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What Practice Guidelines Should You Be Using?

What Practice Guidelines Should You Be Using?

by | Jan 10, 2020 | Articles

Why are guidelines so important and what guidelines in the injury market are excessively important, especially for you, the treating provider?

A treatment guideline is developed after many of your peers have come together and have committed a significant amount of time and energy to analyze several different research models to put forth recommended treatment guidelines for any profession.

                There are several types of treatment guidelines. There can be chiropractic treatment guidelines; there can be physical therapy treatment guidelines; there can be orthopedic surgery treatment guidelines.

Guidelines are best practices established by your profession that you will be judged by. That is probably the most important thing that I’m going to tell you today. Here is the important part. You should be listing what guidelines you use in your private practice. What if someone says, “Hey, I think you over-treated in the injury market.”? It does happen and these are things that you must be cautious of and take into consideration and protect yourself from.

                If you list what guidelines you use, those are the guidelines by which you’re judged by. If you say, “Look, I use the ICA best practice guidelines for my treatment guidelines”, those are phenomenal guidelines for Doctors of Chiropractic to be using. I train doctors to list those guidelines as the primary guidelines that they use. There are also practicing chiropractic clinical practice protocols, PCRP, and you will want to use those guidelines as well. Those are the only subluxation-based guidelines in chiropractic.

Many chiropractors get confused with chiropractic guidelines and the term subluxation. The term subluxation is the same as a spinal instability. A spinal instability and a subluxation are the same thing. You must have misalignment of the bone, mis-motion of the bone causing nerve interference, motor sensory, or pain problem at that level. You must identify that.

If you are a subluxation-based provider, you need to use subluxation-based guidelines because those the guidelines that you must be judged by. In clinical practice, chiropractic clinical practice guidelines, CCP guidelines, and ICA best practice guidelines.

The ICA best practice guidelines will cover your Croft guidelines. They’re included in that. If you looked at the treatment for general conditions under the ICA best practice guidelines you’re very much still going to like those guidelines because it gives you, as a chiropractor, a lot of latitude for treatment and it is your guideline.

                If you do an impairment rating, you can use the impairment guidelines. If you’re going to do disability rating you have to use disability guidelines. Be sure you state what guidelines you are using. This is very simple. Here is an example:

 Patient: Mary Smith

 Treatment: I’m am utilizing the CCP guidelines, the ICA best practice guidelines, and The AMA Guides to Evaluation of Permanent Impairment for any impairment that I discover.

                You need to list your guidelines. Now, why is this important? Well, in the injury space you’re going to notice things called ‘utilization reviews’ and independent medical examinations. If someone says that the care was medically unnecessary, they must refer to a guideline. If you’ve listed what guideline you use, you must be judged by that guideline because that’s the guideline you’ve listed.

Most doctors are not proactive enough about what guidelines they use, and they don’t take the time to read the guidelines. You need to not only list your guidelines, but you need to read the guidelines. Read your ICA best practice guidelines. Some of the top chiropractors in the US spent a lot of time producing those guidelines, and they’re phenomenal guidelines. You want to look at those guidelines and utilize them.

                When you read them I think you’ll be shocked at how much latitude you have as a doctor, and now, if you’re citing that you use those guidelines and somebody has said something contrary to the guidelines, you now have a great rebuttal material for your utilization reviews or any IMEs that you get. Or in the worst-case scenario, let’s say that you have a post-payment review and somebody is saying, “Hey, we think you over-treated and we want the money back.” Well, now you’re actually set up so that you don’t really have a problem with that when you’re trading within your guidelines and you know your guidelines. Guidelines are really, really important today.

                And remember, a lot of times in an IME, or in a utilization review, a doctor will say, “Well, here’s a research paper that states a position that I’m taking.” Remember, a guideline usurps that. Guidelines go through all the research and they form a guideline. And that guideline kind of becomes a law. And until you change the guideline, it’s not changed. No matter how much new research comes out or everything else, until the guideline has changed, the guideline is present. It’s like a law. It could be a bad law, but until the law is changed, it’s present and it stays intact.

                So doctors, one of the easiest things, if you want to have a much easier time in the injury market, a much easier time navigating payment and billing, and all the various stresses that you run into, listing out your guidelines on each and every case is a really great way to start. You will like the results long-term. You’ll be able to sleep better at night when you understand exactly what you’re doing and why you’re doing it, and the fact that you have a lot of consensus. Your profession has consensus that what you’re doing is correct.

