Sorry, no clue. That would probably require the input of an in the trenches WC attorney. I just happened to stumbled upon the the Almaraz-Guzman Opinion becouse it came up when I searched under SB 899. Speaking of which, had you seen or heard of that decision and is there anything in there that might shine light on the question you posed? Do you see the opinion as having any potential effect in your own work?

As an aside, I'm so far out of my own former practice area - bankruptcy - that out of curiousity I opened an emailed invitation to an ABA Section meeting the other day, only to see a memorial award being given in the name of a lady law prof., with whom I used to be a good (professional) friend, in what seems a lifetime ago. :( A further search showed that she passed away 4 years ago. And being totally out of the national game, I knew none of it.

Hi fmichael and Dubious,
Thanks for the interpretation and the analytical questions about the worker comp information!! To the layman, the legal jargon is so intimidating...I don't even know if my attorney would know the details of this info....
There are so many trickster paragraphs..it is overwhelming...

I had read an article in a California newspaper that talked about how the "doctors" who determine authorizatons for treatment by looking through pages of a manual !!! (without even a look or glance at the human being involved!!!) aren't even licensed to practice in California...they are in another state... That way, if there is ever any litigation they would be exempt.......
The whole thing is criminal , but it is what it is..just like my RSD..
Thanks for the hours of research that you delve into and share with us!!!!!

Hope4thebest (doing my best not to let cynicism outweight the RSD!!!!!

Personally, I think it's a stretch to extrapolate this country's WC experience with the health care proposals in Washington. The WC situation exists - replete with payouts so low in California that many doctors will no longer accept patients with that "insurance" - because politically powerful business interests, the insurance companies and the employers who pay into them, are aligned on the one side, with no one to speak of on the other side. Nor does state house politics generate a lot of press in the local media. (I know that in LA, all of the local television stations closed their Sacramento bureaus decades ago.) While money still talks in D.C., this is a much higher profile event than what went on, according to Almaraz-Guzman, when, over time, some 40 states enacted laws incorporating the AMA Guides, to one degree or another.

How the AMA was co-opted is of course another story, but the "Special Report: American Medical Association is Injuring Patients with RSD" of the International Research Foundation for RSD/CRPS, to which I linked earlier (and incorrectly identified as "a terrifying screed by a leading physcian [sic]") is pretty damning. Again, that can be found at http://www.rsdfoundation.org/test/AMA.html. My guess is that the link was forged out of two elements, class and racial bias on the one hand (one group of white shoe guys being sensitive to the needs of another), and economic interests on the other: where an award based high percentage lifetime disability will have a significant present value in to insurance carriers, they are in a better position to pay for expert witness testimony from physicians than are solo or small firm lawyers representing WC petitioners, who will have their fees, and possibly costs, capped by state laws.

But back to the point that was raised about national health-care legislation, there is more (or less) to the notion of "cost-containment" than (1) putting providers on salary as they are at the Mayo Clinic or the original HMO, Kaiser, or (2) having some centralized schedule mandating which test can be ordered for a patient. For a great recent article that explored why 2006 per capita Medicare spending was some fifteen-thousand dollars in the border town of McAllen, Texas - with a state of the art for-profit hospital in which all attendings not only owned a fractional interest but were directly paid off a schedule for each test they ordered - while 2006 per capita Medicare spending was only $6,888 in Rochester Minnesota, the home of the Mayo Clinic - please check out in full "The Cost Conundrum, What a Texas town can teach us about health care," Atul Gawande, The New Yorker, June 1, 2009, a summerizing excerpt follows:

The Mayo Clinic is not an aberration. One of the lowest-cost markets in the country is Grand Junction, Colorado, a community of a hundred and twenty thousand that nonetheless has achieved some of Medicare’s highest quality-of-care scores. Michael Pramenko is a family physician and a local medical leader there. Unlike doctors at the Mayo Clinic, he told me, those in Grand Junction get piecework fees from insurers. But years ago the doctors agreed among themselves to a system that paid them a similar fee whether they saw Medicare, Medicaid, or private-insurance patients, so that there would be little incentive to cherry-pick patients. They also agreed, at the behest of the main health plan in town, an H.M.O., to meet regularly on small peer-review committees to go over their patient charts together. They focussed on rooting out problems like poor prevention practices, unnecessary back operations, and unusual hospital-complication rates. Problems went down. Quality went up. Then, in 2004, the doctors’ group and the local H.M.O. jointly created a regional information network—a community-wide electronic-record system that shared office notes, test results, and hospital data for patients across the area. Again, problems went down. Quality went up. And costs ended up lower than just about anywhere else in the United States.

