New Easy-To-Use Format

            Based on your input, Official Disability Guidelines recently underwent a major re-design to facilitate finding the information you need quickly.  With the new format you can efficiently locate the numbers you need to forecast and reserve a claim, or you can get the in-depth backup information necessary for more extensive case management.  Click here to view a sample page for low back pain.

Most Valuable Features: Up Front

• Return-to-Work Summary Guidelines show estimated days out of work (based on national norms) for each condition in summary, for those who just want to select a target (Midrange) and reserve date (At-Risk), and you can now cost justify case management efforts by “beating the guideline” using the At-Risk date.  They are followed by ODG’s well respected “Best Practice” Guidelines, which have proven indispensable to effective case management by identifying up front what “pathway” a case is likely to follow.  The new Summary Guidelines bring to the forefront of each diagnosis select experience data previously contained in the ODG “decile table”, using as a foundation the 50% claims duration for “Midrange” and the 90% for “At-Risk”.  Some of the ways these numbers are used is as follows:
• Reserves: Estimating duration for purposes of setting conservative reserves (using the At-Risk).
• Targets: Selecting a duration as “the number to hit” (Midrange) or the “the number to beat” (At-Risk).  Cases beyond the Midrange will trigger a yellow flag, and solicit more attention.  Cases beyond the At-Risk date will trigger a red flag, as they become outliers.  This date should trigger a search for factors that may be retarding recovery (co-morbidities, psychosocial or job satisfaction issues, chemical dependence, etc) so that support services or other appropriate recourse may be put into place.
• Pre-authorization rules:  Workers’ compensation systems and insurance companies are using the At-Risk date to trigger pre-authorization requirements, making providers submit approved treatment plans prior to payment for cases that have exceeded this limit.
• Budgeting: Making an initial prediction of disability duration, and keeping that prediction, unmodified, in a database in order to compare the eventual actual duration against that first estimate.
• Grading RTW Performance:  Calculating a percentage and letter grade for RTW performance based on results compared to the guideline, then comparing internal and external claims management entities (TPAs, providers, case managers, etc) based on their grades.
• "Beating the Guideline":  Demonstrating days and dollars saved versus the At-Risk dates, to cost justify case management and demonstrate the value of occupational and integrated health programs.
  
  
• Return-to-Work “Best Practice” Guidelines.  Now upfront for each condition, right behind the Summary Guidelines, the Best Practice Guidelines are the most important feature in ODG.   They show estimated days out of work (based on national norms) for typical cases within each condition depending on severity, type of treatment and type of job, including modified duty .  They are indispensable to effective case management by identifying up front what “pathway” a case is likely to follow.  In addition, multipliers for many common co-morbidities have been added, based on the raw experience data.  They have been fully updated and expanded for 2003 to contain new therapies and new findings on modified duty, and they now interface with Activity Modifications to allow for early RTW without re-injury. 
  
  
• Activity Modifications shows condition-specific modifications for each level of job identified in the “Best Practice” Guidelines, to allow for early return-to-work without re-injury.  These can be used to prepare an employer’s RTW form or in comparison with a Job Analysis form.
  
  
• Description is provided, describing the injury or illness including symptoms and other names.

Other Features Still There, But Relocated

• ICD-10 Codes are still provided, but lower down, providing complete ICD-10 translations for each ICD-9.
• Other Links provides links to pre-screened information for each condition, along with color pictures and explanatory information, including full text state and national treatment guidelines.
• Medical Costs are still provided, showing average medical costs for each condition, including total number of cases per sample.
• Procedure Codes (CPT-4) commonly performed for each condition, plus links to the procedure index with description, cost, and national ranking in workers compensation (Web version).
• Case Management Triage priority indicators (Low Touch, Case Management, or Long Term Planning) for appropriate allocation of case management efforts when resources are spread thin, plus an inflection point, or flag date at which Level 1 claims should be resolved, or if return-to-work has not been achieved, should become Level 2, actively case managed.  
• Physical Therapy Guidelines, showing recommended frequency and duration of PT visits, are still there, but are no longer boxed up.
• Chiropractic Guidelines, showing recommended frequency and duration of chiropractic care, are also still there, but also no longer boxed.
• Age Adjustment Factors providing condition-specific multipliers to adjust expected disability duration based on age, especially important for the aging workforce (only provided where sufficient data/variance exist based on age).  The At-Risk date is pre-adjusted in this section.
• RTW Claims Data for benchmarking is the table formerly called “RTW Raw Data by Decile (with 7-day waiting period)”, showing days away from work by decile (10 percent of claims back by 12th day, etc.), including mean.
• Length of Disability Data from CDC NCHS (Centers for Disease Control National Center for Health Statistics) is still there, charting disability duration data for all cases from the National Health Interview Survey, but now the “Impact on Total Absence”, based on this data, is under this table showing impact on total absence for each condition (total incidence and prevalence data).
• OSHA DAW Data (Occupational Safety and Health Administration Days Away from Work) is still there, providing lost time statistics on work-related disabilities as reported to OSHA, and calculating estimated workers’ compensation indemnity costs for each condition.  Now the “Impact on Occupational Absence”, based on this data, is under this table showing impact on occupational absence (occupational incidence and prevalence data).
• NHDS LOS Data (National Hospital Discharge Survey, Length of Stay) is still last, charting norms on hospital length of stay derived from actual hospital billing records.

Check out a sample page (for 724.2 Lumbago), and place your order today and start saving!

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Copyright © 2009 Official Disability Guidelines
Last modified: May 25, 2010