Remember, everything I teach is about objectivity. Objectivity means things are written down. You can show exactly if you have a ligament condition.  Good, here’s the consensus on it. Here’s what the impairment guides say on it. Here’s what a lot of research says about it. Here’s what Medscape says about it. You want consensus, and consensus reduces the adversarial nature of the personal injury market, and guidelines are a huge part of that.

                So again, doctors, list your guidelines that you’re using with each and every patient and in the long run, you’ll have a lot easier time navigating the personal injury market.

For more information on Spinal Ligament Injuries please check us out at http://www.smartinjurydoctor.comor check out our SmartInjuryDoctors® Podcasts on Apple Podcasts, Spotify, Google Play or Stitcher.

For information on spinal ligament testing by board certified medical radiologists go to www.thespinalkinetics.com

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The Five Steps to Great Spinal Injury Documentation

The Five Steps to Great Spinal Injury Documentation

by | Aug 27, 2019 | Articles, Spinal Injury

The Five Steps to Great Spinal Injury Documentation

There is a lot of confusion about injury documentation. There are five general steps to injury documentation, and it is currently being made much more complicated than it needs to be. All injury documentation has these five basic steps in common and they are really very simple.

Step One:  You Have to Diagnose All of the Injuries

Whenever somebody is trying to adjudicate benefits for a patient, the first thing that they look for is the diagnosis. In other words, how injured is the patient? In a spinal soft tissue injury, there are two imaging biomarkers substantiate injury to the ligaments themselves.

The first is disc herniation. There are 220 specialized ligaments that hold the spine together. 23 of those ligaments are discs. The discs are evaluated generally on an MRI.

If any of the other 197 ligaments, including the disc are damaged, they can cause excessive motion to the spine. Excessive motion is one of the most significant problems that a patient can have. We must diagnose the ligament injuries thoroughly. We must diagnose what is wrong.

  • Did they fracture?
  • Do they have a disc herniation?
  • Do they have excessive motion?
  • Is it causing a spinal instability?
  • What is the grade and severity of the sprain?

That is all part of the complete diagnosis. And you need an accurate diagnosis.

Step Two: You Need to Document If the Condition is Permanent or Not

Any injury that is permanent has a section on t in the permanent impairment guides. Remember, impairment is a derangement of a body part. All injuries are derangement of body parts. The evaluation of permanent impairment that was done by the AMA could be called the guides to the evaluation of permanent injury because it is injuries that caused the derangements in the first place. You need to note whether there is permanency and that’s very easy to do. You  just use the AMA guides to determine if there is a permanency.

Step Three:  Duties Under Duress Factors?

If a patient can do something but it causes them discomfort, it is called a Duty Under Duress factor. They can ride their bicycle with a low back injury, but not like they could prior to the injury. For example, they previously were able to ride their bike for ten to twelve miles and now they are only able to ride it two miles before getting severe back pain. They can still do it, but it is causing problems when they do. These are called duties and under duress factors.

Step Four: Loss of Enjoyment of Life Factors

Let us look at that same back injury but the patient can no longer ride their bike because it is too physically painful. They must stop doing that particular activity because they are physically unable to.  These are called Loss of Enjoyment of Life Factors. These factors must be documented as well.

Step Five: Future Care Needs and General Progress Documentation

At the end of care, all doctors document reevaluation. If you’re doing any kind of a physical rehabilitation on a patient, you’re going to document outcome assessment procedures to show that you are basically gaining ground on the condition. It will show that what you are doing is actually working.

And then you also must document these five factors. All the injuries. Is their permanency, which means permanent impairment guides? Are there any duties under duress or loss of enjoyment of life factors? Now lastly, if let’s say that you’ve gone through your rehabilitation procedures and the patient’s gone through your program, whatever your program is, or you’ve sent patients out for various programs and at this point you’re at maximum medical improvement. Remember, maximum medical improvement is, I’m looking out at that patient. I’m looking out into the future the next year and no matter what I think this patient would do, their outcome is going to be the same. We’re at maximum medical improvement. Now, if a person has a permanent condition and they have a loss of enjoyment of life factor or duties of duress factor, then they also may be entitled to future care. They may need future care, supportive care, to maintain the results with their care. And in that case, it can be substantiated, but you must have all the other factors there as well.

