Documents needed when referring patients

Transcription

1 Documents needed when referring patients UPMC Referral Form Signed Script from the referring provider stating the reason for the referral. PR2 from the provider requesting a psychological evaluation. WCAB claim forms. Client Demographic Information. All available medical reports for patient.

2 Per ACOEM/AMA Guidelines 1. Pain Related Psychological Evaluation with Noninvasive Biofeedback Pain Management Therapy: These patients have been in pain for at least six-to-eight weeks or more and are to be seen immediately. We are to screen these patients by using the questionnaire form. (ACOEM 2e (2004) Chap. 6, Pain, Suffering and the Restoration of Function, pg. 115; Chap. 15 Section F, Stress Management Techniques, pg. 399). The psychological evaluation will determine that patient is not malingering, the pain is organic (real), and there is no psychological maladjustment injury. Generally treat for two-tothree months for secondary psych symptoms due to pain: pain related evaluation, medication if needed, then biofeedback therapy treatment. No P&S reports from the psychologist; they only receive a discharge PR-2 report. Please have all referring documentation indicate the following: The patient has been referred by the primary treating physician in this matter pursuant to an in compliance with applicable ACOEM/AMA Guidelines to assess symptoms due to pain and to determine, if any, counterbalancing factors such as maladjustment. 2 a. Psychological Evaluation & Testing: These are the traditional workers compensation psychological evaluations; the patient can have work related psychological disabilities. The patient is evaluated, treated, then deemed permanent and stationary (P&S). These patients will receive biofeedback therapy, medication; approximately two-to-three months of treatment, then the patient will

3 be declared P&S. The traditional psych workers compensation claim form is to be used. Trauma patients may need treatment for upwards of several weeks. Patients that have undergone surgery may also need more treatment time. The more serious the injury the more treatment may be needed due to anxiety, depression and other emotional symptoms. Overall the psychologist determines the disability and treatment. The physician assistant (PA) may have to do the initial evaluation to prescribe medication but patients generally consult with Dr. Herbert Marshak. 2 b. Psychiatric Consultation: Equivalent to traditional psychological evaluation except for that the patient needs to have medication prescribed as soon as possible. (ACOEM, 2e, ibid., supra) 3. Clearance: These patients need a psych evaluation to determine if the patient is emotionally stable and secure to have surgery or pain management procedures (spinal cord stimulation, epidurals, and discograms). In addition, all surgical clearances should indicate the following: Per applicable ACOEM/AMA Guidelines, a clearance psychological evaluation should be performed including a psychosocial assessment (for example, in advance of discography, ACOEM 2e, pg. 305, et al) to rule out emotional and cognitive symptomology such as maladjustment and/or other disorders to ensure the patient is emotionally stable and secure to undergo the planned surgical procedure. Being that this evaluation is for clearance the report is considered STAT and is issued the next day. These patients do not receive treatment or therapy (one time evaluations).

4 Pursuant to applicable ACOEM/AMA Guidelines, a psychological evaluation is appropriate in cases involving a surgical clearance to establish whether the patient is adequately stable and secure from an emotional standpoint to successfully undergo the subject medical procedure. Refraining from worry, anxiety and other negative moods and adopting a positive attitude are paramount to an orthopaedic patient s physical surgery outcome and recovery speed, according to a review article published in the July 2006 issue of the Journal of the American Academy of Orthopaedic Surgeons. When it comes to recovery, orthopaedic surgeons often consider traditional clinical factors that influence surgical outcome -- the patient s age, physical health status or the degree of the injury, for example, said Patricia H. Rosenberger, associate research scientist in the Department of Epidemiology and Public Health at Yale University School of Medicine, and lead author of the article. This study went above and beyond those traditional factors and considered dynamics like stress, depression, social support, self-efficacy and positive expectations. We found that if a patient s mood and attitude are evaluated, orthopaedic surgeons can actually determine how a patient might physically recover and return to their normal daily activities.

