Meeting Minutes

February 10, 2026 via Webex

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) by proxy to Dr. Brophy
• John Brophy, MD, Neurosurgery
•  Jeff Hazlewood, MD, PM&R, Pain Management
• Lisa Bellner, MD, PM&R Pain Management
• Veatrice Storey, Zurich Insurance
• Ginny Howard, Arch Insurance
• Cerisia Cummings, DO, Bridgestone
• Lisa Hartman, RN, AFL-CIO—joined late
• Tim Jones, MD
• J. Wills Oglesby, MD

Staff:

• Robert Snyder, MD, Medical Director, BWC
• James Talmage, MD, Asst. Medical Director, BWC
• Jay Blaisdell, BWC
• Suzy Douglas, RN, BWC
• Lacy Conner, BWC
• Kyle Jones, BWC
• Suzanne Gaines, BWC
• Mark Finks, BWC

Guests:

• Larry Brinton, Accuro Solutions
• Yarnell Beatty, TMA
• Alton Hunter, MD, TOA
• Sarah Herbert, Erie Insurance
• Tiffany Grzybowski, HealtheSystems
• Tina Uhing, The Hartford
• Adam Jaynes, MGR
• Faith Parrish, VUMC
• Sandy Shtab, HealtheSystems
• Cory Wedding, My Matrixx

In Person:

• David Tutor, MD, Occupational Medicine
• John Brophy, MD, Neurosurgery
• Cerisia Cummings, DO, Bridgestone
• Rob Behnke, Cracker Barrel

By Telephone:

• Veatrice Storey, Zurich Insurance
• Carina Sloat, RN, CCM, Travelers

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 1:02 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, 14/18 members present).

Approval of Minutes

Dr. Tutor called for approval of the minutes for the November 4, 2025, meeting.   Dr. Cummings motioned and Ms. Sloat seconded.   

The minutes were approved as written with no dissent.

All Conflict-of-Interest forms have been turned in for this year.

Old Business 

ODG Updates:

Dr. Snyder outlined the Conference call with ODG which included Troy Prevot and Dr. William Rifkin, the medical advisor for ODG.  Dr. Snyder and Dr. Talmage were on that call, and several things were discussed at the meeting.

The first was the presence of a 2^nd disc recurrence requiring fusion.   The second was to limit the necessity of conservative treatment for a clear cervical radiculopathy to 6 weeks, and that no psych evaluation for clear disc herniation and radiculopathy was necessary.  The next item was physical therapy.   This discussion has been going on for a year and a half because of the limits ODG put on either the number of visits or the length of time for the therapy to continue.  It was suggested that this should be changed to the advancement of functional outcomes instead of based upon the number of visits or the length of time.

The next issue was spondylolisthesis.  Fusion would only be necessary if there is proven instability, especially since there is spondylolisthesis in many older individuals with degenerative disc disease.  We are also recommending how to evaluate that with supine films and neutral standing films.  A change to the stenosis section involves decompression only with no fusion unless there was proven instability.  

The psychological evaluation has certain terms such as uncontrolled psychological conditions and personality style and coping ability that are not defined. These terms need a clear definition to focus on the importance and validity of a psychological evaluation.

The next issue is sacroiliac joint fusion.  Many individuals have degenerative changes and spontaneous fusions as they get older.  Recommending CT scans and arthrography are not always accurate so those changes for false positives were also recommended.

The last item discussed is the confusion concerning cold compression therapy versus continuous flow cryotherapy.   These terms are very specific to ODG, and we have tried to get ODG to come into line with what really is cold compression therapy versus continuous flow cryotherapy when it comes to certain procedures.

As of October 2025, ODG approved continuous flow cryotherapy for shoulder surgeries which has helped some of our utilization review.  Following shoulder surgery, continuous flow cryotherapy is now recommended for 2 weeks by ODG.

The meeting was cordial and ODG was very accepting of most of the changes.  When Mr. Prevot comes on the call,  we will ask for a date when the next revisions come out.

Dr. Snyder asked if there were any questions.

Dr. Talmage commented that 3 times a year the guidelines change, and it is hard since we have not approved any of the last 5.   It is hard to know what to do about UR but perhaps there will be clarity with the next revision.

Dr. Tutor asked if the committee wanted to postpone any action on these changes at this time.  The committee did not take any action.

Dr. Tutor had a question about the psychological evaluations.   He assumed this was about people of sound minds capable of making decisions for themselves.   What type of  spinal surgery has been denied because of the psych evaluation?  Dr. Brophy answered that  it is usually not done for standard insurance practices for fusion, but it is required for stimulators and the most common issue that makes someone eligible is if they have depression issues.  Many times, treating depression can improve the overall situation without surgery.  That’s what they are really looking for.   Dr. Tutor asked, “Have you ever seen an injured worker that wasn’t depressed?”

