Functional Limitations Explained

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There’s a lot of confusion and misconception about the terms of use of “work tolerance”, “work capacity” and “work restrictions”.  When we read impairment reports “work restrictions” tend to be the term utilized most frequently. Actually, the exact opposite is true.

We’re here to help set the record straight on definitions.

A Physician’s Guide to Return to Work (Talmage et al., 2005. A Physician’s Guide to Return to Work. AMA Press) offers useful definitions for these terms  to better describe and communicate these concepts.

Work tolerance is the most common of all work limitations encountered. Tolerance simply means the patient’s symptoms preclude them from participating in certain activities. For example, the employee may have a normal MRI of the shoulder, a normal range of shoulder motion on exam, yet pain symptoms preclude work at or above shoulder level height.

Work capacity is the second  most common of all work limitations encountered. Work capacity refers to a well defined underling medical condition which precludes the patient from performing an activity. In this example a patient with shoulder adhesive capsulitis may demonstrate specific findings on MRI and the condition may also be verified on physical exam testing. For example, the patient may have mechanical limitation preventing motion of the shoulder above 90 degrees. In this situation patient has a medical capacity which limits working at or above shoulder level height.

Work restrictions are the least common of all work limitations encountered. Work restrictions are activities the patient can do, but should not perform because of the risk of significant injury or loss of life. For example,  the patient who has a seizure disorder may have a restriction precluding the driving of a car, because of the possibility of losing control of the vehicle.

We understand that the term “work restriction” has become a cultural term used in many administrative forms, however, inappropriate usage causes unnecessary confusion and delay. Begin using the correct terminology for tolerance, capacity and  restriction to more effective communication in reports and correspondence. Your reward will be faster and more accurate results.

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How to use an inclinometer to measure the spine’s range of motion

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Pronunciation: /ˌinkləˈnämitər

The inclinometer is a tool used to determine angles of motion—particularly when measuring the spine.

Besides being fun to say, an inclinometer is nothing more than a fancy level with a protractor on it.

How to use an inclinometer

Because the spine has motion at both the top and lower segments its necessary that two inclinometers be employed simultaneously for recording the dynamic motion. One inclinometer is placed at the top of the measured spine segment, and the other at the lower spine location. The measurement value of the lower spine is subtracted from the upper spine value. This result is known as the “true angle”.

Types of inclinometers

There are two types of inclinometers: manual and digital.

The manual inclinometer, sometimes referred to as a “bubble inclinometer” has a fluid filled face in a circle. The fluid is a combination of a colored fluid and a clear fluid. The fluid interface moves with gravity, and the movement of the interface is used to read the measurement off a rotating 360 degree face dial.

Manual inclinometers

Measuring spine motion with the manual inclinometer requires a bit of practiced talent. The patient is instructed to stand in the upright position and the dial faces are set to the 0 degree position. The user must then hold the two inclinometers at once on the spine while movement is measured. It sounds easy, but in practice for the first several exams, it is difficult. The user must coordinate the physical control of the inclinometer while also performing the calculations and documenting the findings. When using the dual manual inclinometers for the first time, it is like trying to catch a falling snake. Patience is a virtue and persistence is necessary to capture accurate and consistent measurements.  The upside of the manual inclinometer is that they are relatively inexpensive ($50 each on Amazon as of the writing of this article), and no batteries are necessary. The down side is they do take some practice and can be difficult to read due to the small print face. A good pair of reading glasses are recommended.

Digital inclinometers

Digital inclinometers have been gaining some popularity because of ease of use and automatic calculation of the true angle. Digital inclinometers are two electronic gravity sensors which have ability to standardize a zero measuring reference with the click of a button. They are approximately the size of a pocket-watch and are typically connected by an electronic cord. One end is the measurement reading end (typically referred to as the “master”) placed at the top of the spine. The other device is placed at the lower segment of the spine section (typically referred to as the “slave”). The upside of the digital inclinometer is the ease of use during exam, and it automatically calculates the true angle. The downside is the device may not have an auto off feature.  This means it is easy to leave on, and may be found dead for the next exam. Additionally, digital inclinometers are expensive and can range into the hundreds of dollars.

Conclusion

Regardless of the style of inclinometer used, understanding the inclinometer and its function is essential for accurate and well supported impairment report (PR-4 Report) conclusions. The time invested in becoming familiar with the inclinometer will result in faster and more accurate report for patients, workers’ compensation insurance carriers, employers, and administrators.

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RateFast: Now With Built In Billing Calculator

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Built In Billing Calculator:  Enough said.

Think of the time and money spent when you have to create PR-4 report billing codes.

RateFast now saves you this time and money by creating codes automatically based on user input.  The codes may be printed along with the documentation in your report.

This is a free optional feature, and is updated for the January 1st 2014 RBRVS (Research Based Relative Value Scale) new billing requirements.

Insurance carriers pay for accurately documented and correctly coded reports. Create one today with RateFast Express.

A Stretch In Time Saves Nine

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This quick and simple trick will greatly improve the accuracy of your impairment rating reports.

