ODG Guideline Lowers Medical Disputes & Opioid Use

ODG Guideline Usage in Texas Lowers Medical Disputes & Opioid Use

The Texas Division of Workers’ Compensation recently released a report showing that usage of ODG Guidelines lowered the number of medical disputes and the levels of N-drug opioid usage have dropped by 97% since 2007. Dr. J. Clark Race, Orthopedic Surgeon and Founder/ Executive Director of Expert Witness Doctors, has found the ODG to be very useful and reliable in rendering opinions in workers compensation cases and civil litigation and was pleased to have that usage validated by the report. 

Use Of The Official Disability Guidelines/Appropriate Medical Treatment

On the importance of the ODG, Dr. Race commented as follows:

 “As a practicing orthopedic surgeon in Texas since 1983, I have participated in the Workers’ Compensation System for three decades.

Initially, treating providers were given free rein to evaluate and treat most Workers’ Compensation patients. This led to less than optimal outcomes for injured workers due to over-treatment, and at times under-treatment, of various medical and orthopedic conditions.

Because of the lack of standardized care, the Texas Department of Insurance, Workers’ Compensation Division, adopted the Official Disability Guidelines as the official resource for determining appropriate medical treatment. Use of the Guidelines is now mandated for any provider treating injured workers under the Texas Workers’ Compensation status.

I have found the Guidelines to be extremely helpful in determining necessary and appropriate treatment. The Guidelines contain evidence-based medical recommendations for treatment based upon review of pertinent medical literature regarding multiple conditions. The Guidelines are updated frequently to incorporate new medical knowledge as it becomes available. The main advantage of using the Guidelines, in my experience, is the fact that they are based upon scientifically valid studies regarding diagnosis and treatment of multiple medical and orthopedic conditions. In my opinion, the Guidelines recommend reasonable treatment, which can be amended or modified depending on the circumstances. However, it does set a baseline of treatment, which is extremely helpful to help injured workers receive appropriate and necessary medical care.

It is one of the few resources which compile pertinent medical research which is scientifically valid regarding treatment of multiple conditions. The article quoted notes a significant decrease in inappropriate use of opioids and a significant decrease in disputed cases in the Workers’ Compensation System. This would suggest that the Guidelines are effective in improving medical care and decreasing excessive use of opioids and inappropriate or excessive medical care.”

Below is a summary of key findings from the report:

ODG Study Key Findings

Health Outcomes

Mental and physical functioning scores for network injured employees increased after the formulary. For nonnetwork injured employees, physical functioning scores also increased, but mental functioning scores remained unchanged.

Return to Work

The average return-to-work rate for network and non-network employees increased after the pharmacy closed formulary.

Medical Disputes

The number of workers compensation medical disputes decreased significantly.

Receiving Prescriptions

About 78 percent of injured employees said they had no problem receiving their prescriptions.

Medical Interlocutory Orders

After accounting for withdrawn requests, 60 percent of the Medical Interlocutory Orders (MIO) requested were approved.

Dr. Race is happy to see real-world proof that ODG usage leads to positive outcomes. He will continue applying these guidelines to all cases under his review.