Steve Cattolica Aug 9, 2017 09:44 AM
One of the issues with adopting already out-of-compliance guidelines is that they are out of compliance the very day they are adopted. To say that ACOEM is considering revisions and that those revisions "should be published â€œshortly,â€" provides no guidance to the community whatsoever. Similarly, to state that the elbow chapter, last updated in 2013, "will be reviewed next year," could mean that the review and update process will begin, not end, during the year in which those guidelines fall out of statutory compliance. ACOEM's statement provides no indication how long the community may need to use "work-arounds." However, it is clear that work-arounds might start immediately for any injuries or illnesses involving the hip and groin - to be followed shortly by elbow injuries. It is also important to keep in mind that those obsolete guidelines will be presumed correct and the presumption can only be overcome by use of the protracted, time consuming and largely untested provisions of 8CCR Sections 9792.25 and 9792.25.1. Since the formulary is relatively new and some of the underlying clinical guidelines are out of statutory compliance, if a physician followed the obsolete guideline, its prescription drug recommendations may not be up to date. The treating physician and UR nurses and physicians will be faced with "dueling presumptions" - the recommendation found within the clinical guideline and another, perhaps different recommendation, found in the formulary.