Academy of Chiropractic’s Lawyers PI Program
Lawyers & Medical Specialist Meetings – Communication #25
From the Desk of :
Mark Studin DC, FASBE (C), DAAPM, DAAMLP
“The Practice of Law Business Model… Is Upside Down”
You or your staff attempts to set up a meeting with the lawyer and you can’t get past their secretary. You make repeated phone calls and are politely told the lawyer is simply too busy. However, you are persistent and finally the staff member tells you “please don’t be offended as the lawyer only wants to work with medical neurologists, orthopedic surgeons or neurosurgeons.”
This is a scenario that plays out in offices around the country and to some appears to be the norm with that “glass ceiling” that we just can’t break through. Many lawyers also believe this is the solution to their downward spiraling settlement offers and that chiropractic will be another negative piece of the puzzle towards their financial ruin. This belief system, no different than Chicken Little yelling “the sky is falling” is upside down. If their current belief system is true then how come lawyers 10 years ago were getting $20,000 – $40,000 settlement offers and $2000 – $4000 settlement offers today are being offered as a rule?
The answer is crystal-clear and one the lawyers don’t see and it is your job to first educate and then enlighten them. I believe that this scenario was created by the carriers in a brilliant business move to shift treatment away from the chiropractor to the medical specialists realizing that the medical specialists both does not have the time or desire to document completely in order to satisfy the Colossus algorithms, which is the primary cause for the ”low ball offer.” As a result the lawyers believe they are getting the solution to reverse the trend, however by “staying the path” of medical specialists they are perpetuating the downward spiral of pitiful offers. The sad part is they don’t even realize it.
Lawyers as a rule of business set every case up from day one to go to trial. Therefore they firmly believe that the medical specialists are there best choice for trial with the belief that settlement is an easier pathway and by accommodating the courts in trial settlement will take care of itself. THIS IS THE PROBLEM.
What lawyers do not understand is the following:
(There is a similar ratio on every state)
The question is, which practitioner can take the time to document accordingly considering that a neurosurgeon in NY must collect over $634 per visit just to cover their malpractice? No one gets those fees from insurances, therefore they lose money unless they are operating and are forced to limit clinical time during their evaluations and can only focus on the potential surgical lesion, which is what they should be doing.
In settlement, the Colossus algorithms have to be satisfied based upon gathering and documenting a significant amount of clinical and historical information of the patient. As a rule chiropractors spend between 45 and 60 minutes with each evaluation and provided you have been paying attention and documenting those required “value drivers” (insurance company language) you can begin to help the lawyers realize a fair and equitable settlement offer based upon your findings. I have attended hundreds of evaluations with neurosurgeons, neurologists and orthopedic surgeons and not once has a medical specialist spent more than 15 minutes with a patient… They can’t spend more time and still maintain a viable business.
As a result the chiropractor acting as the primary spine care provider will enter all of those necessary items as fully discussed in the narrative section of the consultations. It is here where the value of the case is realized and then as a true primary care provider you will be triaging your patients to specialists as clinically indicated. I can tell you with a great degree of certainty that I have never withheld a referral on a significantly injured patient to a medical specialists for collaborative care. Therefore the lawyer is going to get the exact same medical specialists after you do your complete workup. Then if the case goes to trial the lawyer has the medical specialists they desire or you as a credentialed chiropractor to choose from. It is a no lose for the lawyer at the trial level and a huge win for settlement purposes.
The problem is most lawyers do not understand the algorithms of the insurance carriers and many have never even heard of Colossus. It seems unreasonable in 2015, however the carriers have been very successful in keeping this “under wraps.” Again, your job is the first educate and then enlighten and once that has been accomplished you can now explain to them how to bring their settlement offers back to a fair and equitable level.
The bottom line in the paradigm shift that you must create is to get the lawyer to realize that it is in the best interest of the case for their clients to start with you, the credentialed chiropractor FIRST and then be triage out to the medical specialists.