California MTUS: A Mixed Bag

| | Evidence Based Medicine, Physician Peer Review, Utilization Review

Dr Cortes MTUS Article Feb 2016

The California Department of Workers Compensation (CDWC) will host its Educational Conference February 25-26 at LAX Marriott in Los Angeles. CDWC will host another conference at the Oakland Marriott March 3-4. One of the hot topics to be discussed is the Medical Treatment Utilization Schedule (MTUS), with an eye toward how it can be improved. In this article, I discuss the history of the MTUS and share with you my thoughts on the MTUS based upon my years of medical practice.

A Little MTUS History

In 2004, California became a “UR state” via SB 228 and SB 899. As a part of requiring utilization review as a cost containment measure, the state adopted the 2004 American College of Occupational and Environmental Medicine (ACOEM) guideline. This was per statute. In 2007, the Administrative Director changed the MTUS to be ACOEM plus the Colorado acupuncture guidelines. In 2009 MTUS was changed again to add post-surgical guidelines and chronic pain guidelines that came from the Official Disability Guidelines (ODG). The last time the MTUS was updated was July 18, 2009.

What Are the Strengths of the MTUS?

My favorite thing about the MTUS is that it is concise. Many guidelines contain superfluous information. It’s as though the authors thought that creating “more information” about a topic would result in greater value. In truth, the opposite is usually the case. When I am looking at a guideline I want it to be concise and laser focused. Just give me what I need. That has always been a strong suit with the MTUS, and it remains so to this day.

What Are the Weaknesses of the MTUS?

I have found that the MTUS is simply not current with many treatment requests. As stated previously, it has not been updated since 2009. Much has changed since then, and many newer treatments that have been scientifically proven to be beneficial for injured workers are simply not addressed. When we see a treatment request that is not covered by the MTUS, we often look at the Official Disability Guidelines (ODG) published by the Reed Group. ODG is well respected in the medical community. But that begs the question. Why doesn’t California update MTUS or simply adopt ODG?

If I Could Waive a Magic Wand

I would like to see the CDWC either update the MTUS so that it has a much broader scope (similar to ODG) or adopt ODG as the required guidelines. My concern about updating the MTUS is that it may take years to complete. This is because, understandably, there is an intense vetting process to decide what to include in the guideline. I also believe CDWC should have a plan in place to update any guideline it produces. Any guideline frozen in time is not optimal. If we want the latest treatments that have been scientifically proven to be beneficial to injured workers then we need a guideline that is continually updated.

Zenia Cortes, MD, Orthopedic Surgeon

Dr. Zenia Cortes brings her combined expertise in sports and orthopaedic medicine to UniMed Direct, along with insights from her experience in peer and utilization review.