The Workers’ Compensation Advisory Council (WCAC), in lieu of its regular March meeting, held a public forum on the proposed chronic pain guideline update within its ongoing mission to update the Medical Treatment Guidelines. This update, as well as the entire set of Louisiana Medical Treatment Guidelines, is based on Colorado’s guidelines, which are then modified for Louisiana injured workers by the Louisiana Medical Advisory Council (MAC).
Assistant Secretary Sheral Kellar, who leads the Office of Workers’ Compensation Administration and the WCAC, has championed the guideline updates as a hallmark of her administration, repeatedly stating in WCAC meetings that she wants the process to be a collaborative one with stakeholders. To that end, the OWCA posted the entire proposal on its website seeking comments before any Notice of Intent is filed in the Louisiana Register. The meeting on March 28th was a continuation of that process, with a court stenographer present to record the comments and concerns.
Troy Prevot, Executive Vice President of LCTA Workers’ Comp and former WCAC member, expressed concern about the evidence table being removed from the update as well as stating that he believes the six month protocol assigned by the guideline is insufficiently supported. “We’ve taken out an entire paragraph and added one sentence,” he said. “The sentence we added is: ‘injuries resulting in temporary total disability require maintenance treatment and may not return to work in six months.’ That’s just a statement, that’s not supported. The American College of Occupational Medicine have been very strong about the decrease in return to work after six months.” Prevot went on to say that he is skeptical of this six month statement because it is likely to come before all of the guideline updates and that Louisiana’s injured workers already have some of the longest disability durations in the country.
On the provider and claimant attorney side, the biopsychosocial model and its attendant emphasis on psychological evaluation was a sticking point. Katie Brittain with the Louisiana Physical Therapy Association took the floor and explained that in her practice, she often sees patients that should be referred to a mental health professional, but that access to that care can become a challenge. “As a physical therapist that currently works in a [biopsychosocial treatment model] just in terms of availability or access to those types of mental health providers, I would just like to encourage you guys to look at workforce data to offer the care that’s recommended in the guidelines,” she said. Brittain also stated that her chronic pain patients face long wait times to get mental health treatment and that insufficient providers to take these patients may create an unforeseen consequence of delayed treatment.
Dr. Lyle Schween with LA Health Solutions concurred with Brittain on the availability of mental health resources, as well as bemoaning treatment delays in general. “In a perfect world if we actually got three months of consistent treatment, this would make sense,” he said. “The reality is we get two weeks of treatment and a month delay…we were told that [the Medical Treatment Guidelines] were pre-approved treatment, but the adjuster for reason will deny it. This [psychological evaluation requirement] is just one more hurdle.”
At the close of the meeting during which Council members offered up their thoughts. Council member Shannon Lindsey echoed the access to care issues identified by the public, but added that she believes the psych evaluations could also create abuse by “blanketing” injured workers with persistent pain at three months as chronic pain patients per se. Shannon Dartez agreed with Lindsey’s concern.
New Council member Dr. Vincent Forte, who is also a member of the MAC, used his time to emphasize that the MAC is looking to reflect the best medical evidence and reach consensus. “I’m rather shocked in that the focus this morning has been the psychological evaluation,” he said. “We’ve worked tirelessly to make sure that this is a very fair process for the injured worker as well as the employer. As they look through the guidelines, they’ll see that we attempted to address everything that was asked of us…including the opioid crisis and urine drug screens.” Forte went on to say that the intention was not to make the psychological aspect mandatory, but rather to voice the medical opinion that all patients should, ideally, have a psychological evaluation.
The next WCAC meetings in scheduled for April 25th.
Members present: Kellar, Lindsey, Losavio, Williams, Forte, Cherry, Davoli, Dartez, Morris, Stokes, Hunter