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New Knee Ligament Discovered - May Impact ACL Repairs
11/8/2013 in Medical Conditions, News

In a rare development, two researchers from Belgium discovered a new knee ligament called the anterolateral ligament ('ALL').  The researchers began looking into the possibility of an undiscovered anatomical structure in the knee because of unusual symptoms that were reported after successful ACL repairs.  Specifically, "some patients with ACL-repaired knees continue to experience so-called 'pivot shift', or episodes where the knee 'gives way' during activity."  Oddly enough, a French surgeon had postulated the existence of an as yet undiscovered anterior knee ligament in 1879.  Over 130 years later he was proven right.  The Belgian researchers published their findings in The Journal of Anatomy.In the claims setting, this discovery may impact future treatment of ACL injuries, though the discovery is so new that the extent of its impact is not known.For more information on Medical Systems go to www.MedicalSystemsUSA.com

The High Costs of Prescription Drug Misuse and Abuse
11/7/2013 in Strategies for Getting the Best IME

It is common knowledge that prescription drug misuse and abuse has become a significant problem in the United States. According to the Centers for Disease Control (CDC), the costs are staggering.

  •  In the United States, prescription opioid abuse costs were about $55.7 billion in 2007. Of this amount, 46% was attributable to workplace costs (e.g., lost productivity), 45% to healthcare costs (e.g., abuse treatment), and 9% to criminal justice costs.
  • Between 1998-2002, people who abused opioid analgesics cost insurers $14,054 more than the average patient.

http://www.cdc.gov/homeandrecreationalsafety/overdose/facts.htmlPrescription drug misuse and abuse impacts claims management in many ways. On the front end of the process, prescription misuse and abuse increases the risk that a person will be involved in an accident, whether work-related or not. In addition, persons with significant dependence problems may see the claims process as a manner of obtaining prescription medications to fuel their dependency. During the claims administration process, prescription drug misuse and abuse increases costs through extended (or unending) recovery periods and higher than normal pharmaceutical costs. In addition, drug seeking behavior often results in increased medical costs through emergency room and urgent care visits used to obtain medications. Finally, the value of prescription drug medications causes some persons who receive them to sell them as a means to generate income.What can claims professionals do to combat prescription drug misuse and abuse among claimants? The first place to start is with the primary treating physician. If it appears from your review of records that the patient is obtaining narcotic pain medication from multiple sources or has asked for an early refill on more than one occasion, communicate your concern directly to the physician. Most treating physicians are sensitive to narcotic use and will not tolerate drug-seeking behavior. In addition, you can encourage the physician to use her state’s Prescription Drug Monitoring Program, which will provide the physician with information regarding from whom and when patients are obtaining prescriptions for narcotics. Second, a medical record review can provide a good option for discontinuing payment of prescription pain-relievers and other drugs that may be being abused. Third, many states have dispute resolution mechanisms designed to address a carrier or employer’s contention that a particular treatment is not necessary to cure and relieve the effects of an injury or condition. This option provides an opportunity to challenge a recalcitrant physician’s decision to provide unwarranted prescription pain-relievers or other addictive drugs without the patient being a party to the claim. Fourth, drug and physician utilization reviews can be used to assess the likelihood that abuse is occurring when abuse is suspected but cannot otherwise be confirmed.The bottom line is that prescription drug misuse and abuse can be a significant claims cost driver. Taking a proactive approach of identifying potential abuse, working with treating physicians to curb abuse, and using independent medical or record reviews can provide an effective means of controlling the claims costs of prescription drug misuse and abuse. Beyond the claims environment, curbing prescription drug misuse and abuse also makes our society better and safer, which is a win-win for everyone.For more information on Medical Systems go to www.MedicalSystemsUSA.com