Dr. Tutor asked for any other comments or questions.

AMA Guidelines®:

The AMA has closed the evaluation committee that was designed to continue changes to the AMA Guides®.   The changes made to the pulmonology section and one other section  were completed in 2025.  As of now, they are not going to make any changes to the substance of the AMA Guides®.  There will probably be some enhancements to the platform itself, but no changes in the content  from now on.  As a result, sometime this year we will get a better evaluation to the Medical Advisory Committee on what our recommendation will be on whether we should recommend going to 6^th Edition AMA Guides®.

Three states have adopted the 6^th Edition 2025 digital.   Wyoming, Arizona, New Mexico have unusual  language that states “most current version” .  Tennessee’s language is specific to the version, and it is in the statute.  Change would require an act of legislature, which is a 3-year process at minimum.

Dr. Cummings referred to a discussion from the last meeting about talking with one of those states that have adopted it to see how it works.  Dr. Snyder has not yet talked with anyone.

 

Medical Fee Schedule:

On January 19, 2026, the medical fee schedule rules went into effect, but all the changes to the rules will go into effect on April 1, 2026.  The fee schedule will be updated by Fair Health and be available by mid-March free of charge to those who want to download it through the Bureau website.

The major changes have to do with the reduction in the number of different categories of reimbursements.  There was an increase in physical therapy.  There was also an increase in the evaluation and management (E&M) for most physicians.  There was a clarification in the language concerning Certified Physicians.

 

Medicare Update:

Medicare announced the new conversion rate of 33.4009, which is a slight increase over 2025.  This conversion factor will go into the medical fee schedule.

Dr. Tutor asked for comments.

UR Report:

There are issues with the peer-to-peer concerning the incomplete information provided to physicians.  The committee has been investigating how to improve the ability of the providers to get in touch with the utilization review physicians in a timely manner.

Dr. Snyder presented some examples of redacted incomplete UR reports on the screen.  In the reports issued by the utilization review,  the voicemail messages that are left for the physician offices say they list a callback number and the  information for callback, but it is not listed on the reports.   No one can verify that the numbers left on voicemail can be reached in a timely manner by the provider to request a peer-to-peer.  What is left is a detailed message that leaves the callback number, but they don’t say what the callback number is.  The Bureau cannot verify that the number can be reached by the provider.   That is the only way the Bureau can get action from the utilization review organizations as to accountability for our peer-to-peer rules.

The Bureau has attempted to strengthen the peer-to-peer by providing a longer time frame for peer-to-peer and providing the possibility that the insurers will have a website or an email address for peer-to-peer contacts.  The committee needs more information.

The committee will move forward with recommendations regarding the problems identified.  Possibly, it can be done by advising the utilization review companies.  It may not be necessary to do it by rule, but we will see what kind of action will improve the possibility that the providers and the review physicians will make contact and provide more information.

Dr. Tutor asked for comments, questions.

Ms. Sloat agreed that this was good to take back to the UR groups because her organization has had the same experience.  It is difficult to tell what number is left for a call back, so they’ve had to go back to the UR providers for the physician advisor to get clarity.   They are encouraging them to put it in their reports.   Start with encouragement about being clear what number was left before making a rule.

Dr. Tutor asked if any of the information from the UR reviewers is time-stamped and dated.  Ms. Sloat answered that there is no electronic time-stamp or date; it is the date or time that they put in the report.  A time-stamp date would track when the UR physician called and when the treating physician tries to call back; a caller record for verification.

One of the complaints from the physicians’ offices is the lateness of calls and the urgency from the UR callbacks such as the physician must call back immediately, or a denial will be issued.  Most of the time the providers do not have a call log to keep track of calls that they could provide to the committee because calls go to a general switchboard.   This system needs to be fixed.

The rules make it possible for insurers and UR companies to set up a website for which written communication can go through.  This does not happen very often, but it is available to them.

Dr. Bellner said that initially doctors often left cell phone numbers but could not be reached.   Now, they give office numbers and when you call, the doctor is not available, or they put on  a staff member to discuss the case instead of the doctor.  This seems to be the present trend for some physicians to avoid speaking with you.

Dr. Tutor asked how her office tracked that.  Dr. Bellner said that it is a very small office and everything is tracked because she is there all the time.  She looks back at the call log to check when they say they have called and usually finds that there were no calls at all or they call at 7:00 PM and hang up and say no one answered.  Dr. Bellner gets all her calls after hours, so they hang up and count that as an effort.  Her office is familiar with these doctors because they are usually the same ones.  Dr. Bellner also remarked that there are some doctors who always make the effort to speak with you.

