Injury Mapping and the Road to Accuracy John Alchemy, MD, AAFP, QME, CIME Alchemy Logic Systems, CEO

When’s the last time you used a paper map to get somewhere?

Technological Advances “We are in a historic moment of horse-versus-locomotive competition where intuitive and experiential expertise is losing out time and time again to number crunching.” –Ian Ayres We now have technology that’s faster better and cheaper than what we’ve had in the past. This is the age of super computing, large database compiling, and statistical accuracy

The Threat of Numbers Experts are being undressed by the reproducible results and transparent conclusions of statistical analysis. “Super Crunching approaches are winning the day and driving out intuition and experience-based expertise.” Ian Ayres

Evidence-Based Medical Treatment What does all this have to do with workers’ compensation? Injury Mapping: The compiling of individual work injury data sets What it does: Assess the severity of the injury: the starting point Determine the rate and trajectory of recovery Estimate the total cost of the claim: the price of the journey Distance to arrival at Maximal Medical Improvement (MMI): the destination

Super Crunching Tools Super Crunching Case Management: Definitions of Terms Recovery Score: this is a 0-100% with 0= full recovery and 100% = worse outcome. Pain Score: A weighted average of analogue pain value adjusted for ADL function: from none to severe constant Claim Data Set: The claim inputs subjective objective diagnostic testing metrics Base claim value: AMA guides 5th edition % WPI Value Apportionment: Permanent disability minus non-industrial objectively weighted factors (i.e. obesity, arthritis, pre-existing conditions etc. ) MMI Analysis: A slope calculation of change between any two points in time defined by the clinical data set and adjusted for available treatment. Functional Parity Analysis: The statistical variance between the subjective pain and reported ADL function compared to the objective findings and diagnostic testing severity The compass room!

Injury Map: Case Example Mr. Smith is seen for a doctor’s first report. Low back injury 4/10 right leg pain 75% frequency of pain in S1 distribution Limited in 6/34 of his ADL’s Physical Exam: Tender right L5 No guarding or spasm Flexion 50 degrees, extension 15 degrees, right bend 15 degrees, left bend 25 degrees Neuroexam decreased light touch with a 2 point loss, 7-14 mm, right s-1 dermatome. BMI is 32.51. OTC ibuprofen and currently cannot stand sit or walk greater than 30 min, lifting is limited to 15 pounds. No prior back problems Provider treatment: RX ibuprofen, physical therapy ordered, sit/stand/walk 10min/20min.

Super Crunching Mr. Smith Mr. smith’s injury map starting point Recovery Score: 80% of normal. Pain Score: Slight and frequent; ADL count 6/34 limited. Case Data Set: Not unusual or extraordinary (not eligible for Almarez-Guzman California 1-3% add on for chapter 18, pain) Base Claim Value: Approximately $11,000 on first visit. Apportionment: Based on his BMI, 23% apportionment. Functional Limits Parity Analysis: Yes; subjective vs. objective findings are validated in this case. E.g. no symptom amplification MMI status: Not MMI A parity calculator

Follow-up visit Mr. Smith comes in for a follow-up visit 6 weeks later. Pain level: 2/10, occasional ADL count: 2/34 Physical exam: 90% expected normal with resolution of S1 right sensory loss He has completed six visits of physical therapy Work status: full duty, x-ray: lumbar spine: mild DJD L5-S1 MMI status: Not MMI; active recovery verified.

Number Crunching Mr. Smith Recovery Score: 90% Recovered Pain Score: Pain forgotten with activity, occasional Case Data Set: Not unusual or extraordinary (not eligible for Almarez-Guzman California 1-3% add on for chapter 18, pain) Base Claim Value: $6,000 (a decrease of $5,000) Apportionment is now 15% for obesity and 15% for arthritis: total 30% Functional Limits Parity Analysis: Parity remains in tact Next steps for MMI: 6+ visits therapy. Consider MRI. Specialty consult if not actively recovering next visit six weeks

Arrived at Destination 12 weeks post injury date, 12 visits of physical therapy completed, recommended non-surgical by spine consult, Mr. Smith returns for a PR-4 Report 1/10 occasional pain 1/34 ADL’s Ibuprofen occasional use no side effects Physical exam: 90% range of motion (validated) MRI L5-S1 Mild DJD Work status: full duty

Final Number Crunching Recovery Score: 90% Pain Score: Pain forgotten with activity, occasional Case Data Set: 95% range of motion; 1/34 ADL limited Base Claim Value: $6,000 Apportionment: 30% Functional Limits Parity Analysis: Parity remains. MMI Status: Verified MMI

Conclusion Stop using a paper map for navigating! “Super-crunching is done by and for decision makers who are looking for a better way to do things.” –Ian Ayres Injury mapping delivers faster, more accurate, and cheaper results for stakeholders Reduce wasted visits, avoid bias, standardize experience, understand return on investment and risk.

J.alchemy@rate-fast.com 707-483-4346 Questions? Contact J.alchemy@rate-fast.com 707-483-4346