Western Occupational & Environmental Medical Association
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Leading Occupational & Environmental Medicine

Welcome to the WOEMA WINDOW, our e-newsletter sent to members by email on a monthly basis. The newsletter links to this page. Below are the items that appeared in the October 2017 issue.



   Lawsuit Filed Over QME Recertification

Controversy has continued over the California DWC’s rejection of many QME renewal applications, with three medical providers now suing DWC for using “underground regulations” to reinterpret statute and denying them due process.  

The former QMEs – an orthopedist, a cardiologist, and a chiropractor – are claiming that DWC has unilaterally changed its interpretation of the criteria necessary for an evaluation to qualify as an ML 104, Comprehensive Medical-legal Evaluation Involving Extraordinary Circumstances. (Specifically, they say, the Division asked the plaintiffs to address medical causation in meeting the criteria for complexity factors – an issue they say is moot when causation is not an issue in the claim).  

For its part, DWC has had longstanding intent to reduce fraudulent billing and improve QME quality, although the Division is not speaking publicly about the case. Here’s a link to the case:  Howard et al v. California Dept. of Industrial Relations.

It will now play out in the courts as to whether the DWCs’ current application of the law constitutes an “underground regulation” – that is, a policy change implemented without a public hearing process – or whether the QMEs were denied due process.  WOEMA will track the case closely, and encourages any member who would like to talk about their experience with QME certification to contact WOEMA lobbyist Don Schinske, dschinske@calcapitol.com.



FREE CME – WOEMA Webinar Series:
Management of Concussion and Post-Concussion Syndrome
Thursday, October 26 • 12:00 PM PDT

[REGISTER]

 

This presentation will provide an updated review of concepts related to the management of concussion and post-concussion syndrome. Previously, management was limited to “watchful waiting” with the concept that although many (if not most) concussive injuries resolve spontaneously, there are individuals who have prolonged and/or permanent symptoms. This “Post-Concussion Syndrome” was often viewed as a “new normal” for those individuals and management was limited to teaching compensatory strategies and attempts at treating symptoms. A more evolved approach is aimed at an aggressive assessment and search for treatable causes of ongoing symptoms with interventions aimed at amelioration and improvement, rather than watchful waiting and compensation.

Learning Objectives – after this webinar participants will be able to:

  • Identify the most common symptoms associated with prolonged concussion and Post-Concussion Syndrome

  • Identify options for treatment of most common symptoms associated with Post-Concussion Syndrome

  • Identify factors (modifying factors) associated with increased risk of prolonged symptoms and Post-Concussion Syndrome

  • Awareness of evolving approaches and future directions for treatment of concussion and Post-Concussion Syndrome

Vernon B. Williams, M.D. was born and raised in Detroit, Michigan.  He is a graduate of Cass Technical High School and The University of Michigan’s prestigious Inteflex Accelerated Pre-Medical/Medical Program. He completed neurology residency at The University of Maryland in Baltimore, MD and is board certified by the American Association of Psychiatry and Neurology. After residency he completed a multidisciplinary, interventional pain fellowship in the Department of Anesthesiology and Critical Care (Division of Pain Medicine) at Johns Hopkins Hospital in Baltimore, MD.  Dr. Williams joined the Kerlan-Jobe Orthopaedic Clinic in Los Angeles in 1997. At Kerlan-Jobe, he is a consulting Team Physician to the Los Angeles Rams, Clippers, Dodgers, Kings, Sparks, Anaheim Ducks, and several southern California collegiate, high school, and elite club athletic programs. He is the Founding Director of The Center for Sports Neurology and Pain Medicine at the Kerlan-Jobe. He is also the Founding Director of the Sports Neurology Fellowship at Kerlan-Jobe. In 2015, Governor Brown appointed him to the California State Athletic Commission Dr. Williams is an active educator on issues related to Sports Neurology and Concussion. He is the Chair of the American Academy of Neurology Sports Neurology Section.  He often serves as a medical-legal expert and as an expert consultant on Pain and Sports Neurologic Disorders to major television networks, radio, satellite, and print media. He is a member of Kappa Alpha Psi and Sigma Pi Phi (Boule’) Fraternities.



WOHC 2017 Photo Gallery

The 61st Annual Western Occupational Health Conference held in Maui concluded on September 16 to hundreds of rave reviews from attendees and a traditional ‘E Ku Mau Mau’ chant. Attendees gained up to 25.0 hours of CME/MOC credit, heard the latest on important OEM topics, and enjoyed networking in the magnificent island setting. Special thanks to the WOHC planning committee, the WOEMA board, the speaking faculty, and all of those that attended for making this WOHC 2017 an unforgettable event!

The WOHC Planning Committee and the WOEMA Board would like to thank Dr. Paul Kim for his hard work in capturing many special moments from WOHC. It was a difficult task and he invested countless hours of his time during the conference for this.

