Meeting Minutes

Medical Advisory Committee Meeting

September 23, 2025 via Teams

Tennessee Room
220 French Landing Drive
Nashville, TN 37243

Members:

  • David Tutor, MD, Occupational Medicine
  • Rob Behnke, Cracker Barrel
  • Carina Sloat, RN, CCM, Travelers
  • Richard L. Cole, DC, DACNB, DAAPM, FICCN, FICC(H)
  • John Brophy, MD, Neurosurgery
  • James G. Kyser, MD, Psychiatry
  • Jeff Hazlewood, MD, PM&R, Pain Management
  • Lisa Bellner, MD, PM&R Pain Management
  • Cerisia Cummings, DO, Bridgestone
  • Lisa Hartman, RN, AFL-CIO
  • Tim Jones, MD

Staff:

  • Troy Haley, Administrator, BWC
  • Robert Snyder, MD, Medical Director, BWC
  • James Talmage, MD, Asst. Medical Director, BWC
  • J. Wills Oglesby, MD, Asst. Medical Director, BWC
  • Amanda Terry, BWC
  • Jay Blaisdell, BWC
  • Suzy Douglas, RN, BWC
  • Lacy Conner, BWC
  • Marshay Jones, BWC
  • Maria Trotter, BWC
  • Kyle Jones, BWC
  • Suzanne Gaines, BWC
  • Mark Finks, BWC

Guests:

  • Troy Prevot, ODG by MCG
  • Adam Fowler, My Matrixx
  • Tiffany Grzybowski, HealtheSystems
  • Faith Parrish, VUMC
  • Yarnell Beatty, TMA
  • Emma Winters, Butler Snow
  • Steven Peters, Enlyte
  • Tommy Castleberry, Concentra
  • Fran Sweatt, VUMC
  • Tina Uhing, Core Claims

In Person:

  • David Tutor, MD, ETUC
  • John Brophy, MD, Neurosurgery
  • Cerisia Cummings, DO, Bridgestone

By Telephone:

  • Tommy Castleberry, Concentra

Virtual Option:

The meeting will be held in the BWC Large Conference Room with telephone and virtual options available. The use of the virtual platform is a benefit to the public, allowing participation of out-of-state stakeholders and others interested in the subjects of this meeting. It is necessary for establishment of a quorum that the members have the virtual option available. The committee rules provide for the members to be counted as present for the determination of a quorum (see rule 0800-02-23-.04 (2-3)).

Call to Order

The meeting was called to order at 1:04 PM by the Chair, Dr. Tutor.

Introductions were made.

Quorum

Mr. Finks took the role, and a quorum was confirmed as present (1/3 of the members needed, 12/18 members present).

Approval of Minutes

Dr. Tutor called for approval of the minutes for the May 5th meeting. Dr. Brophy motioned and seconded.
The minutes were approved as written.
Any remaining Conflict of Interest forms need to be turned in.

Old Business

Guidelines:

Dr. Talmage asked if we should stay with the Official Disability Guidelines or switch to Washington State? Or ACOM’s Guidelines.   ACOM’s guidelines are used in California, New York and Nevada.   ODG is used in many states.  Washington State uses the Canadian model of workers’ compensation, so the state government is the insurer.

Washington has published 2021 surgical guidelines for the back and neck.  They have not been updated since then.

ODG published guidelines prior to July of 2024, then new guidelines in July 2024 that the committee did not like.  The guidelines were revised in November 2024 and revised again in April 2025.    ODG revised well over 100 items in July 2025 but did not change spine from April 2025.  Dr. Brophy and Dr. Talmage looked at ODG guidelines and Washington State’s.  Dr. Talmage did not look at ACOM.

Washington Guidelines covered not only workers’ comp but state Medicaid and state medical insurance for all employees. The people who write the guidelines must live with those same guidelines being applied to their own cases.

Washington Guidelines will not cover lumbar disc replacement, sacroiliac joint fusion, lumbar fusion for back pain or degenerative disc disease, discography, inter-spinous implants.

Washington also requires that the surgeon must have seen the patient at least once in the office.  A mid-level cannot commit the patient to surgery and then the surgeon meets the patient in pre-anesthesia area of the hospital.

Dr.  Brophy remarked on the ODG requirement to wait 3 months.  They sent a copy of proposed changes to their guidelines; they dropped the wait to six weeks which is consistent with ACOM and Washington State.  They have other issues to address. According to Dr. Snyder, if you go on their website, they have not changed the wait from 3 months to 6 weeks. That change is supposed to occur in early October.

Dr. Brophy proposed that the committee wait and see what ODG has decided on and then make a judgment at the November meeting.

Dr. Snyder asked Dr. Brophy for a list of other issues.

Dr. Brophy said that under lumbar fusion, they talk about using an adjacent level with criteria which is basically subjective back pain.  That is not standard.

