DWC plans changes to MTUS guidelines

In August of 2013, the Division of Workers’ Compensation (DWC) made a plea to receive comments on its proposed changes to the Medical Treatment Utilization Schedule (MTUS).  More recently in November 2014, the DWC posted a second 15-day notice, alerting all to the proposed regulations which over time have started to take shape.  The DWC maintains public online forums for stakeholders to voice their opinion about proposed changes.  These forums are intended to improve community input and feedback during the process of developing state regulations for the workers’ compensation system.  The proposed changes according to the DWC statement include:

  • Revision of the definition of “ACOEM” by deleting the reference to the second edition 2004 version and adding a brief description of what the guidelines contain.
  • Revision of the definition of “chronic pain” by adding a three month timeline from the initial onset of pain for clarity.
  • Deletion of the definition of “MEDLINE” because this term is no longer used in the regulations.
  • Modification of the definition of “Appraisal of Guidelines for Research & Evaluation II (AGREE II) Instrument” by adding the May 2009 AGREE II version was adopted and incorporated by reference into the MTUS by the Administrative Director and a copy may be obtained from DWC’s website or by written request to DWC’s Medical Unit.
  • Re-organization and re-wording to express that medical care shall be in accordance with the best available medical evidence when the MTUS’s presumption of evidence is challenged pursuant to Labor Code section 4604.5 or when there is a topical gap and a medical treatment or diagnostic test is not addressed by the recommended guidelines set forth in the MTUS.
  • Clarification that treating physicians may apply the medical literature search sequence, and specifies when Utilization Review physicians and Independent Medical Review physicians shall apply the medical literature search sequence to find the best available medical evidence.
  • Specifies when and by whom the MTUS Hierarchy of Evidence for Different Clinical Questions shall be applied and how the levels of evidence shall be documented in a Utilization Review decision and in an Independent Medical Review decision.

The MTUS will continue to be an important tool for both Agreed Medical Evaluator (AME) and Qualified Medical Evaluator (QME) disciplines.  The DWC requires that an evaluator’s medical opinion be consistent with and refer to evidence-based medical treatment guidelines.  Many of these guidelines are outlined in the MTUS and other peer reviewed studies that help explain the medical basis for reasoning and conclusions.

QMEs interested in learning more about the MTUS can read and review our MTUS course for free.  Those interested in earning QME CE credits can do so as well by taking the course exam.  Once the exam is completed with a passing score of 75% or above, our system will generate a course completion certificate stating the number of credit hours earned.  When the MTUS guidelines are updated, we plan to update this course and the course exam to reflect the latest changes to the MTUS so QME doctors can stay current on the latest regulations from the DWC.