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CA - The Division of Workers' Compensation reversed itself and decided to use the ODG for its proposed postsurgical treatment guidelines after all.

Agency to Use ODG for Postsurgical Guidelines After All: Top [11/21/07]   

After considering what it called "valuable comments from the public," the Division of Workers' Compensation (DWC) has reversed course and decided to use the Official Disability Guidelines (ODG) instead of writing in-house rules for new postsurgical treatment guidelines, the agency said Tuesday.

The guidelines are intended to ensure that injured workers recovering from surgery receive an appropriate course of therapy. The revised version has been posted to a second online forum on which members of the public may review and comment on the proposal, according to the DWC.

It was during the first online forum period, which ended on Nov. 3, that the agency received public feedback that eventually helped convince it to use the ODG. As WorkCompCentral reported earlier this month, the writers of a number of posts had asked why the agency was trying to "reinvent the wheel" by coming up with its own postsurgical treatment guidelines when the ODG were nationally recognized, widely accepted and annually updated.

At the time, Susan Gard, chief of legislation and policy for the DWC, said the agency had decided to write its own guidelines in the belief that they would be "much more comprehensive" than the ODG.

On Tuesday, however, the DWC noted in a written release that it had learned that the Work Loss Data Institute had updated its Official Disability Guidelines. Gard said the agency found the updated version "more suitable" than the earlier one.

Phil Denniston, editor-in-chief of the Encinitas-based guidelines publisher, said recent changes were part of the ongoing process of updating the ODG on an annual basis. He acknowledged that there had been some give and take between the institute and the DWC's advisory committee on guidelines in recent weeks, noting that "they provided some valuable input." 

As an example of the way the process played out, he noted that a year ago the ODG changed its stance on cervical fusion from "not recommended" to "recommended" because the surgical procedure had become more common. Based in part on suggestions from the committee, he said, the ODG recently reduced the number of physical therapy visits for the procedure from 34 to 24 because the rehab period also had grown shorter as the surgical procedure became less complicated.

He said another recent change to the ODG may have made it appear more comprehensive than before: A number of physical therapy guidelines that had appeared only in the return-to-work section are now being replicated in the treatment guidelines - another change sparked by conversations with the DWC.

Denniston said it would be hard to put a financial value on the DWC decision to use the ODG for postsurgical treatment, though any adoption that allows the guidelines to be viewed as a reasonable standard is helpful.

"It's one more re-enforcement that we're doing the right things," he said.

The proposed postsurgical treatment guidelines are authorized by Labor Code Section 5307.27 and Assembly Bill 1073, which provides that the 24-visit cap on physical medicine services shall not apply to visits for postsurgical physical medicine and rehabilitation services provided in compliance with a postsurgical treatment utilization schedule established by the administrative director. The proposed changes are in the California Code of Regulations, Title 8, Section 9792.20 et seq., and will be contained in Section 9792.24.3.

The proposed guidelines define key terms commonly used in the regulations, address the application of the postsurgical treatment guidelines, address postsurgical patient management, set forth the postsurgical patient treatment approach, describe the frequency and duration of postsurgical treatment, and set forth procedures that are not considered surgery requiring postsurgical therapy under the regulations.

The DWC said it will supplement postsurgical areas not covered by the ODG with evidence and input from its medical evidence evaluation advisory committee. The new information will be contained in Table AA, Section 9792.24.3(e)(3).

The postsurgical treatment guidelines are being added to the proposed update of the medical treatment utilization schedule (MTUS), which includes new chronic pain and elbow guidelines. The MTUS update was previously posted to an online forum for review and public comment. Once the comment period for the forum posting on postsurgical treatment guidelines is complete, formal rulemaking on the entire package of updates to the MTUS will begin, the agency said.

Comments will be accepted through Dec. 4. You can find the forum at www.dir.ca.gov/WCJudicial.htm.

Click on "current forums" at the top of the page.