Volume 1 | Issue 1

Medical Peer reviews & Medical records Processing solutions

Many issues are relevant for health facilities in 2016 as coming from the scrutiny of the OIG. If multiple services are offered by one company,

it will streamline your current in-house management of medical services. Imagine being able to pool services such as peer reviews, comprehensive reviews, worker’s com-pensation claims, auto liability reviews along with being able to depend upon additional services such as data entry, clinical prep and management/administrative solutions.

Looking closer at the services available, a peer review is when a state and specialty matched physician will review the medical records of a claimant provided, evaluate the case based on the appropriate guidelines and evidence based medicine to determine medical necessity of the services requested. Direct contact with the treating phy-sician is made in a peer to peer phone conversation in order to obtain additional specific information to facili-tate approval. If the reviewing doctor is not satisfied that the information provided substantiates medical necessity, then the claim is deemed not medically necessary and the treatment is denied.

In 2016 new OIG laws go into effect that make peer reviews an essential step in cost containment.

Pain management strategies lead to quicker recovery after surgery

Breakdown of the workers’compensation medical dollar:

Physician/Hospital = 46%Physical medicine = 22%Pharmacy = 15%Diagnostic Imaging = 9%DME/Home health = 8%

Medical Peer Reviews, LLC. • 4870 Sadler Road Suite 300 • Glen Allen, VA 23060p: 844.887.5088 / f: 720.368.3786

www.medicalpeerreviews.comUtilization Management | Comprehensive Peer Reviews | Workers Compensation

Medical Records Processing | Clinical Summaries | Administrative Services

FEBRUARY 2016

newer Pain ManageMent strategies can lead to quicker, shorter recovery after total knee rePlaceMents

According to a new literature review in the February issue of the Journal of the Ameri-

can Academy of Orthopaedic Sur-geons ( JAAOS), a team-based care approach (consisting of the patient,

family members, the orthopaedic surgeon and other medical practi-tioners) on total knee replacement (TKR) procedures, in conjunc-tion with newer pain management strategies, is key to maximizing patient outcomes.

“Managing post-surgical pain is key to promoting early postopera-tive mobility, reducing medication side effects, and increasing patient satisfaction,” says Dr. Moucha.

Traditional pain management for TKRs include a computerized pump called the patient-controlled analgesia (PCA) with or with-out an epidural which can lead to nausea, vomiting, urinary retention, low blood pressure, constipation

and itching. Newer pain-control strategies—referred to as multi-modal protocols—more effectively manage pain and limit side effects. These include (below):

• a combination of pain management medications (e.g., oral medications and nerve blocks) taken before and after surgery;

• regional anesthesia with pre-operative nerve blocks performed by an anesthesiologist; and,

• intra-operative pain injections performed by the orthopaedic surgeon within the knee.Multimodal protocols are found to:

• lower patient pain severity ratings in the first few days following surgery;

• minimize unwanted side effects more commonly associated with traditional pain control protocols;

• reduce the overall amount of narcotic pain medication needed for postoperative pain control; and,

• help patients be better able to participate in early postoperative physical therapy and be more satisfied with their postoperative

pain control.The study authors also note that:

• patients should avoid long-term chronic narcotic use for knee arthritis pain control prior to surgery because it can lower the patient’s pain threshold and result in increased postoperative pain;

• patients should not abruptly stop oral medications as there is a risk of rebound pain and the development of chronic pain. Many patients will use their prescribed medicines for least the first two weeks after surgery, then taper off as tolerated;

• pain medication may be necessary beyond the first two weeks for certain activities such as physical therapy sessions, but first speak to your orthopaedic surgeon about this; and,

• a strong support system (family, friends, or a combination of both) can be very helpful to the patient in achieving the quickest recovery

“Managing post-surgical pain is key to promoting early postoperative mobility, reducing medication side effects, and increasing patient satisfaction,” says Dr. Moucha.

February 2016 | Volume 1 | Issue 1

in July 2007, accuPuncture was aPProved as a forM of treatMent for wc inJuries in california.

See story in March 2016 newsletter.