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Depositions Don’t Have to be Hard

Depositions Don’t Have to be Hard

Depositions Don’t Have to be Hard

If you are going to be in the injury market and you are a great doctor, you need to be in the injury market. Injury patients need great doctors. If you’re looking at the injury market saying, “I just don’t want to do depositions”, “I don’t want to do court trials.” Don’t look at it that way. It’s very, very easy.

Depositions are part of being an injury doctor.  If you are a Smart Injury Doctor and document as you go, depositions cease to be a stressful or hard activity. As a matter of fact, they can be incredibly fun. Now, why do I say that? I say that from years of experience. I say that from doing lots of depositions. I say that from being successful in court. I say that from training doctors, Smart Injury Doctors, for many years on how to simplify and document as they go. Enabling them to be confident and competent in depositions.

A good example of using standardized methods and depositions is a dentist. He has a patient that was in an accident and the dentist lost their two front teeth on the steering wheel. The dentist did his evaluation, X ray, history, etc.  He determined the course of action and did that action.  He documented what was done.  Would that dentist worry about going into deposition? No. Would he worry about going to trial and testifying? No. Okay, so what are you worried about? What gives you worry when you worry?

From all of my years in the injury market, as a doctor, as an educator, I know it comes from not using  standardized  procedures. It’s not actually having procedures where you immediately week one, determine the severity and location of all of the patient’s spinal injuries and any other injuries for that matter.

You need to objectified it. Make it objective, not subjective. You are high level professional and use only high level professionals to assist you with objectifying it.

If you’re sending out for an MRI, you’re using the best MRI center you can find. If you’re sending out for excessive motion testing, you’re looking for the best radiology service you can find. When using a high level of objectivity, you understand the consensus, the best practices behind this, you’re putting your patient on a treatment plan that’s consistent with all of the best practices that you utilize, that you’re communicating to the market in your patient’s notes that you utilize them. You’re now getting a great result with a patient. Maybe it takes four months, six months, eight months, whatever it takes. However long it takes, right?

You’re documenting your outcome assessment procedures, you’re documenting any duties and address loss of enjoyment of life factors. You’re documenting disability. You’ve referred out to any other kind of professionals. If you need any kind of co-evaluation for a disability case, in the case of an impairment that actually affects a person’s ability to do their work or their job.

When you do all this and do it standardly, as a professional, you do it over and over and over and over and over again, and you do it in the same way. You will see, just like the dentist, the patients, those are all different. But the treatment varies very little. The only variable is the way people respond to treatment, but what you’re doing and how you’re applying it is all the same.

The wildcard is the patient and their response. But how you document and what you do that’s systemized, that’s standard, that’s very easy to make standard. If your clinic right now is not standard,  you are going to have a hard time with depositions and court trials. That is what a Smart Injury Doctor knows and understands.  Being part of our team of dedicated doctors, using the proper and standardized methods, eliminates this difficulty.

It is not hard to go into a court trial to say, okay, here’s what the patient had. Yes, they had an injury. I know what the mechanism of injury is. Mechanism is forced delivery system, the injuries is the derangement pattern that’s left behind and there’s three basic derangement patterns that the spine can undergo or a combination of these three. You can either break it or there’s two significant ligament findings.

One is a disc herniation, which is not as significant as excessive motion. The other is excessive motion, which is found on stress radiology. Disc herniation is found on MRI. Remember, there’s on 23 discs. There’s 220 specialized ligaments, so you’d better be covering all of the ligaments and the ligament injuries. You’ve done that, you’ve got all the injuries, you’ve got it highly documented, you know the consensus, you know your guidelines. Now it’s just sitting down in a deposition and explaining it and actually realizing that your documentation is so good.  My documentation was so good when I finished in private practice that I was sitting there and wondering why would anybody depose me or why would I be in court. All you have to do is read my notes and read my end report. Read my two page summary that summarizes everything that I’ve done and what the patient had, what we did and where we’re at now. Because that’s what I’m going to be testifying about. That’s what I’m going to be talking about. That’s what I’m going to be talking about, whether I’m in deposition or whether I’m in court.

And if they want to argue with me, they are arguing with objectivity. Arguing with consensus. If you have a problem with the impairment level I gave, then you have a problem with the AMA, not me, because I’m doing it exactly the way the AMA said to do it. If you have a problem with the severity and location of the injury, I did the imaging. I’m showing you the consensus of what the results mean. I’m showing the consensus of what fellow doctors say. What is the consensus of the research? This is what it says. If you want to argue, argue with that consensus.

