Shoulder Integrity Evaluation of Whole Person Impairment Rating Specialists

Whole Person Impairment (WPI) Ratings are medical evaluations performed on injured workers seeking insurance settlements in the workers’ compensation insurance system. The examinations performed and reports prepared by medical providers vary considerably in terms of consistency, accuracy, and reproducibility. Incomplete reports and variable outcomes often result in litigation and additional costs for all stakeholders in the system. We have created a systematic inventory model to evaluate quality, completeness, and consistency with a patented impairment method currently used in the marketplace. We have selected the shoulder exam to serve as a pilot to create a database for research. The “gold-standard” outlined in the American Medical Association Guides to the Evaluation of Permanent Impairment (AMA Guides) is used to determine the complete criteria for history, physical exam elements, diagnostic testing, and surgical procedures performed. The exam findings are entered into the system, and an “integrity score” (0-100%) is created for each examiner. Each evaluator is then compared to all other examiners in the study to generate a performance percentile report, indicating overall areas of strengths and weaknesses thereby identifying areas of investment and education for the medical examiners. This new data analysis method allows stakeholders to assess and predict the value of medical determinations using this system to expedite settlement and increase confidence in outcomes.