Academy of Chiropractic Personal Injury & Primary Spine Care Program

Quickie Consult 1074

Infrastructure 232 I

From the Desk of Dr. Mark Studin
Academy of Chiropractic
Preamble: Many of the issues I bring to you are very small, yet each issue is just that, an issue. If you take care of the small issues, then you will be able to build and more importantly, focus on the bigger issues...a larger practice and more family time.

"Managing Cases Prior to Joining PI Program"


Dr. Studin: What was your initial question? Because I don't remember, God, that was like a whole minute ago.


Guest Doctor: Just prior to joining the prep program I had a patient back in 2016 and I notice some things I would like to have done differently in their case.


Dr. Studin: Ah, okay. I remember. So, and as we talked about a moment ago, I get just from 100% of the doctors who start with us. Once you start reading the consultations, you have a holy crap moment. Like, what did I do? And by the way, for me, when this stuff was revealed to me, I wanted a call every patient I treated before and apologize to them. That's how bad I felt. It's like, what was I thinking? And it's like, you know, and the further you get out of school, the more bad habits you get into. And you stop doing things you know you need to do. And it's a challenge. But now all of a sudden, cases come up and holy crap, what do I do? How do I handle it? So, here's the procedure:

I don't want to say close the holes in the bucket because you've already done that, but how do you get the patient back in the pipeline so you can, um, more, I don't want to use the word accurately, but more thoroughly, document the case with what you know is missing. 

So what you do is, the first step is: you call them, not you, but your staff calls every single, you pull every case for the last five years that you've treated, that are PI. I hope you're writing this down. Your staff asks their staff, “is the case still active?” “Yes or no?” “Has it been settled or gone to trial?” And it's just a yes or no answer. And the ones that say yes, it's off the table, you cross off your list. 

The ones that are still active, you're going to call every patient and say, "I need to get you in for a follow-up evaluation so that I can give your lawyer an updated report as to your status so they can help settle this at the highest possible level for you. There is no fee for this." If the case is lean, You don't really need to say that. But I would say there's no fee for it because I want the patient, I want to remove every obstacle. I need to close the door behind me because I really didn't, from my perspective, didn't do such a great job the first time. 

So I would say “this is part of your care, there's no additional fee, but I need to get you in”, get the patient and do the evaluation that you know you need to do. Okay. Fill in all the diagnostic dilemmas, order an MRI if you need to, do functional loss evaluations, perhaps x-ray to digitize, if you haven't done that. All of the things you know you need to do now. And then what you do is conclude an E&M report, but you also have to inspection the functional losses. Now we know that colossus is not the end all. 

I mean it's a teeny tiny piece of the overall picture, but nonetheless, it's still important. So unique to understand that learned duties under duress and loss of enjoyment of life. And if you don't fully understand that, go to section three narratives and look up duties under duress and loss of enjoyment of life and become fully versed in that, you really need to hone in on that. 

Do not use Oswestry, low back index, nexin, don't use any of those things. Keep it real. Mrs. Jones was able to do the dishes for an hour prior to the accident and now she can only do it for 20 minutes due to pain. Ms. Jones is married for 15 years, had a very healthy sex life with her husband and due to the pain, she hasn't been able to have sexual relations, you know, for the last year and a half. The pain is too severe. Things that are real, and by the way, not only is a part of the colossus algorithm, it resonates well with Justices and Juries that you're a doctor and we're able to approach these subjects with patients in a respectful manner. So all of these things have to be documented.

Once you do that, put it in an E&M report and if there's been a gap in care, between, say it's been three months, six months, I mean if there's more than if you have an ordered gap in care. Okay. That's one thing. Another word, the chronology of symptomatology where after you're done, when you, before you MMI them, you put a two, four, six week period of time in between there. But once you MMI them, you want to get them in at least once every three months until the case goes to trial, at least. Because now you're following them, you're seeing what's going on. And even if you haven't seen them in a year, you might suggest they start coming back but find out what they'd been doing during that time, what is an act of care and act of care is, what they're doing for themselves.

You want to find out if they have been walking extra, stretching extra, ibuprofen over the counter drugs supports, have they modified their sleep, if their sleep have modified their work? Do they see their family doctor because they still need medication? All the things that show that they're continuing care but not through your office. So you need to document all those things. Then you're going to call the lawyer and you're going to say, “I have significant new information about your client. I'd like to meet with you”, if in fact, you know, there's been a gap between the way you stopped treating them and now after you conclude that report, you can then either do a robust E&M report or a four corner’s report, which is a narrative covering the four of the case, so that they can go to trial with it. And You understand the difference. Yes?



Guest Doctor: No.


Dr. Studin: E&M and Narrative? When you do an eval and a re-eval it's a 99202, 203, 204, 205. Let's just say a 203, you know what that is, Yes?


Guest Doctor: Yes.



Dr. Studin: And a 99213. You do know what that is, correct?


Guest Doctor: Yes.


M. Studin: Okay. A re-eval, that's an eval and a re-eval, which is good for insurance companies and coach treating physicians. But a lawyer needs a narrative that's called the four corners report. If it's very, very different. And by the way, you need to take the testifying courses part one and part two, um, to really fully understand the process. Now, have you finished reading all the consultations yet? The first six sections.


Guest Doctor: No.


Dr. Studin: Okay. How long have you been in the program? About?


Doctor: Probably 8 to 10 months.


Dr. Studin: It is unacceptable at every level for you not to finish those consultations. There's enough information in there for you to literally almost double your income and resolve all of these issues. So it's just a function of being lazy or just plain and simple. I have no patience for why you are not more successful than you are today. I have no patience. It's unacceptable. It's intolerable, unfathomable to me. And so, consider this your kick in the ass. Now, I mean that sincerely because you should be working on your academics already and six, seven months, eight months in the program, you should be just about on the trauma team. And you are in one of the prime areas in the nation right now. I mean, really one of the hottest locations, and I'm not going to discuss where that is because we're being recorded, also my wife hates this expression but “You've been given away the barn”. There are things that are just slipping through your fingers that you should be grabbing. And it's unacceptable for me, for you not to see more people and make a ton more money than you are now. So, start reading because the answer to what you just asked me is also in the consultations. It's all there. Now. With that being said, when you call the lawyer, you're going to sit with them and if it's been just a short amount of time since you’ve seen the patient, you give them an E&M report. If it's been more than say, four or five, six months, you give them a narrative report and you should use Dr. Schonfeld to write the narratives for you. Because not only is a perfect but, you get oversight with someone helping you understand what's on there and what's not on there. Okay?


Guest Doctor: Okay.


Dr. Studin: Did I answer your question?


Guest Doctor: Yes. I just got paged to go see a patient so I gotta run.


Dr. Studin: Go read. Goodbye. 

PLEASE TAKE FURTHER NOTICE: CONFIDENTIALITY AND PROPRIETARY INFORMATION NOTICE:  This email including attachments is covered by the Electronic Communications Privacy Act (18 U.S.C. 2510-2521) and contains confidential information belonging to the sender.  Nothing contained in this message or in any attachment shall constitute an Electronic Signature or be given legal effect under 44 U.S.C. 3504 Sec. 1707.  The information is intended only for the use of the individual or entity to which it is addressed.  If the recipient of this message is not the intended recipient, you are at this moment notified that any unauthorized disclosure, dissemination, distribution or reproduction of this message or any attachments of this communications is strictly prohibited and may be unlawful.  If this communication has been received in error, please notify the sender immediately by return email, and delete or destroy this and all copies of this message and all attachments.