Grand Junction’s medical community was not following anyone else’s recipe. But, like Mayo, it created what Elliott Fisher, of Dartmouth, calls an accountable-care organization. The leading doctors and the hospital system adopted measures to blunt harmful financial incentives, and they took collective responsibility for improving the sum total of patient care.

This approach has been adopted in other places, too: the Geisinger Health System, in Danville, Pennsylvania; the Marshfield Clinic, in Marshfield, Wisconsin; Intermountain Healthcare, in Salt Lake City; Kaiser Permanente, in Northern California. All of them function on similar principles. All are not-for-profit institutions. And all have produced enviably higher quality and lower costs than the average American town enjoys.

I first saw the article in an email from the RSDSA and it appears on its site at http://www.rsds.org/5/news/2009/May/...er_27_185.html, along with a link to the article source at http://www.newyorker.com/reporting/2...urrentPage=all.

And not to worry. The article, written by a surgeon, doesn't endorse one particular plan or another, just requiring “collective responsibility” at a local level among health care providers.

Mike

ps If anyone wants to ask why attorneys aren't being asked to join into loose confederations of some sort, the answer is simple, there's no widespread analogue to health insurance or Medicare supporting their fees. Certainly not the folks in gleaming office towers with tasteful ash-trimmed interiors, unless they’re representing the governmental unit itself in high end litigation, real estate, bond financing, etc. And with the possible exception of attorneys representing disabled kids in IDEA contingency litigation, I can’t think of another area where a lawyer representing individuals and compensated out of public funds could possibly make enough to put his/her kids through a liberal arts college: something that’s generally not a great stretch for doctors at either Kaiser or the Mayo Clinic.

Of course, the reason that so many incredibly qualified people are willing to join the staff of the Mayo Clinic and live in Southeastern Minnesota is that they don’t have to run a business, just practice medicine with some of the best support services on this side of the solar system.

The other day, in discussing the seemingly alternative tests for diagnosing RSD in the AMA Guides, which were blasted in the "Special Report: American Medical Association is Injuring Patients with RSD" of the International Research Foundation for RSD/CRPS, Dubious asked:

After thinking this thru a little further, since there are 2 comparable but distinctly differenet standards and criteria within the same publication to determine impairment (really weird), which one is used more often and which prevails in court? Mike, do you know?

To which I punted. Having looked more carefully at the Special Report and in particular the corresponding pages of the AMA Guide, while I may not "know," I am prepared to accept the answer set forth by Dr. Anthony Kirkpatrick et al:

. . . contrary to what [Dr. Michael Maves, Executive VP and CEO of the AMA] stated, the neurology chapter does not contain any criteria to make the diagnosis of RSD. The chapter focuses instead on case reports intended to assist the physician in determining physical impairments in patients that have been diagnosed with RSD.

That said, anyone litigating this would also want to know the exact title of Sub-Chapter 16.5, which contains the language at pp. 495 - 496, so that it could then be compared with that of Sub-Chapter 13.8 ("Criteria for Rating Impairments Related to Chronic Pain") and the hypothetical at pp. 343 - 344.

Is this helpful?

Not sure. They now have a month to mull this over, and I suspect will come back with something more along the lines of what was suggested in The New Yorker article, where the mandate will be an economic incentive to enter into local confederations that will guarantee some economies of scale and provide at least some loose and locally agreed guidelines for treatment. By the way, what did you think of it? I was most struck by the around the table discussion with doctors in McAllen TX, who when asked what would happen to the 40 year old woman who complained of chest pains after a fight with her husband, one of them replied, "Oh yeah, she'd definately get the cath."

Mike

Post #15 above. Take care.