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QME Chronic Pain MTUS Guidelines (2020 Update)

by CA-MTUS.


12 Credit Hours - $299
Last revised: 02/04/2020

Course content © Copyright 2020 by CA-MTUS. All rights reserved.



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Course Outline

Introduction

Learning Objectives

Overview

History of the Medical Treatment Utilization Schedule (MTUS)

General Approaches

Clinical Topics

Presumption of Correctness

Take the Chronic Pain Course

Other Resources – Free access to the Guides and online search tool

 

Introduction

 

This course begins with an overview of the purpose of the medical treatment utilization schedule (MTUS).  The overview is contained in the following and is largely paraphrased from the DWC website.  The full text of this overview is on the DWC website and can be found here.  The course then specifically covers the MTUS for chronic pain.  To complete the course, you will need to first read the following overview. Second, review the MTUS Chronic Pain Medical Treatment Guidelines (instructions for doing so are contained in the last section below).  The first MTUS Chronic Pain was adopted in 2009 and is  a 127-page document that is available in a pdf format.  The Chronic Pain MTUS has been updated many times since then. The most recent update was adopted in 2017 and is a whopping 1219 pages long (largely due to the literature reviews) and can be found here (Chronic Pain MTUS, 2017). This course focuses in the key point found in the original MTUS Chronic Pain Guides as well as the updates (Specifically the current list of recommended and not recommended treatments as displayed in the current guide on pages 45-47). Many of the core principles are unchanged.

 

 

Learning objectives

 

Discuss the history and purpose of the MTUS

Describe the difference between nociceptive and neuropathic pain

Explain the biomedical versus biopsychosocial models of pain

List 10 treatments for chronic pain that are “recommended”

List 10 treatments for chronic pain that are “not recommended”

 

 

Overview

 

The medical treatment utilization schedule (MTUS) provides medical treatment guidelines for utilization review and an analytical framework for the evaluation and treatment of injured workers.

 

When an employee is injured at work, he or she is entitled to receive reasonable and necessary medical treatment to cure or relieve the injury. The Medical Treatment Utilization Schedule (MTUS) is a set of regulations found in title 8, California Code of Regulations section 9792.20 through 9792.27.23 that contain medical treatment guidelines and rules for determining what is reasonable and necessary medical care. The MTUS is based on the principles of evidence-based medicine. That means treatment decisions are guided by recommendations supported by the best-available evidence.

 

It helps medical providers understand which evidenced-based treatments have been effective in providing improved medical outcomes to those workers. The MTUS is promulgated by the DWC administrative director under Labor Code sections 5307.27 and 4604.5 and can be found in sections 9792.20 et seq. of Title 8, California Code of Regulations.

 

The MTUS lays out treatments scientifically proven to cure or relieve work-related injuries and illnesses. It also deals with how often the treatment is given (frequency), extent of treatment (intensity), and for how long (duration), among other things.

 

History

 

Jan. 1, 2004 - The Legislature charged the DWC administrative director (AD) with adopting an MTUS that would be presumed correct on the issue of extent and scope of medical treatment, and made the American College of Occupational and Environmental Medicine Practice Guidelines, 2nd Edition, (ACOEM) the standard until the adoption of an MTUS by the AD.

 

June 15, 2007 - The date the MTUS became effective. Among other provisions, the MTUS regulations incorporated the American College of Occupational and Environmental Medicine's Occupational Medicine Practice Guidelines (ACOEM Practice Guidelines) and acupuncture guidelines. The rules also laid out the strength of evidence rating methodology by which specific medical treatments or diagnostic services are evaluated. The rules also established the medical evidence evaluation advisory committee (MEEAC).

 

July 18, 2009 - The date the MTUS was updated. The current version of the MTUS added new guidelines for chronic pain and postsurgical physical medicine treatment. The MTUS was also reorganized to restructure the MTUS into a clinical topics format, which will allow for easier updates of the guidelines.

 

2009-Current. As can be seen in the following section, all of the MTUS Guides have been regularly updated based on new research. The Chronic Pain Guide was update (and accepted) on 05-15-2017.

 

General Approaches

 

The DWC administrative director adopts and incorporates specific guidelines into the MTUS set forth from the ACOEM Practice Guidelines for the chapters on prevention, general approach to initial assessment and documentation, initial approaches to treatment, cornerstones of disability prevention and management. The general approaches section of the MTUS are set forth in § 9792.22 of Title 8, California Code of Regulations and are based on chapters 1, 2, 3, and 5 as adopted from the ACOEM Practice Guidelines, 2nd edition (2004).

