Dr. Michael A. Steingart 2014-05-06 23:30:45
How to Keep Your Finger on the Pulse of a Medical Case More and more frequently, accident and injury cases are resulting in extreme medical costs. How can you best serve your client, be fair and reasonable, justify the medical treatment rendered, while maintaining your esteemed professionalism? You can do this by focusing your efforts on the claimant’s steady improvement with his/her medical treatment. This steady improvement should be the goal. Just like a football team trying to score; the claimant should be improving as the goal. So, how do we keep score? An attorney needs to follow the case as one would follow the game. The score card is the medical record. The medical record should reflect a plan of action, methods of treatment to advance the claimant’s medical condition, and the medical provider’s ability to make changes should there be a stall or lack of progress. The medical record is the game plan. At this point, the concept of electronic medical records as required today needs to be discussed. The advent of electronic health records has made charting more difficult for both the scriber and reader. The old standard and simple SOAP (Subjective, Objective, Assessment, Plans) notes are considered obsolete. The chart note has evolved into an anthology; full of different dates, different authors, and a collection of rambled and garbled medical mumbo gumbo; as an alphabet soup with more letters than broth. Health care providers have been coerced by the federal government either to electronically bill or face the consequences of early retirement. Following the progress of the claimant with his/her medical care, will bombard you with up to eight-page reports, repeating everything from the previous chart, with very little new information. Hospital records are notorious for including every aspect of care rendered regardless of its importance. With today’s electronic medical records one needs a sharp eye, and a penchant for deciphering gibberish from fact, to follow the claimant’s progress. If the treatment rendered is effective, the claimant should make slow and steady progress with his/ her medical condition. Often, this information can be gleaned at the very end of the chart note. After six visits with a therapist or chiropractor, a general assessment of the claimant should be made, as to whether or not he/she has reached his/her goals. If you do not see this report, then more than likely you will see redundant notes without any new information, and the claimant is not being examined. Charges must reflect that the doctor obtained a history, examined the patient, reviewed the testing, and treated. If this is not done, then legitimate charges cannot reflect an office visit. The physical therapy notes will often be informative of the extra-curricular activities that the claimant is not supposed to be doing because of his/her injury. Often these outside activities are not revealed to the treating doctor, but the therapist will find out. The therapist may treat this extra injury at your expense. Beware! As you read the electronic medical records, take notes of the dates. Dates are hugely important, as one provider on one date may give an entirely different account of the claimant than the other. Frequently one provider may note the claimant’s improvement, while the other provider may find minimal gains. Certainly, at this juncture an independent medical examiner may be your best option to assess the claimant’s medical care. Get the independent medical exam early on, don’t wait till the case closes, otherwise you may be giving your opponent more ammunition. Conservative care is truly the mainstay of most injuries and accidents. With the advent of the quick and easy fix, injections have become increasing popular. Yet, most injuries do not require an injection immediately or within six weeks of care. Injections are like bottomless shopping bags, when it comes to medical costs. They usually come in pairs, and once started seem never-ending. Medical fact is that one injection begets another, then another, and another, and so on. True science does not justify these actions. Here may be another opportunity to obtain an independent medical evaluation. To summarize; the medical record is your only way to watch the claimant’s progress. Take note of the details, like dates and specific symptoms and treatments for those symptoms. If the claimant is not improving with his/her current care, make sure the chart reflects that, and see if the medical providers are paying attention and making adjustments. This will reduce costs and yet give optimal care. Dr. Michael Steingart is an osteopathic board certified orthopedic surgeon who has been in practice since 1989. He is published in numerous journals, is an adjunct professor to two medical schools, and is a dynamic speaker. Dr. Steingart is fellowship trained in sports medicine and orthopedics from the University of Arizona: fellowship trained in Minimally Invasive Endoscopic/Laser Spine, and received a fellowship from the American Academy of Disability and Impairment Physicians. Dr. Steingart is also a jazz musician playing flute, clarinet, saxophone and piano. He is on staff at numerous hospitals in the Valley of the Sun. For more information please feel free to call ExamWorks at (866) 800-4637
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