Do you read those PT records? No? Hmmm …

Let me tell you a story. Some details have been changed to protect … well, you know. Once upon a time I was asked to review some records on a young man, about 32, who sustained many fractures in an accident. Let’s call him Charley. Now, several years later, he’d been back to his regular job as a waiter in a busy downtown restaurant. Well, the attorney was happy because there was a physician note from a pain management clinic opining that lifelong physical therapy was a good idea; the associated physical therapist thought so too. And after all, if a doctor says so, it has to be true, right? What could go wrong? Asked for Charley’s PT records, he said, “What do you want those for? You can’t ever read those things anyway.” Please, I said. It turned out that Charley did have quite extensive rehabilitation. After he got out of the hospital, he had outpatient PT for months. As the attorney foretold, the PT flow sheets were poor copies of largely illegible scribbled codes in tiny boxes, all scrambled up and hidden in a pile of unrelated material. However, as I anticipated, the admission and discharge evaluations were typed and clear: Charley had done well in PT, been adherent to a good home exercise program, and was discharged having met all of his therapist’s functional goals.  Ten months later a new physician sent him to a different PT because he had stiffness and joint pain. After eight weeks of care, he had again met all his discharge goals, including demonstrating an appropriate home exercise plan. This therapist noted particularly...

Do you leave money on the table in medical cost projections?

Do you leave money on the table when you use medical cost projections (MCP) in negotiations?  You sure do, if  you think that surgeon fees are all that count. This is surprisingly common. Let me give you have a fuller idea of what’s involved in getting a good MCP, so I can help you get the most bang for your buck for your client. Here’s an example. I recently had a potential client ask me for a MCP “for a skin graft,” which he thought might have been for a scarred knee. I told him this would likely take me about 6-7 hours of work, including looking at medical records to see exactly what was being proposed and speaking to the physician. He demurred at this, telling me that he needed to keep costs down. “I’ll just have my client ask the doctor,” he said. Well, because the nurse in me really wanted to help him, I said, “Fine, and let me send you a list of what she should ask the physician when she sees him.” I am sure my not-quite-client was shocked to see this list of likely and possible billable items come across the wire: Preop testing charges– for what tests? General health panel, serum proteins, local area tissue oxygenation (get all CPT codes) Surgeon fees– do they include pre- and post-op office visits, or are those separate? (CPT codes for each) Anesthesia: What anesthesia technique– spinal, regional, general?  Hospital costs and anesthesiologist professional fees (CPT codes for each) CPT codes for all procedures performed as part of this grafting: graft harvesting (allograft, split-thickness, cultured, or other) or other...

Q&A on Life Care Plans

I know that many –perhaps most– of the people reading this think they know what a nurse life care planner is and does already. And they might. But if there’s one thing I’ve learned in my work, it’s that you can always learn something new. Maybe this is your chance! Here are some questions I get asked by attorneys, trust officers, and others. Q. What’s a life care plan? What’s in it? A. My life care plans are tools to estimate medical and nonmedical needs of a person with a catastrophic injury or chronic illness over his lifetime. They’re dynamic, meant to be flexible as time passes. It’s based on my full assessment, published standards of practice, data analysis, and research. A given LCP could include medical needs and costs, such as physician and nursing care, medicines, and therapies, and less-obvious things like goods and services to help with safe aging in place, architectural modifications, change in level of care, equipment/maintenance/replacement, transportation, furnishings– anything in someone’s life that will incur costs related to the injury or illness. Many LCP cases deal with people in workers comp or liability claims. I see catastrophic conditions like traumatic brain injury, spinal cord injury, major trauma, major burns, chronic pain, major psychiatric diagnoses, or a combination of conditions. I also see children with birth injury or developmental condition like cerebral palsy or mental disability, or elders whose care needs fall to a family member, guardian, or a trust fund and may not involve litigation. Q. Isn’t Obamacare going to take care of all this anyway? A. The Affordable Care Act mandates insurance coverage for doctor visits, medicines, or hospitals for a great many people...

Life Care Planning in Traumatic Brain Injury

What is a life care plan? Who uses it? A life care plan is a dynamic document that outlines medical, therapy, environmental, transportation, equipment and supplies, pharmaceutical, and other needs for a person with a catastrophic or chronic health condition, with all associated costs. It is transparent, meaning that the planner clearly identifies sources of data and costs included, such as from personal contact with treating team members, the patient and family, medical records, and current and proposed vendors. The credible life care planner also clearly describes the methodology used; the planner makes only recommendations for individual plan components within the scope of practice of the planner’s original licensure. Most, though not all, life care planners work for attorneys involved in litigation; I work for both plaintiff and defense clients to avoid appearance of bias. This article is intended to give a brief overview of some of the many factors I consider in life care planning for an individual with brain injury to clarify future needs and expenses. How does a nurse life care planner work? As a certified nurse life care planner (CNLCP), I use my extensive experience as a registered nurse in rehabilitation nursing and case management to guide my assessment of a brain-injured patient. Registered nurse licensure empowers CNLCPs to assess and prescribe for human responses to injury and illness, which privilege we take seriously and is not shared by life care planners with vocational, therapy, or counseling backgrounds. Writing collaborative plans of care with the patient’s best interest foremost is in nursing’s DNA. I develop plans of care for life expectancy based on my personal assessment. I...

Making structured settlements better?

I’ve been learning a lot about the structured settlement industry lately. Though I’m the first to tell you that I’ve still got more to learn, here’s one thing that really struck me early on: there’s a way to improve client outcomes available to conscientious plaintiff and defense attorneys alike, and many of them don’t know enough about it yet. Because I’m a certified nurse life care planner and certified legal nurse consultant, you know what I’m going to say next, don’t you? When the parties negotiate and agree to a settlement, often it isn’t going to be a lump sum, but can be allocated in different ways. This picture is sure to get even more complex when ACA provisions become more prominent. Even if you have an expert nurse life care plan as part of the initial negotiations, it often makes sense for the parties to work with a nurse life care planner, a financial planner, and a specialist in governmental and other benefits to be sure the distribution plan makes sense to meet projected needs. So, if there’s a life care plan already and the settlement has been reached, why would you need a nurse life care planner at this stage? Well, consider that the settlement may not fully cover projected costs in the plan. It’s not reasonable for the client/family member to be responsible for figuring out the best way to allocate those resources, is it? Or a trust officer, whose knowledge about medical, rehabilitation, and habilitation isn’t enough to make those complex decisions? This is precisely where you’d want a solid, experienced, and well-credentialed nurse life care planner, with professional licensure and expertise in the medical arena, on your client’s side. Want...