Website - Division of Worker's Compensation
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Health Care Provider Advisory Committee
Aurora Medical Center in Summit
January 22, 2016
Members Present: Mary Jo Capodice, DO; Amanda Gilliland; Richard Goldberg,
MD; Barb Janusiak, RN; BJ Dernbach (chair); Jeff Lyne, DC; James O'Malley
(acting chair); Jennifer Seidl, PT; and Ron Stark, MD.
Excused: Theodore Gertel, MD; Maja Jurisic, MD; Stephen Klos, MD; Peter
Schubbe, DC; Jennifer Seidl, PT; and Sri Vasudevan, MD.
Staff Present: Mary Lynn Endter.
- 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. Mr. O'Malley informed the members
that the new Worker's Compensation Division Administrator, BJ
Dernbach, will attend the meeting and would arrive late. Mr.
O'Malley also stated that Marlin Nelson resigned from the HCPAC
and that Dr. Michael Lishak had moved out of state.
- Future meeting dates: The members agreed
that they will meet on May 6, 2016, and August 12, 2016. A
tentative meeting date of October 7, 2016, was also set.
- Update on the WCAC Agreed Bill: Mr.
O'Malley advised the members the Worker's Compensation Advisory
Council (WCAC) reached an agreed upon bill and the bill was
pending in the Wisconsin State Senate and Assembly. A plain
language summary of the agreed upon bill was distributed and Mr.
O'Malley discussed this with the members. He further stated the
bill was introduced as a companion bill in both houses and the
Worker's Compensation Division did not expect there would be any
problems with its passage.
- Acceptance of the October 19 Meeting Minutes:
Dr. Capodice moved to approve the minutes of the
October 19, 2015 meeting without correction. Dr. Stark seconded
the motion. The minutes were unanimously approved.
- Other Legislation: Mr. O'Malley advised the
members that other legislation of interest was introduced and
passed, including 2015 Wis. Act 115, relating to prescription,
dispensing, and delivery of opioid antagonists; 2015 AB-364,
relating to reporting, disclosure, and practitioner review
requirements under the prescription drug monitoring program;
providing an exemption from emergency rule procedures; and
granting rule-making authority; 2015 AB-365, relating to duty of
law enforcement officers to report to the Prescription Drug
Monitoring Program controlled-substance violations,
opioid-related drug overdoses or deaths, and reports of stolen
prescription drugs; 2015 AB-366, relating to pain clinic
certification and requirements, granting rule-making authority,
and providing a penalty; 2015 AB-367, relating to reporting by
treatment programs using methadone and requiring review of
prescription drug monitoring database; and 2015 AB-659, relating
to opioid treatment programs. Mr. Dernbach stated that all of
these bills were passed by both the Senate and Assembly.
- Update on the Wisconsin Medical Society's medical
education and training modules: Dr. Capodice said that
she reviewed the training modules but they were of poor quality
and written from the point of view of defense attorneys. She
stated that the modules will be redone as case studies of real
patients, one non-surgical and one surgical. The modules will be
separated into 30 to 45 minute sections covering each case from
beginning to end. The case studies will include information for
the practitioner on issues of return to work, work restrictions,
rehabilitation, chiropractic, permanent disability, and
communicating with the insurers and employers. The modules will
be available free of charge for members of the Wisconsin Medical
Society and $25 for nonmembers. The goal is to have the modules
ready by the summer of 2016.
- Review of ch. DWD 81 of the Wisconsin Administrative
Code: At the last meeting, several changes to s. DWD
81.03 were discussed by the HCPAC. Ms. Seidl requested the
members to consider some additional changes to those sections
already reviewed, as follows:
81.03 (1): add the words "neuromuscular
control and movement" after the phrase "proper body mechanics;
and add the word "manual." The section would read as
"Active treatment" means treatment specified in ss. DWD
81.06 (4), 81.07 (4), 81.08 (4), 81.09 (4), and 81.010 (2) that
requires active patient participation in a manual therapeutic
program to increase flexibility, strength, endurance, awareness
of proper body mechanics, or neuromuscular control and movement.
81.03 (11): add the words "vestibular
function." The section would read as follows:
deficit" means a loss of function secondary to involvement of
the central or peripheral nervous system. This includes motor
loss, spasticity, loss of reflex; radicular or anatomic sensory
loss; loss of bowel, bladder or erectile function; impairment of
special senses, including vision, hearing, taste, or smell; or
deficits in balance, propioperception, vestibular, cognitive, or
81.03 (13) add the words "thermoelectric and
phototherapy" and remove "muscle electric stimulation" and
"manual." The section would read as follows:
is any treatment modality specified in ss. DWD 81.06 (3), 81.07
(3), 81.08 (3), 81.09 (3), and 81.10 (2). Passive treatment
modalities include bedrest, thermal treatment, traction,
acupuncture, thermoelectric treatment, phototherapy, braces,
manual and mechanical therapy, massage, kinesiology taping, and
The HCPAC continued its review of the worker's compensation treatment
guidelines in ch. DWD 81 from where it left off at the last meeting, beginning
at DWD 81.05 (1) (f), guidelines for alternative imaging. Since most of the
following sections required expertise from a surgeon or other specialist, the
members recommended that Dr. Gertel be requested to review these sections in
preparation for the next meeting. Dr. Capodice suggested that a surgeon be
appointed to the HCPAC on an ad hoc basis to help with the review of these
- 81.05 (2) (g), create the following subdivision 6., "For patients where an
MRI is contraindicated, and where further detail of the anatomy is required by
CT and a plain CT of the spine is inadequate to provide further detail of the
- 81.05 2 (j) concerning discography. Dr. Goldberg offered to research the
question of how often discography is used. The members agreed to leave this
section in the treatment guidelines if there are patients for whom this
procedure is still used.
- 81.05 (2) (n), add a new subdivision 7., "In patients with known
preexisting surgery or structural abnoralities with significant low back pain
symptoms where there is a need to view these lumbar structures in a more timely
fashion. In those cases in which clinical presentation is atypical, unusual, or
showing significant impairment, lumbar spine films before 8 weeks may be done,
on a case-by-case basis."
- 81.05 (2) (p), add a new subdivision 4., "Oblique films may be indicated
if a clinician suspects bony structural abnormalities that are only visible in
- 81.05 (2) (q), delete this paragraph as the prior section describes when
oblique x-rays may be ordered.
- 81.06 Low Back Pain. Mr. O'Malley stated that the next sections will refer
to the ICD-9-CM codes and that the HCPAC will need to determine whether to
remove the references to the ICD-9 codes or to replace them with the current
ICD-10 codes. The consensus of the members is to remove all references to the
ICD codes and not replace them.
- 81.06 (1) (h), rewrite the section as follows:
"During the period of initial nonsurgical management, computerized range of
motion or strength testing may be performed but shall be done in conjunction
with an office visit with a health care provider's evaluation or treatment, or
physical or occupational therapy evaluation or treatment. A health care provider
may order computerized range of motion or strength measuring test during a
period of chronic management when used in conjunction with a computerized
exercise program, work hardening program, or work conditioning program."
- Adjournment: There was no new business. There was a motion to adjourn by
Dr. Stark, seconded by Dr. Goldberg. The motion carried unanimously. The meeting
was adjourned at approximately 12:30 p.m.