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Pilot rsd proposal for reinsurance self insurance tpa


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CRPS (complex regional pain syndrome) or RSD (reflex sympathetic dystrophy are over-diagnosed 71%-80% of the time, according to two research groups from Johns Hopkins Hospital. This means 71% to 80% of patients told they have CRPS or RSD do not have it. For an expense of $170,000, to properly diagnose and treat one hundred (100) CRPS (complex regional pain syndrome) or RSD (reflex sympathetic dystrophy, using the on-line tests from, an insurance carrier or reinsurer, or self insured company and the associated TPA, can expect to save $64,000,000. This is not a typo…an expense of $170,000 will result in savings of $64,000,000. The attached proposed pilot research project will prove this.

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Pilot rsd proposal for reinsurance self insurance tpa

  1. 1. Pain Validity Test and Diagnostic Paradigm and Treatment Algorithm:Proposal for a Pilot with Any Reinsurance Company, Self-insured Company, or TPA to save$64,000,000 on a $170,000 Contact DocNelse@aol.comIntroduction:Maryland Clinical Diagnostics (MCD) has reference articles from staff members of Johns HopkinsHospital, which show that 40% to 67% of chronic pain patients are misdiagnosed, i.e. diagnoses aremissed (1,2). Additional articles show that certain diagnoses are overused, i.e. a patient is told that theyhave a disease, which they do not have. One example of this overuse and misuse of a diagnosis isComplex Regional Pain Syndrome (CRPS) or, as it used to be called, Reflex Sympathetic Dystrophy (RSD).One article published by a professor from Johns Hopkins Hospital shows that 80% of patients told theyhave CRPS (RSD) actually have just nerve entrapments and other disorders (3). Another research articlefrom a Johns Hopkins Hospital doctor found that 71% of patients diagnosed with CRPS (RSD) really hadjust nerve entrapment syndromes (4). Based on these finding, the proposed pilot for MCD testing to givesignificant cost savings to TPAs working with any reinsurance company or self insurance companyworking with a TPA, is shown below.1) The company would identify five (5) of their major workers compensation TPAs, who insure atleast 100,000 lives, and ask each to assemble 30 of their active RSD (CRPS) cases.2) The TPAs would send MCD a list of their typical reserves per case for the following diagnoses:a) Reflex Sympathetic Dystrophy (RSD) or Complex Regional Pain Syndrome (CRPS)b) Peripheral nerve entrapmentc) Thoracic outlet syndromed) Carpel tunnel syndromee) Ulnar nerve entrapmentf) Radial nerve entrapmentg) Sural nerve entrapmenth) Saphenous Nerve entrapmenti) Tibial nerve entrapmentj) Common or superficial or deep peroneal nerve entrapmentk) C4-5 or C5-6 radiculopathy
  2. 2. l) L4-5 or L5-S1 radiculopathy3) The TPAs would then administer the $800 Diagnostic Paradigm and Treatment Algorithm, andthe $300 Pain Validity Test to these cases diagnosed as RSD (CRPS) by the treating doctor.Administration would be done by the TPAs own independent medical examiners, or by nursecase managers. Patients listed as “exaggerating pain patients” or “subjective pain patients” bythe Pain Validity Test will be excluded from the study. It is anticipated that 15% of the original150 patients, or 22 patients will be eliminated from the study.4) In all case , which qualify as an “objective pain patients” on the Pain Validity Test, and which arecurrently listed as RSD (CRPS) on the insurance records, which receive the Diagnostic Paradigmand Treatment Algorithm. If the diagnosis generated by the Diagnostic Paradigm was just nerveentrapment alone, or in combination with some other diagnoses, (other than RSD (CRPS)), thereserve for nerve entrapment syndromes, or other diagnoses, which excluded RSD (CRPS) wouldbe listed, and subtracted from the reserve which the insurance company normally has for RSD(CRPS). This difference would be considered the potential cost savings. As an example, if thereserve for an RSD case is typically $1,000,000, but the Diagnostic Paradigm shows a diagnosis ofjust tibial nerve entrapment, which carries the reserve of $50,000, then $1,000,000-$50,000 or$950,000 would be the potential cost savings on the case.5) In cases where RSD (CRPS) and no other diagnoses, appeared, these would be considered RSD(CRPS) cases, and no cost savings would be realized. In cases where RSD (CRPS) was a diagnosisalong with any other diagnoses, including nerve entrapment, these cases would be consideredas an RSD case. (ask for a proforma for calculating projected cost savings- Maryland Clinical Diagnostics will charge $6,000 a day, plus travel expenses, for training of allinsurance adjusters at a TPA,or physicians’ offices which would administer the tests, at each ofthe 5 participating companies offices, so the adjustors and physicians’ staff would know how toorder the Diagnostic Paradigm, through a through the insurance carrier’s own independentmedical examiners, or by nurse case managers, and how to retrieve the results.7) Researchers from Maryland Clinical Diagnostics would analyze the data for each of the insurancecarriers, so that there is no further demand on the resource of the insurance carrier. This is doneelectronically, based on the data transmitted to Maryland Clinical Diagnostics, Inc. by theclaimant who takes the tests. The cost would be $30,000.8) Maryland Clinical Diagnostics, Inc. (MCD) reserves the right to publish this data, but will give theinsurance carrier or TPA the option to participate in the publication or have their nameprotected, at their option. Maryland Clinical Diagnostics, Inc. (MCD) will allow the insurancecarrier access to their own data, via electronic transmission.All expenses for training personnel, travel, communication, research, and test administration will beborne by the insurance carriers and payment would be made prior to the initiation of the project.
  3. 3. Budget for entire project. TOTAL COSTSCost of $300 Pain Validity Test X 100 $30,000Cost of $800 Diagnostic Paradigm X 100 $80,000Travel, training for test administration at 5 TPAs $30,000Cost for compiling data, and publishing research $30,000Total Cost to participate in project $ 170,000Projected cost savings using the Diagnostic Paradigm $64,000,000So for a $170,000 expense, the projected reduction in reserves would be $64,000,000REFERRENCES:1) Hendler,N.,Kozikowski,J.:" Overlooked Physical Diagnoses in Chronic Pain Patients Involved inLitigation." Psychosomatics.Vol.34,No.6:494-501, November/December, 1993.2) Hendler, N., Bergson, C., Morrison, C.: "Overlooked Physical Diagnoses in Chronic Pain PatientsInvolved in Litigation, Part 2." Psychosomatics. Vol. 37, No.6: 509-517, November/December, 1996.3) Dellon, AL, Andonian, E, Rosson, GD, CRPS of the Upper and Lower Extremity: Surgical TreatmentOutcome , J. Brachial Plex. Perihperal Nerve Inj. Feb. 20:4:1, 20094) Hendler, N.: “Differential Diagnosis of Complex Regional Pain Syndrome.” Pan Arab Journal ofNeurosurgery. Oct., pp. 1-9. 2002.