And when you’re doing it at this level and you’re doing it very simply so that somebody who’s 14 years old can understand what you’re saying, then these depositions and court trials are very easy. They’re not hard. And they’re a great source of referrals.

Remember, a lot of doctors out there looking for attorney referrals. Well, attorneys that actually have doctors that do well in deposition or do well in trial, that’s a great source of relief for the attorney. That’s a doctor that the attorney looks to and says, “Okay, that’s somebody I can refer to,” because number one, they don’t miss injuries. Number two, they get great results with my clients. Number three, they document and their documentation is impeccable and number four, you can understand everything that they’re saying and they present the material extremely well if we need to go into deposition or trial.

It’s not complicated. I’ve trained a lot of doctors how to do very, very well in depositions and in trials, and it always comes back to simple basics. Simple basics.

I have a group of doctors called Smart Injury Doctors and I get calls from our group members and they say things like this “Oh my God, I can’t believe it’s that simple.” It is that simple. It’s only complicated when you complicate it.

So in your depositions, keep it simple. Improve yourself clinically to understand how to systemize workups, get that education. You’re putting out a lot of stress that’s unnecessary and you’re missing out on a lot of expansion that can occur within your own practice

The Smart Injury Doctors Education Program is totally geared toward ligament injuries. The number one cause of pain and disability in the world today.  This program is designed to simplifying your understanding of that. And it’s also geared toward helping you be much better in depositions and in court trials.

 

https://www.smartinjurydoctors.com/
https://www.thespinalkinetics.com

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The Importance of the Consultation for any injury’s First Visit

The Importance of the Consultation for any injury’s First Visit

The Importance of the Consultation for any injury’s First Visit

An injury patient has entered your clinic, filled out paperwork, has given your staff insurance information, they are now ready to meet you, their doctor. They want to find out a few things. For example, How are you as the doctor? How concerned are you? How much time do you take? Am I important or is this doctor organizing a thousand different things in his head?  Your new patient can perceive these things, so you need to be switched ON!

So many doctors make the error of not understanding or stressing the importance of the very first consultation they have with an injury patient.  This is the first time that the patient’s going to interact with their doctor for any amount of time.  When a patient has a spinal ligament injury, 50% of these patients never fully recover, and of that 50% that don’t fully recover, 30% have a significant condition associated with it.

This person is literally turning over their life to you. It is up to you to make this a very, very important visit. This visit is also the visit that sets the tone for compliance, that sets the tone for how much they trust you, that sets the tone for how much they’re going to refer you to others.

                                Therefore, at that point in time, this patient must be the only thing in your mind. Your complete focus, razor sharp, should be on the patient.  As a priority, you must document every single symptom that they feel is associated with this condition. If they have head pain, stiffness, neck pain, back pain, arm pain, numbness, tingling, they don’t sleep very well, if they have cognitive dysfunction,  don’t feel like they’re thinking clearly, they feel like they’re foggy, they feel like they’re afraid of driving, they feel depressed, anything what so ever it may be, whether it be a list of 10 or 15 or 20 things, it’s very, very important that you get each and every one of them down.

 

To help you do so, we have in the Smart Injury Doctor’s Program, a form called a Smart Injury Symptom Tracker, and that Symptom Tracker allows you to put every single thing that the patient is saying that they have as a result of this injury in one simple, easy to use form

                                Take your time during this consult. Explore in detail all of the symptoms, how it effects them, their families, their co-workers. It literally takes minutes, but it’s very, very important. What your end result should be is a patient that feels completely duplicated and understood.

Another reason you do this so thoroughly is if you may miss a symptom and its details. For example, they may shoulder pain and you listed it.  On exam three days later, when you’re asking them how they’re doing or on a patient review form a month later and they don’t put the shoulder pain, you know they have improved. 

You only know this if exam was done in a systematic, thorough way. If a patient says, “I don’t know, I’m not doing that good.” You look at your list of 15 things that they listed initially. Now they’ve only listed seven things. That means eight of the things that they originally listed have dropped off the list. That’s the improvement that’s occurring, but because the patient still has these seven things, they don’t think they’re doing that well.

You need to have a way to track the symptoms so that each time you’re basically saying, “Hey, how’s the shoulder?” “The shoulder pain’s completely gone.” “Okay, initially you said headaches, but you’re not listing that you have headaches here now.” “Yeah, it’s pretty cool. I mean, I had headaches for two weeks, but the headaches are completely gone now.” They can see you care, you are interested in their improvement and can show that improvement has occurred. All of this by following a Smart Injury format.

