Thursday, February 9, 2012

AZ Debate on Guidelines: It's All About Big Medicine

Arizona is going through the treatment guideline debate, and experiencing the influence that Big Medicine can have on politics that can cause illogical policy creation.

The Arizona House Banking and Insurance Committee on Monday heard more than three hours of testimony on three bills, one of which would create a presumption of correctness for national evidence-based treatment guidelines. That bill was deferred for further research and to address concerns that were expressed during the hearing.

The guidelines debate is all about the state creating its own set of guidelines, as if people in Arizona have different biology than people in California, New York or Texas.

House Bill 2365 would give the Arizona Industrial Commission until July 1, 2014, to develop evidence-based treatment guidelines. If the commission is not able to produce guidelines by that date, the bill would mandate that either American College of Occupational and Environmental Medicine's (ACOEM) Practice Guidelines or the Work Loss Data Institute's Official Disability Guidelines (ODG) are presumed correct for the extent and scope of treatment.

Objection came vociferously from Medtronic.

Marybeth Thorsgaard, senior director of public relations and communications for Medtronic, told WorkCompCentral on Wednesday that the device manufacturer is opposed to the bill because using only ACOEM guidelines will limit the ability of injured workers to access widely-accepted medical treatments.

"ACOEM guidelines reflect the very conservative world view of one professional society, considered expert in most areas and therapies reviewed," she said. "This conservative philosophy is reflected in numerous therapies not allowed by the guideline -- therapies that are widely accepted, evidence-supported treatments, procedures, tests or therapies that are currently covered under Medicare, Medicaid, most commercial policies, the Department of Defense Veterans Affairs -- creating a two-tiered system for workers' compensation patients."

And, I might note, therapies in which Medtronic has considerable business interests.

Thorsgaard said lawmakers in Arizona should follow a trend seen in other states, such as Colorado, Montana, Delaware and Wisconsin, by tweaking the guidelines, using input from providers. She said guidelines for treating back injuries should have input from back specialists in Arizona. Pain treatment guidelines should be based on input from pain specialists in the state.

Is that because back and pain specialists in Arizona know more than doctors in the other 49 states? Or because the population of Arizona is unique?

Thorsgaard said Medtronic would remove its opposition to the bill if the amendment removed the default to ACOEM or the Work Loss Data Institute.

Medtronic makes implantable surgical hardware. Traded on the New York Stock Exchange (symbol MDT), and last year sold almost $15 Billion in goods.

"We would have no objection to a bill that established an independent medical panel to create an Arizona-specific guideline with no default to a national guideline," she said. "This would give Arizona providers input into their own guideline and give specialists the ability to provide expertise in specific areas under review."

And would give lobbyists an ability to influence state regulators to ensure Big Medicine is included in treatment guides. Divide and conquer is long been a successful business practice where an industry has 50 or more different regulators.workers compensation, work comp, injured worker

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