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DIAGNOSTIC TESTING

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DIAGNOSTIC TESTING

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    2. PAIN, PILLS, PROCEDURES and THE WOUNDED WORKER SYNDROME William Nemeth MD CPE Texas Association of School Boards Risk Management Fund SUMMER 2007

    3. DISABILITY EPIDEMIC!!!!

    5. "Doctors are men who prescribe medicine of which they know little to cure diseases of which they know less in human beings of which they know nothing.“ Voltaire

    7. Wounded Worker Syndrome Chronic Pain – “Suffering” - soft tissue injury Stay off Work Repetitive Treatment Failures multiple providers Victimization (External Locus of Control) Job Dissatisfaction

    8. HOW DID THEY GET THIS WAY? “MEDICINABLING” System ENTITLEMENT Attitude “MEDICALIZING” Docs

    9. System MEDICINABLES! INDEMNIFIES Chronic Disease Chronic Pain Lost Time PROVIDES Socioeconomic Safety Net

    10. System(Payers) DISINCENTIVIZE! Pay for the wrong things Non-work-related diseases Surgery, injections, and other non-EBM interventions Do NOT pay for the right things E&M Codes (Face Time-Education) RTW and Case Management Services Risk Assessment-Early Intervention

    11. Doctors MEDICALIZE! Mis-diagnose Over-treat Give work excuses

    12. MISDIAGNOSIS!!!!!! MISTREATMENT!!!!! Denial- Psychosocial Ignorance Medical Economics- Profit Motive Can’t Say “NO!”

    13. Injured Workers BECOME VICTIMS!!! Entitled- Fear Avoidance Psychological issues Expect “quick fix” External “Locus of Control!” Unfulfilling job

    14. Wounded Worker Syndrome “True” Wounded Worker Disorder Fear-Avoidance / Entitlement / Age / Degenerative Disease(s)/ Workplace Factors Chronic Pain Disorders

    15. PSYCHOLOGICAL BEHAVIORS “SOMATIZATION” ABNORMAL ILLNESS BEHAVIOR “SYMPTOM MAGNIFICATION” “CATASTROPHIZING”

    16. CHRONIC PAIN DISORDERS Physical Condition “COPERS” “SOMATIZATION” Malingering-Factitious Disorder True “Wounded Worker Syndrome” Mood/Anxiety Disorder Pseudo-addiction Substance Abuse (Addiction) Personality Disorders

    18. CHRONIC PAIN IS COMPLEX! Biopsychosocial Model PHYSICAL PAIN GENERATOR (ACUTE) PSYCHOSOCIAL (CHRONIC)

    19. INJURIES HEAL DISEASES PERSIST!

    20. CHRONIC PAIN IS A BRAIN DISEASE

    21. LOOK FOR THE CO-MORBIDITY! IT AIN’T THE NOCICEPTOR NO MORE! WORKERS’ COMPENSATION OR ? DIABETES MELLITUS MOOD-ANXIETY DISORDER ADDICTION OPIOID HYPERALGESIA

    22. RISK FACTORS DOI DUTY DOB DOCTOR/ATTY DIAGNOSIS DEGENERATIVE DISEASE DIABETES DRUGS DEPENDENCY DEPRESSION

    23. CHRONIC PAIN IS REAL! PSYCHOLOGICAL CONDITION Characterized by COLOSSAL MIS-MANAGEMENT! WRONG DIAGNOSES and WRONG TREATMENTS!

    24. The Wounded Worker Syndrome THE PROVIDER’S ROLE Mis-Diagnose - Malingering (Fraud), Depression, Anxiety, Substance Abuse, True “Wounded Worker Syndrome” Over-Diagnose - MEDICALIZATION Over-Treat - Rehabilitation, Injections, Drugs, even Surgery Dis-Enable SAW/RTW - inappropriate restrictions and work excuses

    25. What Doesn’t Work? MRI Discography IDET Repeated Blocks Pain Pumps Back Fusion Disc Replacement Many Drugs

    26. WHAT DOES WORK? EARLY INTERVENTION DISABILITY MANAGEMENT and TREATMENT PLANNING OUTSIDE GUIDELINES or 60 DAYS PREAUTHORIZATION- “PEER TO PEER” NEGOTIATION EVIDENCE BASED- ODG FUNCTIONAL RESTORATION

    27. DISABILITY MANAGEMENT ID “AT RISK” and CO-MANAGE MEDICAL/VOCATIONAL REHABILITATION

    28. EARLY FUNCTIONAL RESTORATION Risk Assessment Early Intervention Cognitive Behavioral Therapy Exercise Adjunctive Care SAW-RTW

    29. Why Disability Management? “Because we can’t afford NOT to!!!”

    30. THAT’S IT FOLKS!!!! William Nemeth MD Somi Healthlink LLC A Pain & Disability Management Co nemethw@sbcglobal.net (512) 695-5599

    31. DISABILITY MANAGEMENT STRATEGIES Education-SAW/RTW-Incentivize Treatment Planning - Benchmark “At Risk” IWS (Stop Medicalization) RTW Resource Centers Functional Restoration (CBT-Exercise) Policy-Activism

    32. Lumbar Fusion Rates by Primary Diagnosis

    35. The Texas 20/80 Rule 14% of Cases Create 75% of the Medical, and 85% of the Indemnity COSTS

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