May “Comp in Focus” Luncheon Zeroed in on the “Evidence” Behind Evidence-Based Medicine

On Tuesday, May 10th, Louisiana Comp Blog hosted its May “Comp in Focus” luncheon at Ralph’s on the Park in New Orleans. The bimonthly series, which aims to generate discussion from a variety of stakeholders about hot button issues in the comp industry, featured Dr. Douglas Lurie speaking on evidence-based medicine.

Dr. Lurie, who is a board-certified orthopaedic surgeon with Orthopaedic Associates of New Orleans and who has also performed thousands of utilization reviews since the passage of the Medical Treatment Guidelines, took attendees through the technical aspects of the “evidence” (see hierarchy graphic below) referred to by such evidence-based medicine (EBM) strongholds as ACOEM and ODG.

Central questions in the debate surrounding EBM are primarily geared toward the notion of “cookbook medicine” – the fear of turning physicians into technicians. Dr. Lurie addressed this with the old adage, “is medicine an art or a science?” The answer, according to Dr. Lurie, is both.

EBM pyramidReferencing a generational divide within the medical community itself, plus the fact that EBM only covers about 20 percent of clinical practice, Dr. Lurie explained that critics of EBM question whether the methodology is as pure as it seems. To that point, Dr. Lurie explained that pharmaceutical companies and device manufacturers provide the funds for a large portion of the studies deemed “highest quality” by EBM guidelines, potentially introducing bias.

Attendees called on Dr. Lurie to share stories from his clinical history of treating workers’ comp patients, and the high degree of socio-economic factors involved in such cases. “It’s rare to see a patient that maps perfectly to a disease […] so the fact that the guidelines say that this person should be back to work in six months doesn’t necessarily make it so,” he said.

Such strict adherence to EBM guidelines, which are based not just on published research, but also on opaque “panels of experts,” can result in barriers or delays to treatment if a payer continually challenges the progression of medical care and the claim ends up in litigation.

Formularies and their relationship to EBM and Louisiana’s opioid abuse problem were also discussed at length. Whether formularies – and the EBM proponents that generate them – are actually geared toward better outcomes, or if they are just a cost-cutting measure, came up as well. Jill Leonard, AVP of Claims Operations at LWCC, and Wayne Fontana, a defense attorney with Roedel Parsons, weighed in on that question, saying that the goal of a formulary with ties to EBM would be to prevent new potential addicts by limiting opioids at the start.

The next “Comp in Focus” luncheon will be held in July, details forthcoming.

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