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According to AMA:
Foundations of the New AMA Guides 6th
Edition
The 6th Edition institutes
ground-breaking changes. Using the 2001 World
Health Organization’s International Classification of Functioning Disability
and Health (ICF) as its basis (WHO, 2001).
This edition incorporates
functional status evaluation
directly into the impairment rating process.
The new rating process closely
approximates the four classic elements of a
routine medical examination:
history, physical examination, clinical studies,
and functional status. In most
chapters, the diagnosis will be the chief
factor determining the “class” of
the impairment rating. Once a class is
chosen, there are only three to
five numbers from which the impairment
rating may be selected. Within the
five class numbers, movement up or
down from the middle number is
determined by the grading factors. The
grading factors encompass the
remaining elements not used to determine
the classification, usually
physical exam findings, clinical studies, and
functional status.
Functional status is determined
either by using a validated functional assessment
testing tool or by the physician’s
assessment alone. If a functional
assessment testing tool is used,
the physician should document further
physical examination findings and
testing that validate the patient’s report
of function. In practice,
functional assessment may only move the rating
number within the class by one
step. Reports that vary by more than one
step are not used in the rating.
The new process creates a new, more realistic
framework for impairment rating.
Using the same methodology for
ratings in the majority of the
chapters is expected to improve a physician’s
ability to perform reliable
ratings. The use of a rating process that parallels
the common medical report
structure should encourage practicing
physicians to use the AMA Guides.
In addition, forcing specific numbers
for specific findings, without
ranges, is expected to decrease some of the
arbitrary variation in ratings seen with previous
editions.
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