                                A patient in that re- eval is going to feel more confident in his doctor if the duplication and documentation of his original difficulties are correct and the patient will be more compliant as well.  This patient will be telling all of his friends about you, talk you up to his attorney and this will all lead to more and more referrals.

Another important area is if the patient has any active preexisting conditions, things that they’re actively being treated for, under care for, that are in the same area or are very similar to what they have now.

                                So an example of that, the patient had neck pain a month ago and was seeing a doctor for this problem. At this doctor, they had taken x-rays, showing they had severe degenerative disc disease, began taking naproxen for this significant neck pain which the doctor had listed and diagnosed, and is now under active care and treatment. This is listed as an active preexisting condition.

An active pre-existing condition is uncommon. The majority of preexisting conditions are called dormant preexisting conditions. They too must be listed. You must list for example, if they are diabetic, have a high blood pressure, or have a problem with their weight.  Any number or pre-existing conditions can be a complicating factor in the patients treatment.

There will be a difference in results and the time of recovery between a 26 year old who has no body fat, works out at a gym three times a week and is a vegan and the person that say is 45 years old, has high blood pressures, is obese, doesn’t work out at all and has a horrible diet.

Another documentation factor is was there any delay or gap in care?  Find out and document what was happening. Were they actively treating themselves? They might say, “Well doctor, I didn’t think it was… I thought it would go away. I thought I could help it myself. I thought if I stretched, if I did ice, if I did over the counter medication.”All of these are active care procedures need to be listed because the patient was trying to do self care, which is active care. It’s a form of active care and it failed.

Another important consultation item is that you cover is ligament damage. In a  consultation it’s very easy to say, to transition, “In a moment we’re going to be doing an examination procedure and in that examination procedure I’m going to be looking for things to help me determine the severity and location of any injuries that you have.”

“Ligaments are the tissue that holds these vertebrae together and in alignment and when they’re damaged they can cause all kinds of problems. They cause instabilities to occur.” During  examination procedures you will to be testing for the effect of ligament damage. Specialized x-rays called stress x-rays will then determine the severity and location of any ligament injuries

Their confidence in you and your team will be so high if you properly assess their symptoms, duplicating documenting them.  Note any pre existing conditions, properly diagnosis and follow up with documentation of any changes and gaps in care. They will  feel cared for and tell their friends, their family, their attorney, their co- workers, and you and your staff.

It is so simple:

Become a Smart Injury Doctor

Use the Smart Injury Symptom Tracker Form

Note any Pre Existing Conditions

Do a comprehensive Examination

Use the Gap in Care Form as needed

If these things are done in a timely manner with total duplication of the patient and properly documented at the time of the event, is a time saver.  Never again say, “Oh, I’m in deposition now. I have to get all of my notes together.”

Join us, become a Smart Injury Doctor We would love to have you on our team.

For more information on Spinal Ligament Injuries please check us out at https://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?

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

contact@smartinjurydoctor.com

Leave A Message

CONTACT US

Smart Injury Doctors
701 Richards Ave
Clearwater Florida 33755

labell@biocyberneticsinc.com
Call Lee Ann at 1-800-940-6513, ext 700

SEARCH THIS SITE

© 2019 Biocybernetics Inc.

The Three Skill Sets You Must Have to Build a Successful PI Practice Today

The Three Skill Sets You Must Have to Build a Successful PI Practice Today

What are the three things as an injury practice business owner do you need to do exceptionally well in order to truly expand in the injury market and do it so that it’s easy? So that it’s not so stressful?

There are three basic skill sets that you must have. I’m going to lay those skill sets out today. They’re very simple.

The first skill set is that you, as a clinician, must be extremely good at what you do. You must be able to do a few things well.

  • You must be able to diagnose all of the injuries that the patient has. And you can’t miss injuries and simple ligament injuries. You must understand that there is a disc herniation and then there is excessive motion. You must understand picking up both findings so that you can determine easily the severity and location of any ligament injury that the patient has. You must be able to diagnose these things incredibly well.
  • Then you must be able to treat them incredibly well.  The first thing to treatment and treatment results is really having a sound understanding \ of what the underlying condition is that you are treating. The better you understand the underlying condition, the better your treatment results are going to be. You must be able to diagnose well, and you have to be able to treat well.

And today in the injury market, you’re in a medico-legal situation. You must document well.

