PERSONAL INJURY CASES CAN BE COMPLICATED
, and co-management of patients is integral to offering comprehensive, cost-effective care. I’m thrilled to have had an opportunity to speak with Scott Tauber, DC, and offer his perspective and experiences gained through his leadership at the American Institute of Personal Injury Physicians (AIPIP), which trains physicians of all specialties in how to improve, protect, expand and market their personal injury practices. Additionally, Dr. Tauber is a diplomate of the American Board of Chiropractic Orthopedists and a certified professional coder.
How has the management of personal injuries changed in the past decade?
The personal injury environment has changed dramatically in the past 10 years. Insurance carrier scrutiny has increased for all providers, and documentation and management are at the forefront of that scrutiny and change.
It has become more about co-management for all of the patient’s injuries. Certain injuries that previously may have been treated in office or possibly not worked up correctly, have now become important to be co-managed. It has become important to document all of the patient’s accident-related injuries, and it’s imperative that providers consider co-management of those injuries as well. Symptoms and conditions such as mild traumatic brain injury, extremity and neurological injuries, in addition to the typical post-traumatic headaches and spinal pain, are prime considerations for co-management.
How does MD/DO collaboration help in PI cases?
Co-management and collaboration with medical professionals helps the chiropractor in a variety of ways. First, co-management decisions for traumatically injured patients allows for another “set of eyes” on the injured patient. As you know, personal injury patients can have a laundry list of injuries and symptoms. Co-management allows for an examination of the conditions and symptoms that chiropractors may not be comfortable evaluating or may fall outside the scope of their practice.
Second, collaboration helps to mitigate the chiropractor’s risk and liability. Personal injury, by the very nature of the patient presentation, has an inherently higher risk and liability. There are so many different types and severities of injuries a patient can suffer after a traumatic event, from sprains, strains, burns, spasms to various types of fractures. I have seen a patient with a cervical spine fracture walk into a chiropractor’s office after an automobile injury. Collaborating with medical professionals ensures the patient is receiving the highest quality care and attention for all their injuries from both specialties.
What medical specialists should DCs look for in building a referral network for PI cases?
Having a strong medical referral network behind you is paramount to personal injury success. At a minimum, chiropractic physicians should look to establish relationships with primary care/general practitioners, orthopedists, neurologists and possibly neurosurgeons.
Co-management with a primary care provider could be for anything from evaluation of abnormally high patient pain-scale complaints all the way through treatment of any lacerations or burns. Philosophy aside, sometimes acute traumatically injured patients may need short term medication to help them manage their pain and symptoms. It is also imperative to have both an extremity and spinal orthopedic specialist available. There are going to be so many spinal and extremity conditions such as disc injuries, labrum, rotator cuff and meniscus tears that will need further evaluation. A neurologist is also essential for evaluating and documenting any mild traumatic brain injury symptoms and radicular complaints.
What concerns do MDs have in working with DCs on PI cases?
Some of the concerns expressed to me have to do with liability. When MDs make referrals to a chiropractor, there is a certain amount of liability. They have to be assured that the DC is capable and competent and will be able to not only treat their patients but understand their limitations and know when and what not to treat. Of course this applies to any other physician that the MD may refer their patients to, but there is just not that comfort level with the chiropractic profession yet.
Another concern that I hear from medical providers is chiropractors often wait too long before referring for a medical consultation or treatment. This is seen in cases where the DC is treating a condition that normally responds well to care and the patient is showing subtle subjective and objective signs of improvement and he or she may hesitate to refer for co-management right away. Before you know it, four to six months have passed with the patient and the chiropractor realizing he or she may have missed something, then makes that referral. In certain cases, the long wait may even border on malpractice. Bottom line: Learn to shorten your personal injury algorithm.
What concerns do DCs have in referring patients to MDs?
: Chiropractors have several concerns when sending their personal injury patients to medical providers. First and foremost, they are concerned about getting the patient back. One of the things we advocate when making co-management referrals is communication with the other provider. These providers are busy just like the DCs, and unless they know exactly what the referring chiropractor wants, they are left to make assumptions. One such assumption is the DC wants the MD to take over the patient’s care and management. To avoid this problem, simply send a letter to the medical provider outlining not only what type of treatment the patient has received to date but what exactly you want from the medical provider. This will help to eliminate this issue.
Another concern is, does the medical provider understand both personal injury and chiropractic? Many do not, so this is a process of educating the medical providers about both topics. This is a great opportunity for chiropractors to begin a referral relationship not only for their PI patients but for their other patients as well. If the DCs can share with the MD the specific documentation required for personal injury cases along with supporting literature about the efficacy of chiropractic for musculoskeletal conditions, this can create a win-win situation for both the physicians and their patients.
Do MDs refer to your members?
: Yes, we have many of our members receive personal injury referrals from medical providers. It’s the by-product of education, mutual respect, persistence and providing a solution to a specific problem medical providers face.
What do they find of value, and how were those referral relationships made?
: For years, medical providers wanted nothing to do with personal injury cases because of fear. Fear of the med-legal environment, depositions, court, attorneys, time away from their practice and being embarrassed in an arena where they were just not comfortable. However, with all the changes recently in general health care, I have seen MDs now start to become open and explore the possibilities of treating and managing personal injury patients.
They also value an alternative form of care and treatment for their patients, rather than just sending them to physical therapy all the time. Ultimately, all this leads to more referrals and better overall care and management for the patients.
If you can provide solid care, treatment, management, education and a viable alternative for their personal injury patients, you have just unlocked an incredible resource.
For more information on the American Institute of Personal Injury Physicians (AIPIP) and its programs, visitwww.aipip.com
. To read a success story of one of its members, please visit www.alignedmethods.com/acatoday
Dr. Acampora is the author of Marketing Chiropractic to Medical Practices and the founder of Aligned Methods, a company specializing in helping DCs establish informed working relationships with medical physicians.