Paul Kim, MD, MPH

Loma Linda University Health
Medical Director, Workers’ Compensation Center
Medical Director, Occupational Medicine Clinic
Associate Program Director, Occupational & Environmental Residency

ACOEM/WOEMA Member
Legislative Committee Member
Newsletter committee Member
WOHC Planning Committee Member


WOHC 2017 Photo Gallery
– Courtesy of Paul Kim, MD, MPH



WOHC 2017 Resident Poster Competition

Last month 15 resident physicians from all over the US came to Maui to attend WOHC 2017 and present posters on occupational and environmental medicine research or projects that have been conducted. Lincoln Holdaway, MD from the University of Utah was awarded first place ($250) in the poster competition for “Does Sleep Posture Play a Role in the Development of Glenohumeral Pain and Rotator Cuff Tendinopathy?”. Dr. Holdaway completed medical school at Eisenhower Army Medical Center in Georgia. He then served as a flight surgeon at Fort Campbell for 4 years, including two deployments to Afghanistan. On track to graduate in June 2018, Dr. Holdaway is committed to occupational medicine and to continue caring for working populations in a non-military environment. A summary of Dr. Holdaway’s research has been copied below.

 

Does Sleep Posture Play a Role in the Development of Glenohumeral Pain and Rotator Cuff Tendinopathy?

Glenohumeral pain and rotator cuff tendinopathy (RCT) are common musculoskeletal complaints with high prevalence among working populations. As a Flight Surgeon in the Army I would frequently see patients with no clear injury or overuse mechanism to explain their shoulder symptoms who would wonder if their sleep posture may have been to blame. I was surprised to find no quality studies to support or refute an association between sleep posture and RCT or glenohumeral pain. I did, however, find studies demonstrating increased subacromial pressures with certain sleep positions and studies correlating sleep sidedness and laterality of shoulder problems. As subacromial impingement of the RC tendons and reduced blood flow are the primary proposed pathophysiologic mechanisms for RCT, sleep posture could be expected to contribute to this condition.  

Sleep posture data had been collected as part of the WISTAH study—a multicenter prospective cohort study of upper extremity musculoskeletal disorders. The sleep posture data was obtained by a questionnaire given to 761 workers and assessed their primary and secondary preferred sleep position from 6 labeled examples—this questionnaire was given at entrance to the study and periodically afterwards. As the WISTAH study included a structured physical exam, and pain questionnaire guided by anatomic chart, the presence of glenohumeral pain and RCT could be ascertained. I used presence of glenohumeral pain plus a positive supraspinatus test, painful arc and/or Neer’s test as the case definition of RCT. I performed a cross-sectional analysis of the baseline sleep posture data and calculated odds ratios for glenohumeral pain and RCT for each sleep posture.

Associations were seen between age, Framingham risk score, sex, BMI and Hand Activity Level and glenohumeral pain and/or RCT.  Interestingly, the sleep position expected to have the highest risk of glenohumeral pain and RCT—lying prone with arms above the head—was significantly associated with a decreased prevalence of glenohumeral pain and also trended toward being protective for RCT. The most common sleep position, and one of the higher risk positions, suggested an association but narrowly missed statistical significance for association with glenohumeral pain and RCT. No significant findings were seen with multiple logistic regression.

No correlation between sleep posture and glenohumeral pain or rotator cuff tendinopathy was found. I had expected to find a relationship based on previous suggestive studies. It was especially surprising to find the highest suspected risk sleep posture appearing protective. Because this study was cross-sectional, results may be confounded as subjects with glenohumeral pain and/or RCT may have learned to avoid sleeping in these higher risk positions. Sleep posture surveys were conducted throughout this prospective cohort study; so, maybe in the future we can re-evaluate this question using longitudinal data to better see if a relationship between sleep posture and glenohumeral pain and/or RCT really exists.




WOEMA Members Elect New Board Members and Officers

At the Annual Business Meeting held at WOHC 2017, members elected two new directors: Rosalie Banasiak, MD, and Catherine Boomus MD, MPH. Each will serve terms through 2020. In addition, Scott Krasner, MD, MPH, FACOEM was elected Second Vice President. President Robert Blink, MD, MPH, FACOEM passed the President’s gavel on to Sachin Kapoor, DO, MBA, FACOEM as he thanked the following for their dedicated service on the WOEMA Board: Chairman Scott Levy, MD, MPH, FACOEM and Director Matthew Chan, MD, MPH.

Click here to view 2018 Board of Directors and Officers Approved Slate

 



Legislative Affairs Committee Update

October 6, 2017

  • AB 570 (Gonzalez Fletcher) – Prohibits pregnancy/childbirth apportionment. It is on the governor’s desk. We have written to the governor’s office to oppose. 
  • SB 617 (Bradford) – Original version (DWC annual report cards to WC providers and AD to provide report to legislature re: alternate WC payment models): we will continue conversation with Senate Labor consultant Gideon Baum. Amended version (bars genetic factor apportionment): the Chairs to review the paper drafted by Drs. Blink and Feinberg.
  • SB 772 (Leyva) – Exempts CalOSHA regs from Standardized Impact Assessment process. It has now become a 2 year bill so we will continue monitoring. 
  • SB 562 (Lara/Atkins) – Single payor bill. The current bill only briefly mentions occupational medicine in regards to research funding and incorporating it into coordination of overall care. Will continue to monitor the bill. 
  • USDOL’s RFI – re: how to score future proposals for state-run demonstration projects on extending RTW-SAW concepts to general medical practice.
  • ACOEM coding project – The project has evolved and is ready to launch a demonstration project. Currently, a survey has been sent out to potential partners who may be interested in collaborating on the medical documentation / coding project. 

Click Here to read WOEMA’s Policy Platform

The Legislative Affairs Committee is Co-Chaired by Dr. Rupali Das & Dr. Roman Kownacki, with Don Schinske as Policy Advisor. For questions or to get information about the WOEMA Legislative Affairs Committee, contact woema@woema.org