You Help the Patient to Get Any and All Benefits That They May be Entitled to.

It is very, very easy today to document injuries, but you must be sure you have all five factors. Many doctors really struggle with one, the diagnosis, especially with ligament injuries. They don’t get a diagnosis of a severity and location of a ligament injury, and without that, the patient is going to have benefit problems. You are also missing out on permanency factors if it is not documented. Without that, there is no rationale for why they have lost the enjoyment of life of something or they have duties under duress factors. These five things must be documented clearly in doctor’s notes, on all injuries.

It doesn’t matter if it’s a work comp injury. Now some work comp providers will say, “Hey, in our work comp jurisdiction, we don’t use the AMA guides to determine disability.” Remember, impairment is how a physical injury influences a person’s activities of daily living. Disability is how it affects their ability to earn a living. In the ‘earn a living’ work comp area, they may say, “Hey, we don’t use the impairment guides for our disability.” A lot of times that confuses practitioners, but it is actually very simple. It just means that they use a modified approach. Everyone uses the impairment guides. No one is going to create new impairment guides to determine impairment. They just may have a modified system in their state that says, “Oh, we don’t use the impairment guides direct. We use a disability guide, which we’ve modified from the impairment guidelines.”

Systematize and Simplify

Injury practice and injury documentation is very easy if you’re systemizing and getting those five steps in place. If you are struggling with reimbursement issues or you’re struggling with doctor’s contesting your care, such as IMEs and utilization reviews, you must look at your documentation. In my experience, if those five elements are left out, and usually it starts with a diagnosis right from the foundation, there is no impairment, no duties under duress, or no loss of enjoyment of life factors. If they are there, they’re not documented properly.

And doctors, you know if you don’t document properly, then you don’t get paid properly and that’s not so much on you. That’s more on your patient. Your patient does not get the insurance benefits that they may be entitled to and it makes everyone’s job harder. It makes the insurance company’s job harder. It makes the plaintiff attorney’s job harder. It makes everyone’s job harder when you don’t document well.

In my experience with teaching, which I have done for doctors all over the country, these things are not being documented well. If you pick up those five things, you have seriously improved your documentation skills in the injury market, and everyone will benefit. You’ll benefit. Plaintiff attorneys will benefit. Defense attorneys will benefit. Insurers will benefit. And most importantly of all, your patients will benefit greatly.

For more information and tips on how to reduce the problems and stress associated today with growing a large and successful personal injury practice please check us out at http://www.smartinjurydoctor.comor check out our SmartInjuryDoctors® Podcasts on Apple Podcasts, Spotify, Google Play or Stitcher.

For information on spinal ligament testing by board certified medical radiologists go to www.thespinalkinetics.com

Want to learn more about Smartinjurydoctor's Program?

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Low Back Injuries and Spinal Instability

Low Back Injuries and Spinal Instability

by | Jul 31, 2019 | Articles

Low Back Injuries and Spinal Instability

Low back injuries are the number one cause of chronic pain and disability in the world today. That’s right, more people suffer from low back problems than any other condition in the world. This means that almost all of us are affected by chronic low back pain – either we have it or someone we know has it. 

In addition to being the most common form of chronic pain, low back pain is also the most expensive condition on the injury market. In fact, it is more expensive than 300 other medical conditions and has a huge financial impact on those who suffer from it. According to the National Safety Council, the medical cost of caring for an injury is $42,000. That is simply an unsustainable number. 

So how do we lower the cost of caring for those with low back pain?

By properly understanding the underlying cause of the pain. 

The Problem with Low Back Pain Diagnosis

The most common diagnosis of low back pain or injury is “nonspecific mechanical low back pain.” This means that the cause of the problem is a physical thing, but we don’t know for sure what that is.  

Needless to say, that vague diagnosis is not helpful. This leads to astronomical medical costs because doctors don’t know what they are treating. 

Getting Specific with the Diagnosis

If we know what is causing low back pain or injuries, then we can specify treatment and get patients back to work and living a normal life faster and with less cost. This is good news for everyone. 

So, what is the diagnosis? 

Spinal instability. 

Most doctors today do not understand spinal instability and it is costing us millions of dollars a year. 

How to Diagnose Spinal Instability 

The good news is that spinal instability is easy to diagnose by clinically correlating excessive motion found with stress x-rays and the clinical correlation of a motor, sensory or pain problem at that spinal motion unit level.

