Impairment Rating Specialists

  • Elementary, my dear Watson!

    25 July 2013 / California Workers Compensation, Chart Reviews, Cloud Based Computing, Impairment Physical Exam, Impairment Rating Specialists, Medical History, Medical Technology / Comments Off on Elementary, my dear Watson!

    There’s a new cloud-based computer service that takes in patient information and then spits out useful results in record time. And no, I’m actually not talking about RateFast. Did you catch the 2011 Jeopardy special where Watson (IBM’s language savvy super-computer) competed against two former Jeopardy champions? The AI system out-answered—or rather, out-asked—both of its human opponents, and won $1 million in prize cash.

    But Watson’s verbal talent is now taking on questions that are tougher than those Alex Trebek would ask: the computer system is diagnosing and generating treatment plans for cancer patients. An agreement between IBM, healthcare company Wellpoint, and Memorial Sloan-Kettering Cancer Center is going to make Watson’s thinking power available to hospitals and clinics around the nation.

    Here’s how it works: you’re a doctor, and you need to write a treatment plan for your patient, but you’re stretched for time, knowledge, resources—or maybe you just want a second opinion. So you log into Watson using an app on your tablet or computer, and you enter your patient’s medical situation. Within minutes—usually within seconds—Watson gives you a series of treatment plans based on the latest medical research, and each plan is ranked by its expected effectiveness and cost.

    Over the past few years, Watson has become an expert oncologist. According to an article at Wired Magazine, Watson needs only a few seconds to search through “600,000 pieces of medical evidence, more than two million pages from medical journals” and 1.5 million patient records. Wellpoint clams that Watson can correctly diagnose lung cancer 90% of the time, as opposed to the relatively paltry 50% correct-diagnosis rate of a human doctor.

    For now, Watson’s expertise is restricted to lung, prostate, and breast cancer, but the computer never stops learning. It’s difficult for doctors to stay abreast of the current medical research in their field, but Watson can “read” the results of new studies as they’re published, and instantly apply the information.

    The Memorial Sloan-Kettering Cancer Center in New York says that it would take 160 hours of reading a week for a doctor to stay current on all new medical knowledge as its published—and that doesn’t even account for applying that knowledge (or taking care of tedious clerical work like filling out PR-4 reports). Obviously, no human medical worker can do what it takes to know everything about their work. But Watson and computer systems like it are unencumbered by the human weakness of, you know, having a life.

    The goal is to have computers crunch numbers and negotiate the rules of today’s labyrinthine healthcare system, while medical professionals can leave work on time. Watson could be a major wave in medical technology’s recent move toward cloud-based apps that aim to streamline productivity around hospitals and clinics.

  • You Just Got Passed By RateFast

    16 May 2013 / California Workers Compensation, Impairment Rating Specialists / Comments Off on You Just Got Passed By RateFast

    Josh Moore's Enduro Bike: Race Fast, with RateFast!

    Joshua Moore, corporate sponsored Enduro racer signs up to race for better impairment rating software.

    A six pack of Northern California’s best beer traded hands.  A gallon of hi test gasoline was procured and added to the deal.  Like that, impairment rating software history was in the making.

    Josh Moore, CPA, and amateur 250cc Enduro class rider, has become RateFast’s first corporate sponsored athlete.

    The deal was formalized later that week on a bar napkin with a sharpie.

    We could all feel the new buzz here at the RateFast team as racer Josh and director John Alchemy penned their names down on the contract. It felt like the revving of a motor, like the thrilling rush of wind as you ride down a steep mountain path….

    Before the first race with the RateFast logo on his bike, I called up Josh Moore and spoke with him about his racing history, and how he got involved with RateFast.

    Josh and John met at the legendary Santa Rosa Accelerated Charter School’s fifth grade trip to Camp Del Oro.  As they were hiking along behind their daughters they realized they had something else in common besides parenthood:  Dr. Alchemy needed an Excel specialist to help with RateFast’s upcoming release, and Josh Moore had an uncanny knowledge of the program.  The two teamed up and haven’t parted ways since.

    Josh started racing motorbikes a few years back, and stepped up his game another notch when he began to look for more people to ride dirt bikes with. I asked him to describe why he likes racing, “It’s like an extreme hike,” he said.  “You get out, go camping, you’re with good people, and you get a little adrenaline rush—it’s just totally fun. “

    This peaked my interest, as I’m an avid hiker, so I had to ask if there were any women in the sport.  He replied, “Some, but not many—there’s a women’s division, they’re out there, and they’re good!” After watching a few dirt-bike racing videos, I was hooked.

