When is a DC a good steward of the personal injury case?
ATTORNEYS WILL DENY that they help manage the personal injury case, but the reality is that they have a strong influence. Chiropractors have tried various ways to market personal injury, but it is impossible to outspend a busy personal injury law firm.
How many treatments do you need to make up for one multimillion-dollar settlement? Attorneys can outspend us every day of the week, so there is no point trying to compete on Google Ads, billboards or other avenues.
How to compete
You can create relationships with other providers; complementary providers to musculoskeletal cases such as pain management specialists, orthopedists and neurologists. For example, if you get a traumatic brain injury, why should you handle the entire case when this is best co-managed with a neurologist? MRIs indicate objective pathology, and if you co-treat with a pain management doctor, it helps the patient and helps the case.
I had a pamphlet on “what to do if you are in a car accident” that I handed out to all my patients and asked them to put in their vehicles. It had a checklist of what to do if you were in a car accident and what type of information you needed. This was useful to the patient, their spouse and teenage drivers, and it was a subtle way to let patients know we handled personal injury patients. I had a network of primary care and urgent care providers and some emergency room physicians. The primary care doctors hated these cases and often referred them to our office. Hospitals generally were not fans of referrals, but all the other providers were open to it. Aside from that, I networked with some attorneys.
When I said you have to be a good steward of a personal injury case, the referring ethical attorney needs to know you will handle the case well. They expect you to make appropriate referrals when necessary so you won’t over- or under-treat the patient. But, unfortunately, there is some babysitting involved. We had to ensure the patient made the appointment with the appropriate paperwork and imaging sent in advance. We had concise paperwork with details about their injury; some information on the car accident, but all of that is in the police report; and an exam that showed medical necessity and consistent progress exams and referrals to appropriate imaging or specialists.
I never made anything up, but it wasn’t a good sign if the emergency room records didn’t match the intake paperwork injuries. If the original complaints were all left-sided, and now you are treating the right knee and shoulder, that looks inconsistent. I told patients this coverage was to cover their injuries and not preexisting injuries. They should consider closing the case if they were inactive in our office or another. I always suggested treatment regularly until they reached pre-injury status for at least a few weeks.
Check your limits
I’m in California, and unfortunately there are low liability limits (which are changing this year). I would have a coverage conversation with the law office at a certain point in the case. If someone had poor coverage but still was injured, continuing to treat them didn’t make sense at a certain point.
The patient is ultimately responsible for the bill, so we had a heart-to-heart with the patient and closed the case. The attorney didn’t want to deal with an upset doctor about an outstanding bill, and the patient didn’t want an additional bill. The attorney also wanted to avoid a patient coming in for sporadic treatments and not going to a specialist for an evaluation if their case justified that referral. Working personal injury doesn’t have to be slimy, but you must know how to drive the case’s value. Just like certain questionnaires and diagnostics meet the local coverage determination (LCD) for insurance companies — it’s the same thing, but a different animal.
I used to keep a sheet of all my personal injury cases that showed their initial date, total charges, visits, next visit date and notes about the case. This was a pain, but necessary to manage the case. This way, I never took a big loss and always made appropriate referrals when necessary. I had another sheet that tracked whether a patient came in each week, and together with a good workup, re-exams, SOAP notes and a decent report, things worked out for us. Everything told the story and made sense. The ER injuries, intake paperwork, exam findings and injuries all correlated somewhat. Nothing was made up, but we didn’t treat preexisting injuries; we only dealt with injuries from the accident.
Finding your system
I’m sure some doctors may not agree with how we handled personal injury cases, but the attorneys liked it, the patients improved and the insurance companies made payments. We always drew the line at unethical behavior, such as when one Los Angeles attorney wanted us to refer certain patients out for surgery that wasn’t required.
We had our patients’ interests at heart, which meant we had to build a good case for them so they had all their treatments covered and received their settlement check. Some doctors don’t like the “game” of personal injury, but if you approach it this way, you can ethically have a decent revenue stream and work with certain attorneys who treat you fairly.
Eventually we made software to manage this entire process with information from the EHR, which we focus on today. We could make a bigger impact on the profession by helping other chiropractors help more people, and that’s what we’ve been doing for the past few years.
Your patients eventually get in an accident, and so do their coworkers and friends. Learning how to manage a case appropriately takes care of patients in your community and adds revenue to your practice. It’s worth investigating some courses in your state; your state association can point you in the right direction.
NAOTA HASHIMOTO, DC, is the cofounder of TrackStat, a patient tracking software that makes it easy for admin people to attract and convert new patients while ensuring existing patients stay in your practice. It offers new ways to retain patients and also offers ways for staff to communicate and schedule patients while providing you all the metrics of success. Learn more at trackstat.org.