Stress X-rays are specialized x-rays that show intersegmental motion. Board certified medical radiologists can accurately measure for any motion problems directly from the stress x-rays.  These measurements should always be performed by an independent unbiased third party that has a lot of experience performing these procedures. They should be performed independent of the treating provider as the findings can drive serious injury benefits and so treating provider bias should always be ruled out. 

Once you have the intersegmental motion of each spinal motion unit imaged, you can then easily correlate with the patient’s examination findings and determine the level and the severity of any spinal ligament injury and any spinal instability that it has been left behind and now causing the patient a great deal of trouble.  This of course leads to more accurate injury analysis and diagnosis so more responsive treatment can be promoted. 

Understanding Low Back Ligaments

Spinal ligaments are not really that strong and their stability is dependent on the muscles that surround them. If you place a 10-pound weight on your chest, then you add 100 pounds of pressure on your lower back. If you push it 25 inches from your chest, then there is now 250 pounds of pressure on the lower back. That’s enough pressure of course to damage every single ligament in your spine. 

So why doesn’t your ligament get damaged right then and there?

Because there is a coordinating system embedded in the ligaments called mechanoreptors that immediately recognize the pressure and causes the muscle system to instantaneous correction for stability need. However, when a ligament gets damaged, that system malfunctions. This leads to spinal instability. 

Patients need doctors who understand spinal instability and how to diagnose it. Employers and insurers also need doctors to keep costs down and employees working. That is why I developed the Smart Injury Doctors’ Program. We need doctors who can help patients identify and treat low back pain with a great deal of accuracy. 

For more information on Spinal Ligament Injuries please check us out at www.smartinjurydoctor.com or check out our SmartInjuryDoctors® Podcasts on Apple Podcasts, Spotify, Google Play or Stitcher.

For information on spinal ligament testing by board certified medical radiologists go to www.thespinalkinetics.com

 

 

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The Two Most Important Imaging Bio-markers for Spinal Ligament Injury

The Two Most Important Imaging Bio-markers for Spinal Ligament Injury

by | Jul 31, 2019 | Articles

The Two Most Important Imaging Bio-markers for Spinal Ligament Injury

In this article, I want to give you a quick overview of the two most important imaging bio-markers for spinal ligament injury. These two bio-markers are what doctors should use to determine the severity and the location of a ligament injury.

Unfortunately, this is not the standard practice, or the standard work up used for spinal injury patients. Most patients that have spinal ligament injuries are working with doctors that actually have no idea about the severity and location of their ligament injuries.

That is really a huge problem going on today because its these injuries that are the most common cause of chronic pain and disability today. We really need to have more doctors in the market that can work up these injuries in a standardized fashion.

What Is a Imaging Bio-marker?

The first challenge we have when understanding how imaging bio-markers can be used to diagnose injured patients is to begin with a definition.

So first off, a imaging bio marker is a feature in an image that indicates a biological state in the body.

For example, a common imaging bio-marker is a fracture. There isn’t anyone who can tell someone they have a fractured bone without an x-ray or a CT scan. It’s a separation of bone or a misalignment of bone that is visible on either an x-ray or a CT scan, which is the definitive imaging bio-marker. These images also show the location and the severity of the fracture.

When we have ligament damage to the spine there are two imaging bio-markers, and there are two completely different modalities that pick them up.

The most prominent imaging bio-marker to determine both the severity and location of a ligament injury is excessive motion in the joint.

Stress radiology, flexion extension radiology where you are stressing a joint coupled with highly accurate measurements of the intersegmental motion allows for discovery of this imaging bio-marker.

The way you uncover this is with Spinal Kinetics, CRMA, or an excessive motion study. You’ll want to use a board-certified medical radiology company like Spinal Kinetics to accurately carry out this study.

Spinal Kinetics is a niche company that serves the entire United States. They do these studies for medical doctors, chiropractors, or anyone else in the spinal ligament injury market. This is a resource we are going to talk about more later in this article.

Let Me Offer A Quick Refresher on The Spine Itself

The spin is made up of over 100 joints and there are over 220 specialized ligaments that hold it together, only 23 of these ligaments are discs, so there are a lot of non-disc ligaments with the potential to cause issues.

As a matter of fact, in between two vertebra there is a disc, we all accept that. There are nine other ligaments that hold that spinal motion unit or joint together.

