There’s numerous published guidelines in the market today.  ACOEM Guidelines, MERCY CENTER Guidelines and ODG Guidelines to name a few.  Not one guideline manual is published consitent with another and most are severely outdated.  Even the most recent ODG Guidelines are inaccurate where the text has to put a “Disclaimer” in the beginning of its text in order to Dodge lawsuits. ODG seems to be the most popular stated reference today especially here in Illinois.  Our center is very familiar with these Guidelines and have spent much time on the phone with the editors and publishing people of this manual demanding numerous answers to specific questions that they simply could not answer like; ie..”If a patient comes in with two or three serious injuries, example, a shoulder rotator cuff tear and a lower back disc injury, how is it that a peer reviewer or claims adjuster think that it is prudent to take the worst diagnosis of all submitted to insurance company and apply your guideline formula acquiring 16-18 visits max for that individual when historically speaking, it would take twice to three times for pre and post surgery just on the shoulder, let alone the back?”  They have no answer! 

You simply cannot categorize an injured patients claim to a "number of visits" and then deny the care beyond this amount.  Every person is different and heals different.  We are online with ODG Guidelines directly spending thousands of dollars each year to utilize their software for appeals review and further, stay in touch with all others and have found none of them to be of any use because they are simply not practical in what they preach.

Our Guidelines and Standards

The patient generally speaking will be examined and if off work, we will start a daily routine of care preparing them from day one, to get stronger and to decrease their pain so that they can go back to work as quickly as possible with restrictions.  After 1-2 weeks of care, or after they have started work once more, their care is dropped to 3x’s/wk with re-exams every 30 days.  The patient’s care from there will decrease in weekly visits as they slowly improve until they are ready to be released.  It all depends on their injury and how severe it really is as well as how compliant the patient was to their care.

Generally speaking, we go by what has worked for us and other colleagues and facilities for over 20 years.  We utilize sophisticated equipment to get rid of the patients’ pain, rehabilitation equipment that is very expensive and unique to other centers focusing on specific body parts allowing us to perform successful therapeutic exercise and work conditioning and work hardening programs, and many other fascinating devices that are very expensive, but work. *( Please see our Treatment section of our web-site).  We get the patient back to work as quickly as possible and to MMI as soon as they are better.  We must stress, although we are sensitive to the insurance companies concerns of cost, we do not compromise the patients treatment.  Most successful cases are those that we are able to have a working relationship with the claims adjuster and the administration from our facility and further, that the Physicians can work hand in hand with the Nurse Case Managers for the most effective outcome for the patient.  There’s professional management on the case from both sides allowing the Physician to do what he needs to do and the NCM for the insurance company, to feel confident with what needs to be done.  We have found this formula to be the most beneficial all around, but it must be built on trust, otherwise, the formula wish list, falls apart and chaos occurs.