    The first race happened a few weeks back. As Josh careened down the sharp turns and steep grades, the RateFast logo was a blur of blue speed passing the other bikes. Like all those doctors still doing worker’s compensation reports without our impairment rating software, the RateFast riding team simply left them in the dust. When I heard about the race I did a small fist pump, thanking that six-pack of beer and gallon of gas—once you RateFast, you never go back.


    P.S. Want a taste of rapid, accurate, impairment rating software? Find out more about RateFast by clicking here:





  • RateFast - The mission: Create correct and rapid impairment reports.

    29 April 2013 / California Workers Compensation, Impairment Rating Specialists / Comments Off on RateFast - The mission: Create correct and rapid impairment reports.

    The RateFast Family: Who We Are

    • Formed by an impairment expert who has been doing reports since 1997, the RateFast team is a group of qualified and experienced professionals who are here to change the world of impairment rating.
    • We hate upfront costs, delays, confusing downloads, and expensive help desks. We’re tired of the current convoluted impairment rating process.
    • We understand how much of your time and money gets wasted on impairment ratings better than anyone. Now you can have a simple solution.

    P.S. Our offer for two free reports is still on! Sign up today to receive your complimentary PR-4 Reports. Visit now!

  • Almaraz­-Guzman II Ratings

    04 April 2013 / Impairment Rating Specialists / Comments Off on Almaraz­-Guzman II Ratings

    In Almaraz-Guzman II, the WCAB said that there are occasions when a doctor
    can use a method of rating something in the Guides which is different from
    the rating method specified by the Guides.

    Almaraz-Guzman II said that the case must meet the following 4 criteria:

    1.  The case must be extraordinary or complex.  (Unfortunately, the WCAB
    did not define these terms.)  AND

    2.  The evaluating physician must do the specified rating under the Guides   correctly.  AND

    3.  The evaluating physician must then indicate that he does not feel that
    the specified rating accurately describes the impairment, and he must give
    his reasons for this conclusion in writing.  AND

    4.  The evaluating physician may then select an alternate method for rating
    from the Guides, BUT  (AND HERE IS THE BIG "BUT")  AND


    Unfortunately, after Almaraz-Guzman II came out, many doctors and lawyers
    started to claim that the decision said a doctor could rate "any way he
    wanted."  This is absolutely NOT what the decision says.  It says the
    physician must follow the criteria of Almaraz-Guzman II for a rating to be
    correct under that case.

    So, in all of your Almaraz-Guzman II cases, check to ensure that the
    criteria above are met.  If they are not, write the doctor (or depose him)
    to question him on each of the criteria.

    In my experience. 99% of "Almaraz-Guzman II" ratings do not meet the
    criteria above.  Simply send the doctor a copy of the decision in
    Almaraz-Guzman II and question him on whether or not he complied with each
    and every criteria listed in the decision. And, if he did not, then move to
    strike that rating as not consistent with Almaraz-Guzman II.

  • Effects of Treatment or Lack of Treatment

    13 September 2012 / Impairment Rating Specialists / Comments Off on Effects of Treatment or Lack of Treatment

    If treatment of an illness produces total remission of the signs and symptoms (for example, a diabetic treated with insulin) but the illness is not cured, then the physician may increase the impairment by 1% to 3% WPI.

    If the treatment or medication leads to the impairment (example: immune-suppressing drugs for organ transplant), the evaluator should rate such impairment.

    If the patient declines treatment for a medical condition, that does not increase or decrease the estimated percentage of impairment for the condition.

    A physician should comment on:

    • Whether the treatment is appropriate, and
    • Basis for the patient's declining treatment, and
    • Whether the impairment is at maximum medical improvement without the treatment, and
    • May estimate what the impairment would likely be with the treatment


    (Sec. 2.5g AMA Guides to the Evaluation of Permanent impairment [Fifth Edition])

  • Ligaments & Permanent Impairment

    07 September 2012 / Impairment Rating Specialists / Comments Off on Ligaments & Permanent Impairment

    A ligament is a soft, fibrous tissue structure that connects bone to bone to form a joint. A ligament differs from a tendon, which connects muscle to bone.
    Injury can occur when a ligament becomes stretched, partially torn, or completely disrupted. The injury can range from a minor strain to complete disruption of all fibrous tissue. Serious cases of injury may result in instability of the joint, significant bleeding, chronic pain, and swelling. Most ligament injuries can be diagnosed by an X-ray or MRI scan and treated with conservative measures such as ice, rest, compression, and limited bracing.