So, when we have excessive motion, we need a study that tells us what is going on with all ten affected ligaments, not just the disc.

This is the imaging bio-marker that tells us how severe the excessive motion is and allows us to grade the severity of the sprain or spinal instability.

We Need an MRI to Pick Up Disc Herniation

Remember, I said there’s 220 specialized ligaments in the spine. If one of the 23 ligaments that form the discs herniates, we need an MRI to pick that up. This is not going to show up on stress radiology, but stress radiology today with excessive motion testing can give us a better idea if the disc is involved or not.

An MRI cannot pick up excessive motion, but it does a fantastic job picking up these disc herniations. These are two completely different imaging bio-markers.

Now, any doctor that’s working with a disc injury patient should first ask the question:

“Is there excessive motion in the other 9 ligaments associated with this disc herniation?”

They then need to assess whether there is significant or severe excessive motion associated with this disc, they need to know is it occurring at the same level? Is it above the disc? Is it below the disc?

If this turns out to be the case a doctor needs to know. That way he or she can devise a treatment plan that accounts for this.

These types of injuries rehab differently. This is something that plagues the injury market. We have patients with this type of injury and the doctors have no idea. Obviously, with this being the case, they cannot offer an effective treatment and the patient shows limited if any improvement.

An Outside Third-Party Is Needed to Find These Imaging Bio-Markers

Something I’m going to suggest doesn’t always sit well with doctors. That doesn’t make it untrue. These imaging bio-markers are so significant that they should always be done by a qualified independent third-party medical radiologist in order to have the findings accepted. Period. That way everyone is assured that provider bias is not in play.

Treating providers should stay in their lane with treatment and leave imaging to the radiologists. That way everyone is doing what they do best. This also removes the issue of bias. We need these images to be beyond reproach. Why?

The imaging findings themselves are what drives all reimbursement.

What I found out a long time ago as a treating provider, is that it was best to have these done by an unbiased independent third-party. As a treating doctor, if I was going to send out for an MRI study to check for disc herniation, I wanted it done independently.

I wanted zero liability of having the images come back and try to read them myself. I don’t deal with them enough. Best to leave this to the experts and stay in my space.

What my space was, was the treatment of the conditions that the radiologist identified.

If I wanted an excessive motion study done…again this needed to be done in an unbiased manner.

This way us treating providers can just use the results to drive care. It’s done unbiased, so there’s no manipulation of the results.

Treating Providers Are Looked Upon as Having a Bias

Often, treating providers are seen as having a vested interest in a finding coming out a certain way. This can cause reimbursement issues and integrity issues. This is something that us doctors in the space have no need for.

Let me give you an example to show you what I mean and how this looks to an insurance company.

Say, we have a surgeon and he does spinal fusion surgeries. There is no way that it’s going to be looked upon favorably if he is ordering, executing, and interpreting his own excessive motion studies to obtain pre-authorization of these procedures.

We can recognize that the insurance carrier is going to have an issue with this way of doing things. It just wouldn’t be allowed to happen. And in the spinal injury market, it shouldn’t happen either.

These finding are so important; they drive all reimbursement. They need to be done in an independent and unbiased manner.

So, let’s recap what we’ve went over today.

There are two imaging bio-markers that we need to become experts in:

  • MRI Studies
  • Stress X-ray Excessive Motion Studies

One of them, the MRI shows us herniated discs and the other one shows us the severity of injury and location of injury of the other spinal ligaments.

Whenever we order one of these studies they need to be done and interpreted by an independent third-party.

This removes all issues of bias and allows for easier documentation. This gives us our best chance for reimbursement from the insurer.

By accepting these two Imaging bio-markers we can move towards a standard way of diagnosing these injuries. Cavities in the dental industry are all worked up the same. Spinal ligament injuries should be no different. This is something that is sorely lacking and one of the things that the SmartInjuryDoctors®Program brings to the market today.

For more information on Spinal Ligament Injuries please check us out at www.smartinjurydoctor.com or check out our SmartInjuryDoctors® Podcasts on Apple Podcasts, Spotify, Google Play or Stitcher.

For information on spinal ligament testing by board certified medical radiologists go to www.thespinalkinetics.com

 

 

Want to learn more about Smartinjurydoctor's Program?

Learn more about dr. cronk

Reach Us

Want to know more? We are happy to receive a message from you.