Reflex Sympathetic Dystrophy Syndrome (RSDS)
1/24/2013 in Medical Conditions
Reflex Sympathetic Dystrophy Syndrome (RSDS) is medically defined as a “rare” disorder. Yet, it has recently become a common claim following litigated injuries. Claims of this disorder are increasing faster than medical technology, making the job of claims handlers—and litigators alike—extremely difficult. Unfortunately, RSDS can be difficult to diagnose because its symptoms are mostly subjective in nature. As a result, few doctors are experienced in treating the syndrome. Doctors need to know more about RSDS to ensure proper diagnosis and treatment. Claims handlers need to be informed about RSDS to have successful claim management.DEFINITIONRSDS is a rare disorder of the sympathetic nervous system, which regulates involuntary bodily functions. It can increase heart rate and blood pressure. It can also constrict blood vessels. RSDS can also be referred to as: Algodystrophy, Algoneurodystrophy, Causalgia Syndrome (Major), Reflex Neurovascular Dystrophy, Sudeck's Atrophy, or Complex Regional Pain Syndrome. Claims handlers and doctors should be familiar with this terminology.SIGNS & SYMPTOMSUsually, RSDS clinically progresses through three stages--acute, dystrophic, and atrophic. Each stage lasts from three to six months. RSDS symptoms begin with burning pain in the arm(s), finger(s), palm(s) and/or shoulder(s). The skin over the affected area(s) may become swollen (edema) and inflamed. Affected skin may be extremely sensitive to touch and sensitive to hot or cold temperatures (cutaneous hypersensitivity). The affected limb(s) may perspire excessively and be warm to the touch (vasomotor instability). In some individuals, RSDS may occur in one or both legs or it may be localized to one knee or hip. TREATMENTThe most widely used therapy for the condition has been cervical or lumbar paravertebral sympathetic blockade with anesthetics such as mepivacaine or bupivacaine. The pain relief may be dramatic, with a duration outlasting the action of the anesthetic. Several regional blockade procedures have been developed using a modified Bier block. The administration of corticosteroids has also been advocated. Another therapy for this disorder is therapeutic exercise and hand conditioning. A coordinated multidisciplinary approach to treatment seems to work best.REASONS TO GET AN IME FOR RSDS CASESCausation: The exact cause of RSDS is not fully understood, although it may be associated with injury to the nerves, trauma, surgery, atherosclerotic cardiovascular disease, infection or radiation therapy. It can occur following sprain, fracture, or injury to nerves or blood vessels, particularly in the extremities. As a result, a neurologist familiar with RSDS will understand appropriate signs and symptoms and should be able to confirm the diagnosis Save Treatment Dollars: Frequently, RSDS may go undiagnosed. It can also be misdiagnosed as a painful nerve injury. Therefore, a neurologist who has had experience in diagnosing and treating the disease can save significant treatment dollars.Permanence: Diagnosis is important in determining treatment. However, in one large study, 60% of patients had continuing pain regardless of treatment. The pain may be excruciating, resulting in dramatic physical and psychological alterations. An experienced neurologist, who is familiar with RSDS, will be able to diagnose and recommend appropriate treatment.Medical Systems, Inc. offers several neurologists familiar with the diagnosis, treatment, and evaluation of RSDS. Call: 800-261-3278 to schedule.
The Role of Physical Therapy in Worker’s Rehabilitation
12/21/2012 in Treatment
In today’s competitive climate of rising costs and shrinking profit margins, an increasing number of businesses are looking for ways to ensure a healthy bottom line. The rising cost of Worker’s Compensation claims, as well as the direct and indirect cost of job-related injuries, is being closely scrutinized.One way to control costs is to develop a comprehensive approach to reducing and treating injuries, and an effective method for treating injured workers is the use of professional physical therapy services.PHYSICAL THERAPY IS A DISTINCT PROFESSIONThe physical therapy profession is a distinct entity within the allied health professions. The physical therapist is a licensed trained professional who plans and administers a physical therapy plan of care for medically referred patients in need of physical therapy services.USED TO TREAT MOVEMENT DYSFUNCTIONThe role physical therapy plays in workers’ rehabilitation is primarily in the assessment and management of movement dysfunction. Physical therapists work to restore the functional abilities of individuals who are either permanently or temporarily disabled due to illness, disease, trauma, or congenital abnormalities. In addition to their role as clinicians, physical therapists may serve as educators, consultants, and researchers.MAJOR OBJECTIVESThe major objectives of physical therapy are:• Prevention and relief of disability and pain;• Preservation or restoration of maximal functional capabilities;• Promotion of healing; and• Adaptation to temporary or permanent disability.EXERCISE AND PHYSICAL AGENTS USEDThe field of physical therapy typically uses exercise and physical agents such as heat, light, water, and massage to relieve pain caused by surgery or by chronic medical conditions, improve muscle strength and mobility, and improve basic functions (standing, walking, and grasping) in patients recovering from debilitating illness or accidents, or for those who are physically handicapped.The physical therapist selects specific rehabilitative treatments based on the patient’s individual medical condition. Heat may be applied to ease stiffening and joint pain. The heat source may be a hot bath, compresses, heat-creating lamps, or ultrasound waves which generate heat in tissues that are too deep to be reached by external heat applications. Massage is a standard physiotherapeutic technique, both for easing pain and for improving circulation. Hydrotherapy is useful in rebuilding injured or wasted muscles.The most frequent type of physical therapy treatment, however, is exercise, carefully chosen to increase joint mobility or to improve muscle strength and coordination.Patients with physical handicaps may be trained to learn or relearn elementary motor functions, such as holding a spoon or turning a doorknob, or they may be taught how to use crutches, prosthetic devices, or other mechanical aids. The work of physical therapists is often closely coordinated with that of the occupational therapist, since both fields involve training patients to improve their motor abilities.INTERDISCIPLINARY APPROACH EFFECTIVEThe physical therapist often works in tandem with other medical professionals, to more completely evaluate a patient’s condition from a medical, behavioral, functional and ergonomic perspective. This interdisciplinary approach is an effective way to clearly define the problems which are preventing an expedient or eventual return to work. Once these issues are appropriately addressed and managed, the ultimate goal of improved quality of life for the injured person, as well as reduced Worker’s Compensation costs for the employer can be realized.For more information please visit www.MedicalSystemsUSA.com

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