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Monthly Archives: April 2011

DecisionUR Expands to Include New York and California Treatment Guidelines

Utilization Review Software for Workers’ Compensation Will Integrate Reed Group’s MDGuidelines With New York Treatment Guidelines & ACOEM portion of California MTUS Guidelines

DecisionUR (DUR) announced today that its web-based workers’ compensation utilization review software will now include the New York Treatment Guidelines as well as the ACOEM portion of the California MTUS treatment guidelines.

DecisionUR will integrate Reed Group’s MDGuidelines With New York Treatment Guidelines, which contains both proprietary licensed content from ACOEM (American College of Environmental and Occupational Medicine) as well as Reed Group’s proprietary data crosswalks that allow navigation of the New York Guidelines by CPT (medical procedure) and ICD (diagnostic) codes. DUR also will incorporate the ACOEM content of the California MTUS.

Reed Group’s MDGuidelines navigation software is used by the New York State Workers’ Compensation Board and is the only product on the market that is licensed to distribute the ACOEM portion of the New York Treatment Guidelines.

DecisionUR’s software “pre-scrubs” workers’ compensation claims to ensure they qualify with medical treatment guidelines. By automating the application of specific, proven medical protocols, DUR is a highly effective cost-containment tool, offering users flexible pricing by transaction or licensing.

“Integrating MDGuidelines With New York Treatment Guidelines makes DecisionUR the must-have utilization product for anyone working in the New York workers’ comp industry,” says DecisionUR Medical Director Lester Sacks, MD. “Reed Group’s MDGuidelines makes it easy to navigate the New York Treatment Guidelines and ACOEM content for MTUS. We’re very pleased to offer the power of their content and search tools to our customers.”

“DecisionUR is an essential tool for the cost-effective adoption of state guidelines,” says Jon Seymour, MD, president, guidelines, for Reed Group. “We’re excited to offer integration of MDGuidelines with DUR’s excellent software and, thereby, make adoption of state treatment guidelines easier for all workers’ comp stakeholders.”

DecisionUR’s software is used by payors, providers, third-party administrators (TPAs) independent review organizations (IRAs), utilization review organizations (URAs) and other stakeholders throughout the workers’ compensation industry.

For more information, please visit www.DecisionUR.com.

Reed Group & Webility Offer Disability Duration Guidelines E-Learning

New Online Training Course for Physicians is a Primer on Disability Prevention and Management

For most working adults, getting sidelined by illness or injury can have devastating consequences for their family and career as well as for their financial, physical and emotional well-being. Yet very few physicians receive formal education or training in how to prevent and minimize that impact on patients’ major life functions, especially their jobs.

To respond to this need, Reed Group and Webility Corporation have joined together to offer a new e-learning course: Mastering MDGuidelines: Using Disability Duration Guidelines for Clinical Patient Care.

Co-developed by disability experts Jon Seymour, MD, and Jennifer Christian, MD, the brief e-course efficiently delivers a primer in disability prevention and management to treating clinicians of all specialties.

Helping Physicians Communicate in Disability Cases

Reed Group President Jon Seymour, MD, says that patients, employers, insurance carriers, case management firms, and claims administration companies all complain of physicians’ lack of awareness of – and willingness to play – the communications role prescribed for them in disability cases.

“This e-course will help address that issue by building clinician awareness and ability to use MDGuidelines in the manner in which it always has been intended – as the source of objective information that, when shared, creates common ground and allows all parties to achieve common goals and better outcomes in the return-to-work process,” he says.

“We designed this e-course like a Cliff Notes introduction to disability prevention and management for busy doctors: 30 to 45 minutes of clinician-friendly instruction on how to give sound practical advice to working-age patients about what they should and shouldn’t do, both at home and at work while recovering from injury and illness,” says Webility Corporation President Jennifer Christian, MD.

How to Get the E-Course

To arrange group purchases of the e-course, you can call Reed Group at 866.889.4449 or email John Nelson.

To take the course, go to the Webility website and click on MDG101: Mastering MDGuidelines: Using Disability Duration Guidelines for Clinical Patient Care. Tuition is $50, payable by credit card. Course completion earns 0.75 hours of Category I CME credit.

USERRA Note: Notice of Intent to Take Military Duty Leave Sufficient to Provide USERRA Job Protections

By Marti J. Cardi, Chief Compliance Officer, Reed Group

Employers are familiar with the Uniformed Services Employment and Reemployment Rights Act (USERRA), which provides American servicemembers in civilian jobs with protection from discrimination on the basis of military service and job restoration rights following service.

A recent opinion from the First Circuit Court of Appeals, arising from a case in Puerto Rico, makes it clear that the protections under USERRA arise as soon as an employer is notified of the potential for an employee to be called to active duty. In Vega-Colón V. Wyeth Pharmaceuticals, Vega, a member of the U.S. Army Reserve, commenced employment with Wyeth in 2002. In 2006, while inactive and before receiving formal orders, Vega notified his Wyeth supervisor that he had accepted a promotion to captain on the condition that he return to active duty at some as-yet unspecified date.

Vega claims that Wyeth then took various negative employment actions against him because of his intent to serve (including a poor evaluation, extension of a performance improvement plan, denial of a promotion). Wyeth argued that Vega was not entitled to USERRA protections because he had not yet returned to active duty.

The First Circuit rejected this argument: “[It] is only logical that USERRA coverage would be triggered at the point in time in which an employer has information about an employee on which it could base discriminatory treatment. Here Vega expressed a definite intent to return to active duty in the near future. To deny an employee who has expressed such a definite intention the protection of USERRA until his literal application for service is signed and delivered would be contrary to the stated purposes of USERRA.”

Lesson for Employers:
The purpose of USERRA is “to encourage non-career military service, minimize disruption based on this service, and prevent discrimination against service members.” 38 U.S.C. § 4301. Be sure your supervisors are trained not to discriminate against active or inactive military members, and understand your obligation to reinstate your employee upon return from service.

Reed Group manages military leaves of absence protected by USERRA and similar state laws. Contact us if your organization is interested in learning more about USERRA or about Reed Group’s services. More information about USERRA.

Vega-Colón V. Wyeth Pharmaceuticals (1st Cir. Oct 28, 2010)