    When a ligament overlies a joint, it may become difficult to determine if pain and symptoms are due to a ligament injury or an underlying joint injury. In certain instances such as a knee injury, the tendon and joint cartilage may be injured at the same time. Injuries that do not respond to conservative care may require additional imaging by an MRI and/or referral to an orthopedic specialist.

    • A ligament connects bone to bone.
    • Treatment is usually conservative. If the condition fails to improve, additional imaging by an orthopedic specialist may be indicated.
    • Caution must be taken when diagnosing an injury that involves a ligament overlying a joint. Consideration must be given for a possible deep joint or cartilage structure injury.

    Rating Comment: The AMA Guides to the Evaluation of Permanent Impairment Fifth Edition provides impairment rating for ligament instability/injury in the shoulder and wrist, Chapter 16: Upper Extremities and in the knee, Chapter 17: Lower Extremities. Additional impairment rating may also be assigned in some circumstances for ligament injuries that impair range of motion.

  • Getting Almaraz-Guzman II Ratings Correct

    31 August 2012 / Impairment Rating Specialists / Comments Off on Getting Almaraz-Guzman II Ratings Correct

    California was the 44th state in America to adopt the AMA Guides for calculating permanent impairment. In fact, this book is the most widely used book in the world for calculating permanent impairment. It is used in all Commonwealth countries, many Federal compensation systems, and in auto accident cases in some states.

    Why has this book become the most widely used book for calculating impairment in the world? Because it is based on one simple idea: 2 doctors, looking at the same patient at about the same time and getting the same results, should come up with the same impairment rating. Pretty simple, huh? It says: 2 + 2 should equal 4 each time.

    In order to do that, physicians must look at the same things and measure them the same way. These are called objective factors of impairment.

    Let me give you an example: If my arm were cut off at the elbow, shouldn't every doctor measuring that be able to measure it the same way and come up with the same result. Yes, and yes. If one doctor said 50% of the arm were cut off, and another said only 10% was cut off, we would say that is wrong, wouldn't we? Yes, and yes.

    So, the Guides give doctors things to measure and tell them how to measure them. The goal is for all doctors to be able to calculate impairment the same way by looking at the same body parts and measuring them the same way.

    For those of us in California, the concept of two doctors coming up with the same permanent impairment rating is hard to get our minds around because our entire workers' compensation system has been built on two doctors looking at the same patient and coming up with different impairment numbers. Kind of like saying, Dr. A looks at my arm and says 50% is cut off. Dr. B looks at my arm and says only 10% is cut off? Can both of them be correct? No. But, for 50 years in California, instead of saying that one of the doctors was wrong, we would split it in the middle to get the case settled. Kind of crazy, but that is what happened.

    California adopted the AMA Guides in 2004 in an effort to end that. The purpose of adopting the Guides was to get correct impairment ratings. Period.

    After the Guides were adopted in California, various legal challenges were launched to them in an effort to get rid of them. All of those challenges lost. The Guides were found to be Constitutional, and the Legislature was found to have the power to adopt them to measure impairment ratings.

    And, for a period of about 6 months, we began to get impairment ratings which were correct under the Guides. When I say correct, here is what I mean: 2 + 2 = 4. Not 5 or 1,000. It is just like grading a test. If you were asked what 2 + 2 equals and you answered "4," your answer is correct. If you answered "1,000," your answer is wrong. Because 2 + 2 = 4 every time.

    And every challenge to the Guides lost, until one: Almaraz-Guzman II.

    See tuned for the next blog for the rest of the story.

  • NEWSFLASH:  90% of AME Reports are Incorrect

    09 August 2012 / Impairment Rating Specialists / Comments Off on NEWSFLASH:  90% of AME Reports are Incorrect

    NEWSFLASH:  90% of AME reports are incorrect; 72% of QME reports are incorrect; the average overpayment is $17,500 per report.

    My Team and I have reviewed over 2,500 reports from California physicians under the AMA Guides.  On average, those reports provide PD $17,500 more than the law specifies.  AME's are the worst, with 90% of their reports incorrect.  QME's are second worst, with 72% of their reports incorrect.