Dr. Snyder asked for 2 separate lists of doctors who return calls and doctors who do not.  Dr. Bellner agreed to do that.

Dr. Tutor asked if those correlate to different UR organizations.  Dr. Bellner knows the doctors’ names but doesn’t know the organizations.

In the utilization report to be completed by the end of March,  the doctors who are doing utilization reviews are hired by more than 1 company, maybe as many as 6 companies.  They are doing utilization reviews for different UR organizations under the physician review of different companies.  The issues seem to be more with the doctor than with the UR company.

New Business

WCRI Reports:

Dr. Snyder summarized a WCRI report regarding total joint replacements in workers’ compensation.  Total joint replacements have increased from 7 per 1,000 claims to over 8 per 1,000 claims from 2015 through 2025.   A jump of an entire percentage.  Since 2015, shoulders have now made up almost 43% of total joint replacements done in workers’ compensation.  Unfortunately, their data would not allow them to differentiate between reverse total shoulder replacements and standard total shoulder replacements.

For all total joint replacements, inpatient surgery is now only 20% of the total.  It has moved to outpatient and to ASCs.   Fifty percent of all replacements are done within 1 year of the injury which include 40% of hips and 10% of shoulders being done within 30 days of injury because most of those are fracture treatments.  This has become the standard  of care.   Forty percent of knees and shoulders were done within 1 year of the injury, so these are occurring very quickly.  You can make the case that functional improvement requires those, but  then if they had not been under workers’ compensation, would the same surgery have occurred?  In Tennessee, early revisions within 2 years of total joint replacements are 5.5% compared to 4% on average countrywide.   So, we have more surgery being revised early than the average.

The average 24-month cost to the insurer for a total joint replacement is $127,000.00, of which $68,000.00 is medical, $48,000.00 is indemnity, and $9,000.00 is other services including physical therapy.    The average duration of temporary disability is 48 weeks, almost 1 year from the date of surgery.   The diagnosis: two thirds of knee replacements are due to arthritis, 45% of hip total joint replacements are done for fracture  and another 40% for arthritis, 35% of shoulders for rotator cuff disease, 10% for fracture, 35% for arthritis.   The average age is over 50 years for 80% of these, and 63% are male.

There is significant interstate variation;  4% of claims are in Texas, 16% are in Louisiana, and 11% are in Tennessee.  The choice of provider seems to make a difference.   More surgeries are seen when the employees choose the physician but there is no obvious pattern.  Dr. Snyder can send a summary of the report or the entire report to anyone who requests it.

Dr. Tutor referred to the arthritis in joint replacements and asked if they could differentiate what was post traumatic arthritis prior injury with arthritis or pre-existing osteoarthritis that was aggravated by an injury at work.  The surgeons and physicians are very poor about the accuracy of the diagnosis.   You can have an otherwise normal joint and 2 years later, it will be labelled osteoarthritis and not post-traumatic arthritis.  What comes out of the data is that it is all osteoarthritis regardless of whether osteoarthritis was present at the time of the initial injury.  It is like trying to figure out the reverse total shoulder replacements versus the standard, the data is hard to analyze.  The study was 32 states.

Ms. Hartman had a question about the statistics from Texas, Louisiana, and Tennessee.   Is the difference in the type of work they do in those states causing the different percentages?  Dr. Snyder did not have an answer for that since that data was not part of the study.  In the utilization review information for total joint replacements, they are usually truckers and service workers.  The demographics of individuals for total joint replacements tend to be in the age group 45 to 60 with pre-existing arthritis, obesity and other risk factors.

Texas has a unique system in workers’ compensation because they can opt out and provide their information or treatment outside of their workers’ compensation bureau.  Maybe this is occurring outside of the way they collect the data.

Announcements:

The 2026 Tennessee Workers’ Compensation Educational Conference will meet in Murfreesboro on June 10-12, 2026.

The conference is in the planning process and there will be at least 10 hours of CLE for the workers’ compensation attorneys.  There will probably be 5 breakout sessions on medical topics, and preliminary subjects will include access to care, analysis of utilization review, and an ethics session for the case managers.

Kids’ Chance will be there  on Thursday, the 11^th.

There is legislation  proposed this year in Senate Bill 1981 that looks to increase the amounts that attorneys receive in settlements, the percentage.  It also creates disability benefits.  It is being presented by the trial attorneys and the self-insured groups, the chamber.  Mr. Behnke just met with them, and they are discussing what they’re looking at and ideas to compromise.

Next Meeting: May 5, 2026

Second Meeting: August 25, 2026

Dr. Snyder thanked everyone for their attendance and all the work they do to help with workers’ comp and the injured workers.

Adjournment: 

1:46 PM CDT.