treatment and the functional capacity at the end of treatment. These proposed amendments were tabled. The consensus of the members of the HCPAC was the use of the same coding for all functional capacity evaluations and assessments was the problem. Dr. Stark described his experience in having a new treatment code created to correctly reflect a particular type of hand surgery that was accepted by Medicare.

     


  8. Wisconsin Medical Society Medical Education and Professional Development: Dr. Capodice and Nancy Nankivil, Chief Strategy and Operations Officer, Wisconsin Medical Society, appeared at the meeting by teleconference to discuss the Wisconsin Medical Society's medical education and professional development mission for physicians treating injured employees. A copy of a scope statement was provided to the members of the HCPAC. Various learning modalities including webinars, on line modules, seminars, journal CME, performance CME and custom education were discussed. Ms. Nankivil suggested that the Wisconsin Medical Society and the Worker's Compensation Division work together on planning future education and professional development activities. Dr. Capodice and Nancy Nankivil, Chief Strategy and Operations Officer, Wisconsin Medical Society, appeared at the meeting by teleconference to discuss the Wisconsin Medical Society's medical education and professional development mission for physicians treating injured employees. A copy of a scope statement was provided to the members of the HCPAC. Various learning modalities including webinars, on line modules, seminars, journal CME, performance CME and custom education were discussed. Ms. Nankivil suggested that the Wisconsin Medical Society and the Worker's Compensation Division work together on planning future education and professional development activities. Dr. Capodice and Nancy Nankivil, Chief Strategy and Operations Officer, Wisconsin Medical Society, appeared at the meeting by teleconference to discuss the Wisconsin Medical Society's medical education and professional development mission for physicians treating injured employees. A copy of a scope statement was provided to the members of the HCPAC. Various learning modalities including webinars, on line modules, seminars, journal CME, performance CME and custom education were discussed. Ms. Nankivil suggested that the Wisconsin Medical Society and the Worker's Compensation Division work together on planning future education and professional development activities.

     


  9. Acute Pain Assessment and Opioid Prescribing Protocol: A copy of the paper Pain Assessment and Opioid Prescribing Protocol from the Institute for Clinical Systems Improvement (ICSI) was distributed to the members of the HCPAC at the request of Dr. Jurisic.




  10. Minnesota Administrative Rules Related to Permanent Partial Disability (PPD): Mr. O'Malley distributed the table of contents of Minnesota Rules ss. 5223.0300 through 5223.0650 that contain ratings for permanent partial disability (PPD) schedules. A copy of Minnesota Rule s. 5223.0390 covering the musculoskeletal schedule for the lumbar spine was also discussed. Dr. Capodice suggested at a previous meeting that the Minnesota PPD schedule may be useful in updating Wisconsin's PPD schedule of injuries.




  11. Unfinished Business: Dr. Capodice will forward a letter from individual members of the HCPAC to the Worker's Compensation Advisory Council (WCAC) to recommend adopting limits on reimbursements for compounding drugs. Mr. Metcalf stated the Department will continue its project to update Chapter DWD 80.32 of the Wisconsin Administrative Code. This section provides minimum PPD ratings for certain conditions and procedures. Mr. O'Malley explained the process for updating the rule and noted there must be a consensus among practitioners who treat and examine injured employees before any new permanent partial disability ratings can be presented to the WCAC for approval to be included in the Wisconsin Administrative Code.



  12. Adjournment: The meeting was adjourned at 12:20 pm. The next meeting is scheduled to be held on January 23, 2015, or in the event of inclement weather conditions the next meeting will be held on an alternative date, February 6, 2015.

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