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 skin substitute material, site preparation, placement, blood flow check for site postoperatively, special graft and donor site care
  • Supplies in OR: dressings, antibiotics, IV fluids, pain medications
  • Hospital charges: OR, preop holding area and postop holding (PACU) (usually billed in 15-minute increments), dressings/supplies/medications/IV fluids, inpatient stay vs. 23-hour observation vs. discharge home, equipment and fitting (crutches? brace? splint? cast? pressure dressings? other?)
  • Home care: nursing visits, dressings, pharmacy / medications
  • Post graft care: Physical therapy / occupational therapy post knee immobilization; plastic surgery clinic to follow healing if surgeon doesn’t do this in office visits
  • Possible complications: Costs for admission for infection, graft removal and wound care; regrafting if needed

Now, you have to realize that there isn’t a physician in practice who knows, or whose office knows, the cost of any of these items except his own fee. And this list has probably given you the idea that a good MCP includes much more than you’ll get from “just ask the doctor’s office.” Have you ever tried this tactic? As Dr. Phil would say, “How’d that work out for you?”

This is how it will work out. While he has (so far) avoided paying me for my expert research and generously provided me with the topic for this blog entry, it is very likely that this attorney will underestimate his client’s actual medical costs by tens of thousands of dollars. He also doesn’t know a thing about how to get these figures.

This will not serve his client’s interests, even if it means a faster settlement. Howland Health Consulting does work for both plaintiff and defense firms. We have often said to a defense client, “If that’s all they’re asking for, write the check with a smile.” The carrier in this case doubtless has someone like me telling them that the actual bill will be far higher. Therefore they will cheerfully accept a lower demand for the favor of signing off the claim.

Don’t be that guy or gal on the other side of the table, the table with real money on it. Contact me! I am a professional legal nurse with life care planning and costing expertise to make you the best-prepared attorney in the room. Call Howland Health Consulting at 866-604-9055 or via our online contact form to get started now!

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