246 Tierney Drive, Suite 1,
New Richmond, WI 54017

1-800-940-6513, ext 700

[email protected]

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701 Richards Ave
Clearwater Florida 33755

[email protected]
Call Lee Ann at 1-800-940-6513, ext 700

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What is ligament laxity?

What is ligament laxity?

by | Jul 31, 2019 | Articles

What is ligament laxity?

Ligament laxity is a big key word, things that Doctors of Chiropractic are now looking at. Everybody thinks with ligament laxity.

Ligament laxity is just that. It’s where the ligament goes lax. Ligaments have this incredible quality. They don’t just break or snap, they stretch, they hyper-stretch. And when they hyper-stretch they cause laxity. For example, if you were to take the ring from a six pack and stretch it, it wouldn’t break, but would deform. And in that deformation, you could never put the can back into it and you would not have a totally 100% functional ring.

Ligaments hold bones in alignment under movement. And when they are damaged, they can no longer hold the bones of the joint in alignment under movement. So, we have what’s called hyper mobility or excessive joint motion. And if we have excessive joint motion, we know it’s due to the laxity in the ligament.

We have body conditions that cause all joints to be lax. They are very specific conditions and are rare. When we are talking about spinal ligament injuries and ligament laxity, we’re not talking about disease states or hereditary conditions. We’re talking about specific joints being damaged, the ligaments being damaged, and showing excessive motion.

Ligament laxity is benign. Ligament laxity occurs any time a spinal motion unit (two vertebra) move more than a millimeter in motion. If they slide back and forth more than a millimeter, we consider that to be a laxed ligament.

If the spinal motion unit angulates more than seven degrees greater than the next vertebral body angulation, we consider that to be hyper mobility in an angular pattern. The joints that are holding that unit together and prevent it from angulating are now lax. That is known as ligament laxity.

You can have ligament laxity and not have it cause anybody any issues whatsoever. Ligament laxity is benign as a condition. It just means that the ligament has somehow been damaged. It doesn’t tell you how much damage it is. You could have ligament laxity that is severe, causing the vertebral bodies to move to the point where it causes cord compression or serious nerve compression.

We don’t know how much damage there is, so the term ligament laxity, doesn’t tell you a lot. It doesn’t tell you how lax the ligament is.

Today, as doctors, we know that ligament laxity is not symptomatic. When ligament laxity becomes symptomatic, the clinical term is spinal instability. The spinal motion units are held together by ligaments and when those ligaments become damaged and there’s laxity in the ligaments. There is now excessive motion in the joint, and that causes a motor sensory or a pain problem. If a nerve is influenced negatively, it is called a spinal instability and it can cause the following:

  • motor conditions
  • weakness in the muscles
  • sensory conditions
  • hypersensitivity in an area
  • pain associated in that area

Spinal stability says that ligament laxity has caused a clinical scenario and the providers that are doing spinal instability evaluations have taken that laxity off of an x-ray and said, “Great, that laxity is causing excessive motion, which is causing a motor sensory or pain problem at this level. It has now become a clinical entity called a spinal instability.”

How is ligament laxity shown?

It’s picked up in Stress Radiology. In injury work, stress radiology should be performed outside of the treating provider’s office. In other words, the treating providers should not do an excessive motion test on his own patient’s spine.

Why? Well, the simple answer to that is because the provider is biased, and the provider is looked upon in the market as bias. Ligament laxity that causes spinal instability measured on x-rays can cause the patient to have findings that are allowed within the presurgical authorization guidelines. With many insurers in the U.S., this can cause or trigger findings that are significant enough that allows the surgeon to get preauthorized based on the spinal fusion surgery guidelines to do spinal fusion surgery.

Now, would an insurer look at a spinal fusion surgeon that was doing his own ligament testing and always coming up with results that were allowing him to do spinal fusion surgeries? Anyone will look at that and say, that’s very suspect.

These findings of ligament laxity that lead to spinal instability and can lead to impairments of the spine and allow preauthorization for surgical fusions to occur. They can lead to a lot of different things, but they ultimately lead to the accurate diagnosis of the patient’s condition and then the treatment thereof.

These findings, such as disc herniation or excessive motion findings, should be done independent of the treating provider. That treating provider had ought to find the best place possible in order to get that testing done and then rely on that testing and know that that testing was done in an unbiased, independent manner so it can be relied upon. You are certainly not going to attack the provider and say, “Well, the provider’s bias. Provider didn’t do their study. The providers actually tried to over escalate the condition itself because they’re trying to get enriched.” None of those things can occur, which oftentimes they do in the injury market.