What’s the secret of reproducible measurements? Having patients do warm up exercises before taking down the exact numbers.

You’ll find that taking the the time to encourage your patient to do two or more warm up exercsises before taking measurement is absolutely worth it.

Your results will be more accurate and consistent, with greater reproducibility. Reproducibility within 10% is necessary for measurements to be considered valid by the AMA guides. Reproducible measurements also support stronger impairment conclusions. Although it may seem like extra work, the time you’ll save doing measurements on a patient that is properly warmed up will limit the need to reproduce measurements later on because your exam findings were off by more than 10%.

Don’t forget to do both the right and left side (yes, even the non-injured side!) so that you may compare measurements.

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The RateFast Philosophy

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A lot of impairment rating reports (like PR-4 reports) are wrong. By “wrong,” we mean that many impairment ratings are not calculated according to the rules in the AMA Guides.

The insurance company has no standardized easy method to verify the doctor’s conclusions. The patient who depends on the doctor and the insurance carrier to correctly assign some monetary value to the injury is doubly in the dark.

Who loses when the impairment report is incorrect?

Everyone.

The doctor often needs to create a supplemental report to correct the rating and do the work twice. The insurance carrier has to re-issue a settlement and do the work twice. The patient loses faith in the accuracy of the doctor’s abilities, and has no choice but to endure additional delay. The employer’s insurance premiums are affected by the overall cost of the process.

There is good news, however. This story doesn’t need to happen anymore because doctors, carriers and patients can use  RateFast. RateFast is a web based program designed specifically to create or check the accuracy of California PR-4 reports.

The RateFast philosophy is simple: “Impairment ratings should be done right the first time.”

The RateFast answer is waiting for you now, just a click away on any internet device.

RateFast For Doctors

Doctors, you can start doing California PR-4 reporting accurately, quickly and confidently using RateFast.

Simple exam menus speed up reporting time and accuracy. RateFast is transcribing your report and preparing the impairment rating, leaving you free to communicate more meaningfully with the patient. Submit the report for rating with the click of a mouse or a tap on your iPad.

RateFast stores all of your workers’ compensation reports in digital form. You can also write Doctor’s First and PR-2 reports.

Doing work right the first time means more time getting paid, and less time fixing mistakes.

RateFast for Insurance Carrier Adjusters and Attorneys

Insurance carrier adjusters, start verifying the correct values of California PR-4 reports using our administrative portal. Simply provide the information for the PR-4 report that you need to review. Based on the hard facts of the claim, you’ll receive an impairment rating that is completely justified according to the AMA Guides.

RateFast for Patients

Patients, make sure your doctor is using RateFast. Ensure that your California PR-4 reports are complete and consistent with the California AMA Guides 5th Edition guidelines.

 

To check us out, go to our main website, www.Rate-Fast.com. Simply create an account, log in, and in seconds find out how easy and accurate California PR-4 report is done.

RateFast: Finally, A Solution That Works

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Who among us is frustrated with the broken process of creating California PR-4 reports?

See the patient in a hurried clinic schedule. Take some measurements, or maybe not. Scribble some notes on the paper chart. Place it on a stack to be done later, much later. Because there are so many other tasks to do without the required block of time necessary to write a PR-4 report.

Why do we repeat this process day after day, month after month, year after year?

Why? We’re too busy to find a solution.

Well, a solution just found you. The solution is RateFast.

RateFast is a web-based application like no other solution you have ever imagined. RateFast is complete point of service impairment reporting.

RateFast turns the ugly PR-4 report cycle on its head, and makes reporting simple, fast, profitable, and fun. Yep, we said “fun”.

Simply create an account, log in and in seconds you will be interviewing patients, taking guided measurements instructed by our interactive menus. All the while RateFast is transcribing your report and preparing the impairment rating while you are with the patient. Submit the report with the click of a mouse or the tap of an iPad.

At the end of your office visit your report is done. Yes, we said “done”, and that rhymes with “fun”.

…and best of all, with the extra time you finally get to meet those people who live in your house. They’re called your family.

Click here to start today and receive your first two reports entirely free.
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RateFast: California Worker’s Compensation PR-4 Reports Get A Total Makeover

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Creating California PR-4 Reports just got easier for California workers compensation primary treating physicians. Gone are the confusing patient visits, incomplete questions and physical exams. Forget wrestling late nights with the AMA Guides tables and charts. Introducing RateFast.

RateFast is the first cloud-based comprehensive platform for creating complete and accurate California PR-4 Impairment reports.

Doctors simply create an account and start reporting.

RateFast has simple easy to use menus that guide the doctor and patient through the impairment rating process in the exam room.

Menus are customized to each patient’s individual injury. RateFast transcribes the impairment report as the doctor inputs relevant symptoms and physical exam findings.

The doctor’s findings are used by RateFast to create objective and supportable medical conclusions, including a whole person impairment rating (%WPI), in an easy to understand format.

Everyone benefits from a fast and accurate impairment report done right the first time.

Click here to start today and receive your first two reports entirely free.

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