Survey Reveals Overall Favorable Response to AMA Guides Sixth Edition

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Early response to the AMA Guides Sixth Edition has been mixed but is generally favorable according to the results of a survey performed by Brigham and Associates, Inc., inviting feedback from attendees of their live and web-based seminars and from purchasers of the Sixth Edition through their website http://www.impairment.com.

The AMA Guides to the Evaluation of Permanent Impairment is the recognized international standard used to quantify the impact of an injury and disability. The new Sixth Edition, published in December 2007, addresses many of the criticisms of prior Editions and reflects significant evolution in the impairment evaluation process. According to Christopher Brigham, MD, Senior Contributing Editor to the Sixth Edition, early response has been mixed, with generally favorable feedback from physicians and criticism from plaintiff's counsel. A survey was performed by http://www.impairment.com (Brigham and Associates, Inc.) to better understand the reaction to the new Sixth Edition by various stakeholders.

An invitation was sent to over seven hundred individuals who participated in live and web-based training programs provided by Brigham and Associates, Inc., or who purchased Sixth Edition publications. Of the 115 respondees, the three largest groups responding were physicians 38%, chiropractors 19% and plaintiff attorneys 10%. Although the sample size is small, it does provide some insights to reactions to the Sixth Edition.

The Guides are used in workers compensation cases by 83% of the responders, followed by personal injury by 55%, and automobile casualty by 45%. The Fifth Edition is used for workers' compensation cases by approximately one half (53%), the Sixth Edition by 36% and the Fourth Edition by 15%; some respondees reported using multiple Editions. Approximately one quarter (26%) are currently using the Sixth Edition for workers' compensation cases, 22% anticipated its use within the next year, and an additional 9% anticipated its use within the next two to three years; therefore most expected use of the Sixth Edition with the next three years. The Guides are used for different purposes in state workers' compensation cases, including as direct determinate of disability (18% of respondees), used in a specific formula (with other factors) to rate disability (17% of respondees), used among other considerations to rate disability (19%), used to rate scheduled injuries (15%), and as threshold determinate (i.e. differentiates more severe losses, 8%). 11% percent did not know how the Guides were used for workers' compensation cases in their states. Impairment ratings were reported as important or very important by nearly all (89%). Most had considerable experience with prior Editions of the Guides (82% reported having performed or reviewed 30 or more ratings), but only minimal experience with the Sixth Edition (only 6% had experience with 30 or more ratings.)

The response to the Sixth Edition appears to correlate closely with professional groups. Overall, 48% agreed or strongly agreed that the Sixth Edition is a significant improvement from prior Editions and 33% disagreed; 60% of physicians and 41% of chiropractors agreed it is an improvement; however the vast majority (94%) of plaintiff attorneys disagreed. Of the seven defense attorneys who responded, four agreed it is a significant improvement, one was neutral and two disagreed. Of the nine claims professionals who responded to this question, 55% agreed it is a significant improvement, 22% were neutral and 22% disagreed. Therefore the majority of the groups agree that is an improvement, with the exception of plaintiff's counsel.

Although nearly everyone felt emphasis on function is important, a higher percentage of physicians (81%) and chiropractors (83%) shared this emphasis than the attorneys (56%). Only 7% of these attorney respondees felt that the use of the International Classification of Functioning, Disability and Health (ICF) is appropriate with the Guides; however 69% of physicians and 59% of chiropractors supported the use of the ICF model. There was agreement by all that the concepts of impairment and disability are often confused.

55% of physicians agreed or strongly agreed with the statement that ratings will be more reliable with the Sixth Edition, 26% were neutral, and 9% disagreed. None of the plaintiff attorneys agreed that ratings will be more reliable, 12% were neutral and 88% disagreed. 55% of physicians also agreed the impairment values were more reasonable, 35% were neutral and only 11% disagreed; in contrast none of those attorneys agreed, only 6% were neutral and 94% disagreed. Many physicians reported that the Sixth Edition was much better than prior Editions in terms of being clearer (56% reported better or much better versus 23% reported worse or much worse), easier to use (54% better vs. 25% worse), more internally consistent (68% vs. 5%), more reliable (62% vs. 11%), and more inclusive for conditions (69% vs. 8%); approximately one quarter of the physicians were neutral on these issues. These responses are in stark contrast to those provided by plaintiff's counsel who felt the Sixth Edition was much worst in terms of clarity (73%), ease of use (57%), internal consistency (60%), reliability (73%), and inclusivity (57%).

In summary, and understandably given its recent publication, there has been minimal experience in the use of the Sixth Edition to date. More experience is necessary to reach definitive conclusions, but the response so far to the Sixth Edition has been mixed with generally favorable response by physicians and negative response by plaintiff attorneys. Further information on the Sixth Edition is available at http://www.sixthedition.com.

About Brigham and Associates:

Brigham and Associates, Inc. (http://www.impairment.com) was founded in 1995, and is recognized as the nation's leading resource on impairment, disability and causation evaluation. Their well-trained and highly credentialed professional staff utilize advanced Web-based technology and database systems to provide high quality, cost-effective consultation services, including impairment report critiques and case reviews. The firm also provides evaluation resources, publications and training in live, web-based and online education formats.

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Mindy Brigham
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