They talk about fusion for lumbar stenosis; that is not standard.  Fusion should be for instability, and they should say that.

They talk about fusion not authorized for disc herniation or first recurrence, but they don’t address second recurrence.

There is the issue for lumbar fusion: 3 months of conservative management, which is reasonable.   In the rare occurrence of a second recurrence, the patient frequently has incapacitating leg pain, and it all needs to get done so that should happen well under 3 months.

For physical therapy, there is an arbitrary number of treatments, and the duration of treatment makes no sense.  It should be determined by the patient-specific diagnosis, not in general terms such as there are in the guide.  How does the patient respond to treatment?

Mr. Prevot said that ODG tried to address physical therapy concerns.

If the concerns were not addressed, any language would be helpful for the editors to consider.   Regarding duration, ODG tried to make the PT visit durations more of a guide.    They are designed to be a guide for adjusters to look at as they follow their claimant/patients.

There was language being added that would allow functional improvement to guide physical therapy.  Mr. Prevot asked for any feedback to take back.

October 3rd changes are coming up and it will be hard to make changes from feedback at this point.  They will probably be considered for the January cycle.  It will be difficult to make interim changes.

Dr. Talmage said that many back surgery sections have a requirement for psychological evaluation, which is logical.  However, a closer look is needed at what is actually required.

  • What is required is to assess motivation for recovery and return to work.  The assessment does not have to be favorable to recommend the patient for surgery.
  • There is also a requirement to assess any uncontrolled mental health or substance use disorder.  Even if such a bad prognostic sign were present and documented, if it has been assessed then you have complied with the criterion.
  • Personality style and coping ability must also be evaluated, and these are undefined.

Buried in the text, it says that part of the psychological evaluation should be standardized, well-known psychological tests, at least 2 of which have built-in symptom validity checks.

There are people who fail symptom validity testing in psychological test—well-constructed, psychometric, well-known instruments. This criterion is buried in the text and is not in the bullet points.  Then the criterion is 6 months of cognitive behavioral therapy or psychotherapy.   Cognitive behavioral therapy has been well-documented to be effective for chronic pain.  It’s well documented that supportive psychotherapy does not help these people.  And yet, 6 months of seeing a psychiatrist or psychologist for supportive therapy meets the criterion.

The criteria listed in multiple surgical sections for psychological evaluation need to be re-examined.

Mr. Prevot agreed.

Dr. Tutor asked Dr Brophy if his patients went through psychological evaluation before fusion.

Dr. Brophy said no, but it is done for spinal stimulators.

Dr. Tutor asked if the guidelines protect patients regarding spine surgery.

It gets more difficult to find neurosurgeons.  Sometimes patients must be sent to Jackson, Chattanooga, Nashville or Tri-Cities and the treatments seem questionable.

Will ODG protect patients if the rules are applied?  From surgeons who are a little too aggressive?

Dr. Brophy said yes, and it supplements the guidelines agreed to 10 years ago.   The biggest problem is the patient that comes in with degenerative changes, and they do a fusion, and the patient does poorly.  It should not have been approved because it was all pre-existing, and the state of Tennessee is not required to be covered.  This is told to adjusters when they ask to discuss criteria.  Many don’t know or have enough experience for it to make an impression.  The entire cost could have been avoided with a good decision in the beginning.

Dr. Snyder asked if the guidelines protect the patients, and do they provide the patients with appropriate treatment?

ODG should do both things in the long run.  Make sure that what is approved is appropriate and make sure that it protects patients against any inappropriate things.

Mr. Prevot agreed that the guidelines are supposed to show what is appropriate and prevent what is not.

Dr. Tutor asked if the committee needed to take an action on this.

Dr. Brophy motioned that the committee delay action until they can read the final copy of ODG that comes out October 3rd and discuss it at the November meeting.

Dr. Talmage seconded the motion.

The motion passed without dissent.  The committee will delay the vote until the next meeting.

Dr. Snyder sent an article to ODG on cryotherapy, cryo-compression therapy, in shoulder and knee surgery.  ODG will make that change in October, as well. Mr. Prevot sent Dr. Snyder the draft of the change.

It will make a difference in the number of appeals for cryotherapy.

Drug Formulary:

Most of the changes were topic changes.

The first 7 had to do with recommendation and conditional recommendation for mental health and pain management for psychoactive drugs.

Dr. Snyder said he would forward any comments to the ODG.

The next update is due in October.  Dr. Snyder will publish it within the next week, and it will become effective October 1st.

Mr. Prevot commented that Ibuprofen 300 has been addressed in the new formulary.  It has a new NDC and is not a real cost-effective drug in a 300mg form.  Any feedback would be helpful.

Dr. Cole motioned to accept the changes, Dr. Talmage seconded.