    What does that mean?  It means you will be overpaying $17,500 in most of your cases, unless you use Achem's Razor.

    Achem's Razor means finding the simplest solution to a problem.  Identify the right problem, then apply the simplest, most effective solution.

    1.  What is the problem?  Using the wrong doctors.

    2.  Solution:  Use the right doctors.

    3.  How can I find out who they are?

    a.  First, use doctors associated with Impairment Rating Specialists.  I have hand-trained each of those doctors on the AMA Guides.  They do correct ratings.

    Think of it.  If you use a doctor who does the rating correctly, then there is no need to write the doctor to get a corrected rating, no need to depose him, nothing the DEU can do to screw up the rating, and you have a report on which you can settle the case.

    Using the right doctor saves you time, money, and effort.  That is Achem's Razor--the simplest, most effective solution for the problem.

  • Residency and Beyond

    07 June 2012 / Impairment Rating Specialists / Comments Off on Residency and Beyond

    Dr. John AlchemyUpon completion of residency I learned something very important. The kind of thing you can only learn looking back, after having completed the experience.


    The lesson was this: In the early stages of exploring a specialty of medicine, even as a doctor, it is nearly impossible to separate our opinions of a specialty from the teachers who are teaching us. For example, a very enthusiastic instructor can make boring and dry topics come to life based on presentation and emphasis of the material.


    By telling stories, making connections, and pointing out the recurring themes of practice that weaves the patient and the medicine together, it is very easy to confuse the subject with the instructor. It is kind of like clothing. Some colors and styles compliment people in very unique ways. Try that same clothing on yourself, take a look in the mirror, and you say.. “maybe not so much”, or if you are lucky you will say, “Yep, this is exactly my size. Time to go to checkout!” That is the summary of trying to pick your specialty in medicine.


    It was 1997, when I finally found the suit that fit me in that mirror. I was taking an elective rotation in Occupational Medicine. I stumbled into the rotation when I was looking for a practice setting that had a combination of urgent care medicine, with continuity of care follow up visits. I still remember putting together my first two weeks of discovery on that rotation. Here I am, able to focus on a single set of problems, in an urgent care setting, with cases that had something I had never imagined existed….an administrative end!! How was this? It was amazing!


    These occupational medicine cases actually had a beginning, a middle and an end. Then it got even more amazing (like the advertising for the set of steak knives that can cut through the hood of a 1957 Buick, then effortlessly cut a freshly baked loaf of bread with laser precision). There was the language. I was intrigued with the language, and the endless definitions.

  • The Pieces Finally Start to Fit -- Diary of an Impairment Rater

    31 May 2012 / Impairment Rating Specialists / Comments Off on The Pieces Finally Start to Fit -- Diary of an Impairment Rater

    Overtime the pieces finally started to fit. The other doctors would be kind enough to take me aside and give me amazing mini lectures on the medical legal paring of the specialty. The phrases they used, the words they placed in their exams (later to be “unleashed” if necessary during a deposition), and the verbal “jujitsu” of the daily report writing. The doctors I always admired the most were the ones who had an answer for everything, every situation, every possible employer call or scenario. They were brilliant. How did they come up with this stuff? I would try to pose my best attempt at tripping them up with yet another “hypothetical situation” (actually my last patient in the room with a question I could not answer), only to have it turned inside out like a sock.


    This was the beginning of my occupational medicine addiction. Sure, I would stray from the calling here and there with a stint in a primary care clinic for a year or two, but there was always the calling to return to the work comp clinic. And this is where our story begins.


    From the very onset, the words “California Workers’ Comp” strikes fear into the hearts of nearly every physician. It strikes fear because we as physicians are suppose to have, for some reason, a firm grasp of not only medicine, but in general every topic or problem that our patients might encounter in the course of their care (or life). A patient even asked me once where the best place in town was to have their car brakes repaired!


    Imagine being put on the spot to generate a medical legal document using words and ideas that are completely foreign to you. Not to mention that if the report is not correct or complete, your patient may be denied or delayed benefits they may be entitled to this system. And just like that steak knife ad…there’s more! You may even get deposed if your report is ambiguous or unclear in anyway. How does that sound? Kind of makes you want to jump up and down saying, “Pick me! Pick me!” or maybe not.

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