5 The Clearance for Surgical and Medical Procedures Maximum 75 minutes for patient testing and evaluation; Screens for cognitive and psychological stability; Determines whether patient pain is psychogenic (non-physical based) or organic (intrinsic to physical trauma); Preliminary summary report sent out same day as clearance evaluation; Sample clearance report attached; The ACOEM Guidelines 2e indicates (page 391) that the initial assessment of patients by the primary treating physician ( PTP ) should screen for potentially serious psychiatric disorders, to assess the patients physical and psychosocial situation, and to establish an effective treatment plan The initial assessment is a critical tool for detecting potential emotional problems that require the attention of a psychiatric or other mental health professional. As well, at page 315: the physician should discuss the physical and psychological mechanisms of pain at each patient encounter. See also, AMA Guides, chapter 14.

6 TOP 8 FAQ s RE PSYCH CLEARANCES FOR WORKERS COMPENSATION SURGICAL AND MEDICAL PROCEDURES 1) Q. What is a psych clearance for surgery or medical procedure? A. An evaluation by a psychologist as to whether a patient is emotionally ready to undergo surgery or other significant medical procedure. 2) Q. Why is this important? A. Because if patient is not adequately stable from emotional standpoint it could adversely affect the outcome of surgery/medical procedure and or healing/recovery. 3) Q. Is there authority for the psych evaluation? A. Yes, ACOEM GUIDELINES, 2 e, pgs ) Q. How long does the psych clearance take? A. Between 60 to 75 minutes. 5) Q. How does the clearance get scheduled? A. The doctor scheduled to perform the surgery or medical procedure, frequently the patient s PTP, contacts UPMC at ) Q. Who performs the clearance? A. One of UPMC S licensed staff psychologists. 7) Q. How is the clearance documented? A. By a summary report that goes out to appropriate parties the same day as the clearance evaluation is done followed by a narrative report later. 8) Q. If the clearance evaluation results is no clearance, is there another clearance evaluation later? A. Yes, usually by or within 30 days.

7 UPMC Universal Psychiatric Medical Center Herbert Marshak, M.D. Psychiatry, Bilingual Matthew Maibaum, Ph.D, QME, AME Diplomat, American Board of Forensic Medicine Diplomat, American Board of Medical Psychotherapy Norman Reichwald, Psy.D, QME, (SCIF) Clinical Director Date: Patient Name / Address Phone: Referring M.D. Phone: Fax: Attorney s Office: Phone: Fax: W/C PI QME *PLEASE INCLUDE DEMOGRAPHICS, DR S 1 ST REPORT Pain related Psychological evaluation (ACOEM/AMA) Chp. 6, pgs, 109 & 115/ACOEM Guidelines 2e (2004) (re: medications/biofeedback/core Alpha-Stim) Psychiatric & Psychological evaluation & treatment (compensable disability rating) (re: medications/biofeedback/core Alpha-Stim ) Clearance for surgeries and pain management procedures (ACOEM/AMA) Chp. 6, pgs, 109 & 115/ACOEM Guidelines 2e (2004). *to include body parts and type of procedure, If psych is NOT on the claim form patient having symptoms due to PAIN If psych is ON the claim form Patient having procedure=needs PSYH CLEARANCE to rule out psychogenic factor LOCATIONS PANORAMA CITY (Matthew Maibaum, Ph.D QME) 8121 Van Nuys Blvd. Suite 316 Panorama City, CA LOS ANGELES (Marjorie Cohn, Ph.D) 1711 W. Temple Street Suite 4100 Los Angeles, CA SANTA ANA (Raymond Shallbetter, Ph.D, QME) 1206 East 17 th Street, Suite 106 Santa Ana, CA PASADENA (Matthew Maibaum, Ph.D QME) 960 E. Green Street Suite L-2 Pasadena, CA POMONA (Norman Reichwald, Psy.D QME) 1902 Royalty Drive Suite 290 Pomona, CA SAN DIEGO 6717 Convoy Ct. San Diego, CA LONG BEACH (Raymond Shallbetter, Ph.D, QME) 2777 Pacific Avenue, Suite K Long Beach, CA TELEPHONE (888) 85-PSYCH (77924) FACSIMILE Contact Corporate Office for an immediate appointment

8 Referral for Psychiatric Evaluation and (TREATMENT)- Compensable This Patient is experiencing psychiatric consequences in the form of anxiety; depression and other related psychological symptoms due to his/her work related injury of. Referral for Psychiatric Evaluation and Pain (Per ACOEM/AMA) Pursuant to ACOEM/AMA guidelines, a psychological evaluation is needed to rule put emotional and mental malingering maladjustment and to determine the pain related psychological pathology. -The above blurbs should be included in your reports.