By: Shelley Boyce, CEO, MedRisk
Evidence-based medicine is now widely accepted in workers’ compensation and guidelines are proliferating. New York State recently implemented guidelines addressing lower back, neck, shoulder, and knee conditions and is working on a fifth guideline on carpal tunnel.
I applaud this and other states’ efforts to go far beyond simply authorizing a set number of approved visits and to incorporate treatment guidelines into the decision-making process.
However, it’s important to note that not all guidelines are created equal. As Joe Paduda pointed out in a recent blog post, many guidelines are not based on solid research.
When examining guidelines, it is important to verify the science and methodology behind them. Are they specific enough? Do they not only address what should be done, but do they also address what the evidence says should not be done? And how are they used? Are they prospectively given to the treating providers at the beginning of a case? Are they used throughout the course of treatment to identify when a case might be going “off-track”? And are they then used as a tool to coach the provider in best practices, proactively moving an “off-track” case back on track before it’s too late – improving patient outcomes?
Finally, consider this: guidelines should not only be expert-based and literature supported, but they also need to be outcomes validated. As an industry, we should track the effectiveness of guidelines by analyzing outcomes. Accomplishing this requires cooperation and participation on the part of many stakeholders, including clinicians, payers and managed care organizations. It’s time for the industry to combine its resources and convert data into useful analytics that will continually improve treatment guidelines and the quality of care delivered to injured employees.
That’s what I think.
About Shelley L. Boyce
Shelley Boyce is founder and chief executive officer of MedRisk, Inc. – the nation’s leading provider of physical medicine management services for the workers’ compensation industry.
Along with overseeing all aspects of MedRisk’s strategic growth and business development initiatives, Ms. Boyce serves on the board of directors of the Workers’ Compensation Research Institute (WCRI) and is a member and former chair of WCRI’s Core Funders Group.
Ms. Boyce is also involved in a number of initiatives that support business and educational development. She is on the University of Virginia (UVA) School of Nursing Advisory Board, is a member of UVA’s National Committee on University Resources (NCOUR) and 2011 Jefferson Scholars Selection Committee. Ms. Boyce is also on the board of the Children’s Scholarship Fund Philadelphia and is Chair of the Board of Advisors for the Wharton School of Business Entrepreneurial Program.
Ms. Boyce holds a Bachelor’s Degree in Nursing from the University of Virginia and a Master of Business Administration from the Wharton School of Business at the University of Pennsylvania.
Founded in 1994 and based in King of Prussia, Pa., MedRisk, Inc. is one of the fastest growing companies in the Greater Philadelphia area, according to Deloitte’s “Technology Fast 50” and Philadelphia SmartCEO magazine’s “Future 50” award. The company provides physical medicine management services to the workers’ compensation industry. MedRisk has leveraged its technological expertise and evidence-based research to provide a growing list of products and services to its client community including data analytics, specialty network services and utilization review services. MedRisk’s programs deliver savings and operational efficiencies that are significantly greater than traditional programs. Customers include insurance carriers, self-insured employers, third-party administrators, state funds, general managed care companies, case management companies, claims adjusters and physical medicine providers. To make a referral or for more information, visit www.medrisknet.com or call 800-225-9675.