As I previously stated, ligament laxity is a benign thing. It just says that there is laxity in the ligament. It doesn’t mean that it’s clinically causing anything else unless the provider understands how to take ligament laxity and use the clinical findings, motor testing, sensory testing, and pain correlation findings to correlate it and to say that they now have an active spinal instability.

For more information on Spinal Ligament Injuries please check us out at http://www.smartinjurydoctor.com or check out our SmartInjuryDoctors® Podcasts on Apple Podcasts, Spotify, Google Play or Stitcher.

For information on spinal ligament testing by board certified medical radiologists go to www.thespinalkinetics.com

 

Want to learn more about Smartinjurydoctor's Program?

Learn more about dr. cronk

Reach Us

Want to know more? We are happy to receive a message from you.

246 Tierney Drive, Suite 1,
New Richmond, WI 54017

1-800-940-6513, ext 700

[email protected]

Leave A Message

CONTACT US

Smart Injury Doctors
701 Richards Ave
Clearwater Florida 33755

[email protected]
Call Lee Ann at 1-800-940-6513, ext 700

CONNECT WITH US

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The Insurance Carriers Are Not Your Adversaries

The Insurance Carriers Are Not Your Adversaries

by | Jul 31, 2019 | Articles

The Insurance Carriers Are Not Your Adversaries

In this article what we want to cover today is the area of your relationship with insurance carriers. In personal injury work, insurance carriers are not your adversaries. In fact, just the opposite can be true.

You can have great relationships with these insurance companies when you are working in the personal injury realm.

What does a productive, healthy, and great relationship look like with these companies?

It means that you have a smooth billing process. You bill them fairly and accurately and they pay you for the services your render. It’s as simple as that.

Let me illustrate how I came to this conclusion. Most of us know that in the personal injury area, you feel like you are constantly fighting with insurance carriers over billing and payments. I was no different. For the longest time, I just thought that is the way that things work.

Then after I’d been in private practice for around year 8, 9, or 10 of my 17 years running my own practice I had one of those “a-ha” moments.

My awakening if you will, was when I realized that these insurance carriers were paying for everything that I had. These companies really wanted the same thing I wanted as a doctor with my personal injury patients.

Let talk about that for a minute.

What Did I Want as A Doctor?

First, I wanted to treat a lot of injury patients. I wanted to build a successful practice. I knew that to do this I needed to get good physical results for injury patients. As you know, if you’re getting these kinds of results in the injury market today, you understand diagnosis. That is something worth noting. If you do not understand the critical role of diagnosis, I’ve written some pieces on that subject that you need to check out.

Now in the area of spinal ligament injury diagnosis, we know as a fact, that there is a shortage of doctors who can do an effective spinal ligament injury workup. We can accept that as true.

How do we know this?

Just look at the statistics in the injury market today. If you do a little research, you quickly learn that around 50 percent of auto accident injury patients never fully recover. What’s worse is that 30 percent of them have significant life changing disabilities resulting from these injuries.

This information helps form the picture of what these insurance carriers want in the personal injury market. In fact, if we’re keeping it simple. The insurance company is after the same thing that the patient wants, the same thing that the lawyers want.

They are all looking for a doctor that understand how to diagnose all these injuries.

They want a doctor who doesn’t miss injuries, one that can tell the difference between a disc herniation and a non-disc ligament injury. They all need someone who knows how to image these injuries using a digital X-ray and how to work it up.

They are looking for a doctor who can clinically correlate for a motor sensory or pain problem at the injured area. Above all they are looking for a doctor who can treat the injury and affect a good result.

And as a caring doctor, isn’t that what we want as well?

Let’s Talk About What A ‘Good Result’ Means.

A good result means that we get a result that minimizes the risk of long-term complaints. Put plainly, we want the patient to fully recover, this means no:

Pain

  • Residual symptoms of any kind
  • Deficits in activities of daily living
  • Interference with the ability to hold a job and earn a living

A doctor that can do this, is sought after in the market. They are the ones who diagnose these injuries quickly and accurately. They jump on the treatment plan right away to minimize the pain and suffering of these patients.

We Really Aren’t Adversaries, Are We?

