In personal injury (PI), “medical collaboration” is the name of the game.
It impacts both the quality of your patients’ care and your reputation as a value-driver in personal injury. Collaboration also paves the way for compliance with the No Surprises Act.
And given that the best growth in PI can more often come from your peers and existing patients (rather than law firms), medical collaboration is not just a medical necessity but a business advantage.
For all these reasons (and more!) PI is a high-profit highway for doctors of chiropractic. This article explores what it takes to be a great collaborator, specifically when interacting with invasive-based pain-physician specialists, so your PI segment can flourish.
Be a great quarterback
As the DC, you will often be the first stop on the patient’s road to recovery. And because chiropractic is the top medical specialty in PI, patients will come through your doors, even if they don’t “believe” in chiropractic care, simply because their attorneys or your peers tell them to. This gives you an opportunity to educate new patients about the magic of chiropractic.
This also puts you in a position of great responsibility: You are the quarterback of the healthcare management team and must do what is medically right and necessary. It’s up to you to decide when to hand treatment off and when to run with treatment.
Sometimes, what is right for the patient can conflict with what is seemingly in your best interest. Just like a quarterback may have to pass the ball to a teammate to score a touchdown, you may need to hand the patient to another medical specialty for a play or two. In the event of an injury requiring surgery or invasive procedures, the patient may even need a new quarterback. Oftentimes, that new quarterback is a pain-physician specialist.
When your nonsurgical and non-medication approach is not working on a certain body part or brain area — or when it isn’t working fast enough — the best thing you can do for your patient and your practice might be to pass that ball, often to an invasive pain-physician specialist.
This might be referring to a pain MD, an orthopedist, a neurologist or a neuropsychology specialist, which might lead to a surgical or other invasive procedure. And this might cause you concerns: What if a pain physician or other specialist poaches your patient? If this is a fear, consider this: When passing the ball is medically indicated, medical ethics mandate you make the referral. Simultaneously, that referral helps substantiate the PI case.
If a referral to a pain-physician specialist is medically indicated, refer out sooner rather than later. This referral not only protects the patient and the PI case, but also protects you from a legal or medical ethics complaint.
Let me explain: If you refer out and the pain-physician specialist recommends a more invasive treatment, the patient may prefer more conservative treatment in the form of more treatments from your office. That collaboration then serves to provide medical support for extended treatment and higher bills. On the other hand, a good defense attorney will argue that failure to refer out in a timely manner must mean the patient was not in that much pain. If the referral happens late in the treatment, the attorney will argue the referral was intended to increase medical bills and not a true medical necessity.
When you take the lead and refer out properly and timely, good attorneys will want to use you as a go-to medical provider in future cases. They know that when you quarterback healthcare management, they can focus on the legal and financial nuances instead of worrying about proper, timely healthcare for their clients. In other words, medical collaboration is a value-driver in PI.
Rules for referrals
Recruit the best medical lien team in advance. When you already have a great network of referrals, you won’t have to scramble to find someone who will take your patient on lien/letter of protection.
If you can, provide patients with multiple referrals for each specialty. This protects you from accusations of kickback schemes. Plus, when several specialists know you are referring to them, you have a marketing advantage.
Vet and approve providers referred to you by the patient’s attorney. You are the quarterback of your patient’s healthcare team, and you are the person with liability exposure.
Embrace the role of a convening, primary medical provider
Medical collaboration is built into PI, but it is a relatively new legal mandate. If you are the first stop along the patient’s healthcare journey, you will likely be what the No Surprises Act (NSA) considers a “convening provider.”
A convening provider is responsible for coordinating with other medical providers and facilities in providing a patient with a good-faith estimate (GFE) of projected care, as required by the NSA. A convening provider is generally a medical provider with whom the patient scheduled a visit for primary care.
When the NSA was passed, the government expected someone to play the lead by gathering all estimates from the various providers and facilities included in the projected treatment plan, giving the patient a single, aggregated estimate of the cost. You don’t need anyone to tell you how complicated this aggregation is! The government failed to account for the systems necessary for HIPAA compliance and privacy, as well as the inter-practice communication and cooperation required to have accurate, protected and compliant coordination.
As a result, in December 2022, the government delayed enforcement of the co-provider and co-facility requirement.
This doesn’t mean you should not comply. It means the government won’t be instituting fines — yet. For now, start considering what you need to do so you can fill the role of a convening provider when you are the first stop or lead in the patient’s medical journey. When you refer out, you will be doing everyone a favor if you have systems in place to compel other providers to produce GFEs and comply with the NSA.
Though the NSA requirements are relatively new, compliance isn’t optional. The NSA can be confusing, including “who” is a convening provider, and it might later involve finger-pointing among providers. Therefore, the safest approach is this: If your office schedules patient visits, consider yourself a convening provider. If other specialists will be needed for your good-faith estimate, your GFE should include those treatment estimates, even if it is only the cost of the initial visit to that specialist.
As you collaborate with co-providers and co-facilities to create that GFE, remind them about the NSA. Don’t be surprised if they have never heard of the new law, so keep this in mind: You brought value to the provider in the form of legal protection when you educated them about the NSA. Ask these providers to either provide you with a GFE, or let them know you will be sending your patient directly to them for that estimate. In either case, be sure to document everything.
Get the collaborative peer-referral advantage
Both PI and the NSA provide advantages for your business in the form of peer referrals.
Let’s start with PI: When you learn how to navigate the legal complexities of personal injury, you become a value-driver to peers, who are then more likely to want you on their team. And when you let those specialists know you take a science-based approach, you align with pain-physician specialists and PI attorneys.
When you understand and follow the NSA, you can educate those pain-physician specialists. (Send them to the Center for Medicare and Medicaid Services (CMS) for help.) The fact that you already comply puts you a step ahead of your competitors and other rehab specialists. You move to the front of the line.
Final thoughts
Medical collaboration has advantages for patients, who get better healthcare and improved health outcomes. Medical collaboration also has advantages for medical offices, who get new patients and new peers, both of whom can be educated about chiropractic, your specialty and your office. In short, this collaborative peer-referral opportunity is a business advantage!
Additional reading
- Coates M. Personal injury and the No Surprises Act. Chiropractic Economics [Digital]. May 14, 2023. CE website. https://www.chiroeco.com/personal-injury-the-no-surprises-act/.
- Coates M. Don’t be surprised by the No Surprises Act. Chiropractic Economics [Digital]. March 24, 2022. CE website. https://www.chiroeco.com/no-surprises-act/.
MICHAEL COATES is a national authority on personal injury medical lien recovery and the founder of PIMadeEasy.com, which educates, coaches and trains medical providers and their staff to accelerate their success in personal injury by focusing on process, profits and growth. Coates also trains in Negotiations Aikido, where you can learn how to get paid more from your trusted attorneys but even out-negotiate the difficult ones. If you have questions, reach out to michael@pimadeeasy.com and through his free Facebook group, PI Made Easy Insiders.