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Sixth Edition Structure
The Sixth Edition is 634 pages in length and
is comprised of 17 chapters; it is similar in length to the
Fifth Edition (613 pages) and has one less chapter since the
Cardiovascular System is now a single chapter. Chapter 1,
Conceptual Foundations and Philosophy and Chapter 2, Practical
Applications of the Guides define the overall
approaches to assessing impairment. Most impairment ratings
are performed for musculoskeletal painful conditions;
therefore the most commonly used chapters will be Chapter 15,
The Upper Extremities, Chapter 16, The Lower Extremities, and
Chapter 17, The Spine and Pelvis. Chapter 3, Pain-Related
Impairment, Chapter 13, The Central and Peripheral Nervous
System and Chapter 14, Mental and Behavioral Disorders will
also be frequently referenced. Chapters 4 to 12 focus on other
organ systems and structures. A comparison of chapters and
length is presented in Table 1.
Click here to view the differences in chapters:
Table
1. Comparison of AMA Guides Chapters: Fourth, Fifth and Sixth
Editions
The most significant change with the Sixth Edition is the
development of Impairment Classification Grids based on the
ICF model. To appreciate the overall impact of the Sixth
Edition it is helpful to summarize the chapters most often
referenced: the first two chapters, the musculoskeletal
chapters, and the chapters on the nervous system and mental
and behavioral disorders.
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International Classification of Functioning,
Disability and Health
The Sixth Edition uses the framework based
upon the International Classification of Functioning,
Disability and Health (ICF), a comprehensive model of
disablement developed by the World Health Organization. This
framework is intended for describing and measuring health and
disability at the individual and population levels. The ICF is
a classification of health and health related domains that
describe body functions and structures, activities and
participation. The domains are classified from body,
individual and societal perspectives. The ICF systematically
groups different domains for a person in a given health
condition (e.g. what a person with a disease or disorder does
do or can do). Functioning is an umbrella term encompassing
all body functions, activities and participation; similarly,
disability serves as an umbrella term for impairments,
activity limitations or participation restrictions. Since an
individual's functioning and disability occurs in a context,
the ICF also includes a list of environmental factors.
The following definitions are used in the ICF to facilitate
communications and standardization:
- Body functions: physiological functions of body
systems (including psychological functions).
- Body structures: anatomic parts of the body such
as organs, limbs, and their components.
- Activity: execution of a task or action by an
individual.
- Participation: involvement in a life situation.
- Impairments: problems in body function or
structure such as a significant deviation or loss.
- Activity limitations: difficulties an individual
may have in executing activities.
- Participation restrictions: problems an
individual may experience in involvement in life situations.
The ICF model reflects the dynamic interactions
between an individual with a given health condition, the
environment, and personal factors. Impairment, activity
limitations and limitations in participation are not
synonymous; an individual may have impairment and significant
limitations in most activities but be able to participate in a
specific life situation of relevance, have minor impairment
and activity limitations with inability to participate in a
specific life situation, or any permutation of these three
factors.
Use of the ICF model does not indicate that
the Guides will now be assessing disability rather than
impairment. Rather, the incorporation of certain aspects of
the ICF model into the impairment rating process reflects
efforts to place the impairment rating into a structure that
promotes integration with the ICF constructs for activity
limitations and limitations in participation, ultimately
enhancing its applicability to situations in which the
impairment rating is one component of the "disability
evaluation process".
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B & A Team is Growing & Evolving to Better
Serve You
2008 will be a superb year - we have worked
diligently to come together as a team and to consistently
exceed the expectations of our clients.
Mindy's role as Director of Marketing & Communications
does not accurately reflect her responsibilities. She will now
take on the title Vice President of Operations - this
encompasses not only her work with marketing, but also playing
an integral role within the operation of our company. She is
responsible in working with all of us in ensuring our products
and services are of high quality - and performed efficiently
and smoothly. Responsibilities also involve hiring staff,
supervision, training and functioning of employees in the San
Diego office, overseeing daily operations in the San Diego
office, and maintaining positive client relationships. Mindy
will be on maternity leave beginning in April and is planning
to take about 8 weeks off. Email Mindy
Brigham
As Mindy moves into this role, she will be working closely
with Krystle who will be our Marketing and Graphic Design
Specialist. Krystle has been our administrative support for 9
months now and has decided to take on the new challenge of
learning how to market our services and is eager to begin
contributing more by putting her marketing and graphic design
education to better serve our clients. She has begun traveling
to conferences this month to "learn the ropes". Krystle's
background in graphic design will be put to better use;
assisting me on improving projects and presentations as
needed. Email Krystle
Llanto
Rachel Thurber is our newest team member and will be
providing our administrative support. Rachel is experienced in
this area, however is new to our industry and excited about
the challenges ahead. We are thankful to have her on staff.
Email Rachel
Thurber
Our team is dedicated to our clients and always striving to
exceed your expectations. Please feel free to contact us at
any time with questions or feedback. We look forward to
assisting you!
Warm Regards,
Chris Brigham
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Hello Everyone! We have a lot of exciting events beginning
in February. One other big event is our move. We are growing
and expanding into a new office space. We will still be
located in the same office building: 8885 Rio San Diego Drive,
San Diego, CA 92108 but our new suite number will be 310.
We plan on being up and running in our new space on
February 4, 2008. As a result of our move this week, our fax
might be down part of the day on Friday. So if you fax over a
referral or records, please call 1-888-262-1202 to make sure
that it was received. Don't forget to make note our new
location and we look forward to seeing and working with all of
you this year!