So, if that is what doctors want and insurance companies want the same thing, it’s hard to view this as a hostile relationship.

The problem is that this is not the results that most insurance companies are routinely experiencing in the injury market today.

That is what doctors like me are trying to change. We produce doctors who can deliver this to the carriers through our SmartInjuryDoctors®Program.

This is going to be the big emphasis as the market moves forward. By 2020 and beyond the market is not going to tolerate ineffective doctors and patients without results.

The market will dictate that these doctors better get physical injury results. As a doctor operating in this area, you must adapt to avoid hardships and poor relationships with the insurance carriers.

Insurance Carriers Will Actually Look for You.

Insurance companies are smart companies. They are always looking to be more efficient. They will start to profile the doctors who get results for injured patients and provide a minimal amount of hassles.

They will begin to say, “Okay, great here’s a doctor who is actually doing an excellent job. The documentation is solid. The diagnosis is solid. And there is no over-utilization of procedures. There’s no stacking of procedures. This is a doctor we want to work with.”

They are looking for a logical progression that has strong outcome assessment procedures that determine a patient’s progress. They are looking for a doctor who knows when the maximum medical improvement has been reached and states that further treatment is not indicated.

These are the types of doctors who are going to survive this shift.

Who Has Problems with Insurance Carriers?

So, let’s go through what types of doctors are having trouble with insurance carriers. Generally speaking, there are three things that cause the relationship to turn adversarial.

1.      Poor diagnosis

2.      Treatment without results or improvement

3.      Documentation that lacks information

It doesn’t matter if you are an orthopedic doctor, a physical therapist, or a chiropractic doctor. The insurance company is looking for those three critical elements.

From their point of view, this is a straight forward easy thing to do.

Here is what they want to know:

  • They want to know what the injuries are.
  • Are these injuries permanent?
  • How did you determine if they are permanent?
  • Is there lasting pain or discomfort to the patient?
  • Can the patient no longer perform their job?
  • Have they lost the ability to enjoy an area of their life?

Let me give you an example to illustrate what they want to know.

Say you have a patient who had a low back injury. Now, you’ve diagnosed it correctly, that’s step one. You make the determination that this is a permanent injury. They can return to work, but they do have a loss of enjoyment. They used to enjoy a 5- or 10-mile bike ride every weekend, but now they cannot even get on the bike. That is what they mean when they refer to a loss from enjoyment of life factor.

It Comes Down to Documentation.

You need to supply the documentation that explains all this in a way that makes sense to the insurance carrier. A lot of doctors just do not realize what the factors are that an insurer needs to cover.

Take a minute and put yourself in their position. If you were paying the bill you would want the answers to these questions. Treat the carriers how you would expect to be treated and you know what? These insurers are going to treat you well. It’s just this simple.

By understanding this, you are going to quickly realize that documentation in the personal injury space is probably the simplest documentation that there is.

Adversarial Relationships Are Futile

There is no practical reason to be at odds with an insurance carrier. It serves no practical purpose. If you want to constantly be arguing, if you actually enjoy arguing, if your one of these doctors who sees themselves as the only expert. Sort of an expert witness type, all the time. You’re going to find things are difficult.

My advice? Stop Practicing That Way

Most doctors do not want to waste a bunch of their time every day arguing with insurance companies on the phone. They really don’t. They want to have a fair, productive relationship. We’ve told you what you need to do to achieve that. It is something that I am really passionate about. I teach it all day everyday with my SmartInjuryDoctors® Program.

To be successful in this area, you need to document in such an easy and simple fashion. You must make it easy for everyone who’s making a benefit determination to know what’s going on. This is going to improve your relationships with all involved not just the carriers.

If you can do this, it will be easy for you to stand out in the market. It’s not what they’re used to. So, remember the three things that we preach here:

1.      Diagnose completely, accurately, and effectively

2.      Treat patients in a way that produces results and fives them relief.

3.      Document in a way that tells everyone what is going on with each patient

Our most successful doctors are the ones who understand that it’s neglecting even tiny little things in these three areas that can cause friction. Friction that is easy to eliminate by just correcting a few simple things.

For more information on Spinal Ligament Injuries please check us out at http://www.smartinjurydoctor.comor check out our SmartInjuryDoctors® Podcasts on Apple Podcasts, Spotify, Google Play or Stitcher.

For information on spinal ligament testing by board certified medical radiologists go to www.thespinalkinetics.com

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