The formulary changes were accepted as written, no dissent.

AMA Guidelines®:

The digital version of the AMA Guides to the 6th Edition has been published and finalized. The people who would be involved in evaluating have been busy with ODG.  At this point, there is no update.  It will be an agenda item in November.

Mr. Prevot announced that before the end of the year, ODG will be able to deliver the digital guidelines through the web version of ODG.  Subscribers will be able to access it through the web.  ODG has an agreement with the AMA.

Mr. Prevot will notify Dr. Snyder when done so he can notify the committee.

The 6th Edition digital will be part of the ODG subscription.

 

Legislative Update:

Ms. Terry reported that legislation is coming up next year.

 

The Medical Fee Schedule is at the Attorney General’s office.  She has requested an update and has been sent some information and will continue working on that.

Claims handling and case management rules are on their way to Gov OPS on October 15th.

Dr. Snyder explained that the biggest change in the fee schedule has to do with increasing fees paid to physicians in three categories to meet inflation.

Case management will have the ability to use virtual communications, such as secure audio-video, for some face-to-face meetings.

The biggest change in the claims handling standards is identifying contact individuals at insurance companies, carriers and employers, requiring them to update every 6 months.

If there is a problem with an adjuster or claim, then we will have the adjuster’s information and contact information with the carriers.

The Medical Fee Schedule is published on the Secretary of State’s website.  You can see what has gone to the Attorney General’s Office.

UR Report:

The utilization review report contained the compiled utilization review organization annual reports.   We were successful in getting 34 out of 37 organizations to respond with accurate information concerning utilization reviews.

Between 11,000 and 15,000 utilization reviews are done on Tennessee’s injured workers every year.

The breakdown in that data is also by the utilization review physicians.  The physicians that have had over 20 utilization reviews in the state are broken down into a separate worksheet so you can see the numbers.

Three physicians have done approximately 200 reviews.  It also lists the number of companies that each one of the physicians works for.  Some physicians work for up to 13 companies.  It provides valuable information to evaluate what utilization review is occurring in the state.

For a couple of months this fiscal year, the staff was able to send out every appeal determination the same day it could legally be sent.

Once an appeal is filed, there is a minimum of 5 days to let the adjusters either reconsider or let the appeal go through.  For 2 months, the reports were sent out on the 5th day.

Congratulations to the staff, Dr. Talmage, and Dr. Oglesby, for all their hard work.

If you compare Tennessee’s statistics with California’s IMR process, they are within 30 days on average of issuing their reports.  California’s IMR process also upholds the denials 90% of the time. Tennessee’s statistics are closer to 40% of the time.

Penalties:

Since the last meeting, there were 9 referrals to penalty.

  • Five of them were for records violations.  Example: Appeals with 750 pages of records with duplicates go to penalty.
  • Two referrals were where the peer-to-peer contact was not carried through by the reviewing person.
  • Two referrals were peer violations.  They were not the same or similar specialty or were not Tennessee licensed.

Appealing physicians should document whenever they are unable to make a peer-to-peer contact.

New Business

WCRI Reports:

Hospital Outpatient payments.  Tennessee ranked below the median state for outpatient payments, and they pay about 62% of Medicare.  The range for most states is about 110% of Medicare, but the growth rate in outpatient payments is between 10% and 40%.  Tennessee has one of the lowest increases for all the states.

Advanced practitioners.  According to WCRI, advanced practitioners make up an average of 30% of all initial non-ER appointments.   It’s higher than 37% for specialists.

They provide quicker availability and shorten the time for first diagnostics and first treatments.  They have slightly higher medical costs but lower indemnity payments.

They have slightly longer out-of-work or restricted duty than physicians.  The claims’ outcomes are very close to the same.

Medical Fee Schedule.  Tennessee is approximately 50% above Medicare which is slightly less than most states, based on 2023 data.

Emergency room visits and radiology services are higher in Tennessee than average.  E&M services and EMG services are significantly below at 62%.  Physical therapy and physical medicine are about 25% above the median state.  Surgery is about 100% above the median state because of Tennessee’s multiplier for orthopedics and neurosurgery.

Inflation Report from 2020 to 2025.   Tennessee providers have cumulatively lost 2% over that period per year while medical inflation went up 13%.   Physicians were essentially 11% down over course of those 5 years.  Tennessee ranks on the lowest side for increased rates of payments over that period, despite attempts to increase them.  Hopefully, the new fee schedule will address many of these issues.

 

Announcements:

The National Work Comp Meeting will be held at the Music City Center in Nashville on November 11th and 12th.

  • Next Meeting: 11/4/2025
  • Second Meeting: 2/10/2026

Dr. Snyder thanked the committee members.

Adjournment: 

1:59 PM

This Page Last Updated: December 11, 2025 at 10:47 AM