 

Clinical Topics

 

The clinical topics apply to the initial management and subsequent treatment of presenting complaints specific to the body part as set forth in § 9792.23.1 et seq. of Title 8, California Code of Regulations. All of the following Guides can be found here or the links to follow (This information is provided for reference only and is not necessary for the Course).  

 

Initial Approaches to Treatment Guideline (06-30-2017)

Cervical and Thoracic Spine Disorders Guideline (05-27-2016)

Shoulder Disorders Guideline (08-01-2016)

Elbow Disorders Guideline (2013)

Hand, Wrist, and Forearm Disorders Guideline (06-30-2016)

Low Back Disorders Guideline (02-24-2016)

Knee Disorders Guideline (10-28-2015)

Ankle and Foot Disorders Guideline (2015)

Eye Disorders Guideline (04-01-2017)

Hip and Groin Guideline (05-01-2011)

Occupational/Work-Related Asthma Medical Treatment Guideline (01-04-2016)

Occupational Interstitial Lung Disease Guideline (01-04-2016)

Chronic Pain Guideline (05-15-2017)

Opioids Guideline (04-20-2017)

  

Special Topics

 

The special topics of the MTUS addresses issues in common across the clinical topics and are set forth in § 9792.24.1 et seq. of Title 8, California Code of Regulations. The chronic pain guidelines are set forth in § 9792.24.2 of Title 8, California Code of Regulations. The chronic pain guidelines (May 2009) consist of two parts and one appendix.

 

The Chronic pain medical treatment guidelines document includes the information for this course and core principles related to chronic pain.  The reader is encouraged to review the most recent updated Chronic Pain Guides paying attention to current recommended and not recommended treatments (See the Chronic Pain MTUS, 2017 – specifically the summary Table on pages 45-47). More information about accessing the guidelines will be discussed subsequently.

 

Presumption of correctness

 

The MTUS is presumed to be correct on the issue of extent and scope of medical treatment and diagnostic services it addresses. However, that presumption can be set aside by a preponderance of scientific medical evidence using strength of evidence criteria to show that a variance from the schedule is reasonably required to cure or relieve the injured worker from the effects of his or her injury. For all conditions or injuries not addressed by the MTUS, authorized treatment and diagnostic services must be in accordance with other scientific, evidence-based medical treatment guidelines that are nationally recognized by the medical community as set forth in § 9792.25 of Title 8, California Code of Regulations.

 

As found on the DWC website, “The MTUS regulations also contain rules to determine what is reasonable and necessary care in the two limited situations that may warrant treatment based on recommendations found outside of the MTUS treatment guidelines. Recommendations found in the MTUS guidelines are presumed correct and will automatically be applied to guide patient care, unless the injured worker’s injury or condition is not addressed by an MTUS medical treatment guideline or if the treating physician disagrees with its recommendations and wishes to rebut the presumption of correctness.

 

The MTUS regulations describe the medical evidence search sequence that guides the order in which a search for medical evidence shall occur and also establishes the methodology that shall be applied by reviewing physicians when evaluating conflicting recommendations. The MTUS is based on the principles of evidence-based medicine. The MTUS regulations establish a systematic methodology to determine the quality and strength of evidence used to support treatment recommendations for a medical condition or injury. Recommendations supported by the best available evidence shall be used to guide treatment decisions.”

 

Take the Course

 

To take the course, review the original MTUS Chronic Pain Medical Treatment Guidelines.  These Guidelines, adopted July 18, 2009, update the ACOEM Practice Guidelines and are presumed correct.  Then review the most recent summary Table for recommended and not-recommended treatment (See the Chronic Pain MTUS, 2017 – specifically the summary Table on pages 45-47). At any time, you can take the test.  For this course, the individual Help-Feature for each question is not available.  However, you can take the test as many times as you like, until you pass.  You will receive feedback each time you submit the test for scoring, until you pass. We hope you enjoy the course and reviewing this valuable information. To access a copy of the Chronic Pain Treatment Guidelines from the DWC website, click here. To access a copy in pdf format from this website click here.  The documents are identical. To access a copy of the 2017 updated Chronic Pain MTUS click here.

 

OTHER RESOURCES

 

The Division of Workers’ Compensation (DWC) announces that medical providers who treat injured California workers can now have free online access to the State’s Medical Treatment Utilization Schedule (MTUS) guidelines. Licensed healthcare providers who treat California injured workers can use MDGuidelines: CA MTUS-ACOEM Edition to quickly search the latest evidence-based recommendations incorporated into the State’s MTUS. Providers who perform qualified medical evaluations, utilization review or independent medical review can also register to use the online tool free of charge. Providers must register in order to gain access to the site administered by the Reed Group. The site includes online training webinars and instructions. Users can email MTUS@reedgroup.com for more information or register here.

 

 

 



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