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Impairment Rating Values |
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The Sixth Edition reflects very substantial change, a
change more significant than any prior Edition change. With
the Sixth Edition the impairment values for the most
frequently used impairments and diagnoses are similar to the
Fifth. However, some adjustments were required, with certain
ratings being lower and others higher. There are conditions
that did not receive ratable impairment in the past (such as
lateral epicondylitis and non-specific spinal pain) which in
certain circumstances may now be ratable as Class 1 (mild)
impairments. Sixth Edition ratings are based more on the
end-result and the impact on the patient, rather than what
types of treatments or surgeries have been performed.
Therefore, other ratings (such as spinal fusions) will receive
lower ratings.
In assessing the impact of the Sixth Edition it is
important to consider whether original or expert ratings are
being considered as the baseline. Most impairment ratings
performed by the Fourth and Fifth Editions have been shown to
be erroneous when these original ratings are reviewed by
experts in the use of the AMA Guides. Therefore in
comparing differences it is important to determine the
relative change from observed ratings and those that are
consistent with the Guides.
The full impact of changes in ratings will not be available
until a large number of cases have been rated or comparative
studies are performed where cases are rated by both the Fifth
and Sixth Editions. It is critically important to understand
this impact on the systems that make use of the Guides.
Comparative studies of ratings performed by the Third
Edition, Revised, Fourth Edition and Fifth Edition concluded
that the Fourth and Fifth Editions are more complex than the
Third Edition, Revised, and, in general, require more effort
by rating physicians and result in lower ratings.
Erroneous ratings with prior editions often occurred
because unreliable examination findings were used to define
impairment. With the Sixth Edition it is probable that the
errors will result more from inaccurate diagnoses and
misclassification of the Class of impairment. The definition
of the Class of impairment is the most significant factor in
defining the extent of impairment. |
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CompTalk
Radio on the Sixth Edition |
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CompTalk Radio Discusses the Sixth Edition of the AMA
Guides to the Evaluation of Permanent Impairment -
Recorded Thursday, January 3 2008.
Take a detailed look at the new Sixth Edition of the AMA
Guides to the Evaluation of Permanent Impairment with
Senior Contributing Editor and noted expert Dr. Christopher R.
Brigham. In the first of a two part interview, Dr. Brigham
shares with the audience an overview of the history of the
Guides, and the work, focus and changes that went into
this latest edition.
You may listen to the program by clicking
here (25 Minutes - you may be prompted to allow an
Active X Control to run. This is only to allow the Quicktime
Player to function) To download this program for later
playback on your MP3 player, Right Click Here and choose "Save
Target As".
For more information you may visit
www.sixthedition.com.
Part 2 of this interview was released on January 17,
2008.
Click
Here to Listen. |
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AMA
Guides, 5th Edition: 101 Webinar
Series |
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Brigham & Associates, Inc. and Insurance Education
Association Present the AMA Guides, 5th Edition: 101
Webinar Series
The Fundamentals is an overview on the use of the AMA
Guides, 5th Edition, with a focus on principles of
impairment evaluation, and assessment of spine, upper
extremity, lower extremity, neurological, and pain
impairments.
The seminar is offered in four convenient two hour
sessions, totaling eight hours of superb training. This
seminar is designed for physicians, attorneys, and claims
staff with minimal or no experience in the use of the
Guides. It is also an excellent review for individuals
who may have attended an introductory course and desire
further review and clarification. Most individuals require two
to three learning experiences to grasp the complexities of
impairment evaluation.
At the conclusion of these Guides Webinars you will
be able to:
- Demonstrate the appropriate use of the AMA Guides to
the Evaluation of Permanent Impairment, 5th Edition in
assessing musculoskeletal, neurological and pain impairment.
- Explain how to review an impairment evaluation report to
determine if the rating is accurate or not.
- Describe specific claims and legal strategies to manage
erroneous ratings.
The schedule for this series is
as follows:
- Wednesday, March 5th, 2:00-4:00 p.m.
PST:
Overview, Lower Extremity
- Wednesday, March 12th, 2:00-4:00 p.m. PST:
Upper
Extremity
- Wednesday, March 19th, 2:00-4:00 p.m.
PST:
Spine
- Wednesday, March 26th, 2:00-4:00 p.m. PST:
Other
Chapters & Strategies For More Info Click
Here
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6th Edition
Seminar in San Diego, CA
- February 4, 2008
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The new Sixth Edition of the AMA Guides to the Evaluation
of Permanent Impairment has just been published. It is
dramatically different from any prior Editions. It is
imperative that you understand how these changes will
profoundly impact impairment assessment and your management of
these cases. We highly recommend that you register in advance
and forward this email to all of your colleagues (including
attorneys and physicians) - everyone will want to attend and
space is limited. It is probable that this will be the only
offering in CA this year - an event not to be missed.
Click here to register: http://www.impairment.com/6thEditionSeminar.htm
The American College of Occupational and Environmental
Medicine designates this educational activity for a maximum of
7.5 AMA PRA Category 1 Credit(s). Physicians should only claim
credit commensurate with the extent of their participation in
the activity.
Dr. Brigham had the opportunity to serve as the Senior
Contributing Editor to the Sixth Edition and is Editor of the
Guides Newsletter and Guides Casebook, therefore he can
provide you with a unique inside perspective. It is essential
that you understand the profound impact of the innovative
approaches in this new Edition- this may be the most important
seminar you attend in 2008. |
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