  • Your documentation determines the benefits that the patient is going to be able to have access to and potentially get.
  • Your documentation determines whether the plaintiff attorney has a hard time or not.
  • Your documentation determines whether the defense attorney has a hard time or not.
  • Your documentation depends whether the insurer has a hard time or not.

You must be able to express yourself simply when in a deposition or a court trial setting.

  • You, as a doctor, must be able to diagnose all the injuries the patient has.
  • You must be able to get great treatment results with these conditions on a regular basis. And I mean great treatment results.

If a patient that goes through your treatment program, no matter how long it takes, they should not have chronic pain, any activities of daily living disorders, duties under duress, or loss of enjoyment of life factors.

If you can do this with a high degree of confidence and a high degree of predictability and routinely with patients, that’s step number one in your business because you are the person that produces the product and results of an injury clinic.

The second biggest thing that you must have is a well-trained team. Your team is super, super important and training your team is one of the highest returns on investment activities that you can actually do.

Everyone trains their staff, everyone trains the front desk staff how to answer the phone, the billing person how to code for bills, how to send out and make phone calls to insurance adjusters, and to follow up on denials. Everyone trains their staff to help your patient fill out the paperwork correctly ,how to route the patient to the room correctly, or how to schedule the patient correctly. Those are all routine things. That’s not what I’m talking about here. What I’m talking about now is the ability to train your staff to answer questions about the injury work that you do, as good or better than you do. When I say better, sometimes the staff are better because they’re simpler and they put things in layman’s terms much.

  • Your staff needs to understand what a patient is going through. They need to understand the reality of the patient, whether it’s day one, which is one of your most important visits.
  • What is that patient going through?
  • When they first get into your clinic, what is the experience that they’re going to go through? What’s the experience with the first phone call?
  • Routing them in, filling out your paperwork, gathering their insurance information,
  • Introducing you, the doctor in their first visit.
  • Your consultation, examination procedures,
  • Imaging procedures of you do them internally.
  • Treatment procedures.
  • Information that you provide them with to take home.
  • How they are rescheduled.

Every person in your staff needs to understand the high points of what needs to get communicated in each one of the visits.

  • If you or your staff do not understand, or  you don’t have a team around, you’re seriously cutting the number of referrals you can get;
  • you’re seriously cutting the amount of the reduction of problems that you would have with reimbursement;
  • You’re seriously cutting down the results that you can get with the patients as far as their physical results;
  • You are cutting down a lot of things that simply don’t need to be cut down.

Training your staff is one of the most important things you can do but training them specifically in what makes you unique as an injury provider is even more important. When patients leave the room and walk down the hall and suddenly have more questions, if they can’t go to anybody in your clinic and ask and get a great answer to the question, you’re seriously losing money, results, and causing yourself a lot unnecessary of stress. That’s simply because you haven’t trained your staff.

The doctor also must be able to market. Marketing is nothing more than determining how you want to be perceived in the market.

  • You must ask yourself how you want to be perceived in the market? You want to be perceived as the best doctor a patient can go to.
  • And what does that mean? It means that you are fast, effective, you don’t miss things, make the rehabilitation very easy and simple to understand, and you get great results.
  • You document so that anyone that the patient is involved with, from a plaintiff attorney, defense attorney, their insurance carriers, to their state work comp carriers, has a lot easier time with it.

That’s how you want to be perceived. I want to be perceived as somebody who doesn’t miss injuries. If I’m going out to attorneys, I want to be perceived as somebody who documents so incredibly well that it makes their life super, super easy. If I want to be looked at by insurers, I want to be looked at somebody that’s honest, ethical, and highly professional. That’s how I want to be looked at. That is called a marketing strategy. Deciding how you want to appear to your market.

A marketing plan is deciding how you want to get that perception out to your community. Advertising is where you put that message on paid or unpaid communication lines. A paid communication line might be a radio commercial or a TV commercial, or you might do some sort of a newspaper ad. You might be doing all kinds of social media posts. You might be sending newsletters out to your patients, past and present. You need to communicate to your patient base on a regular basis. That’s called marketing.

When you accomplish these three things, it becomes very easy to expand. It’s easy to put associates in behind you. It’s easy to bring in new, well trained staff and retrain staff. If you understand how you want to be perceived and you’re putting that perception in the market, you’ve got it made in the injury market. And the injury market, in my personal and my professional experience, is the most fun market to be involved in because it’s a very high purpose game.

Patients that are injured have a 50/50 chance of never fully recovering, so they need the best doctors to be treating them. And that’s what made that game super, super fun for me because I wanted to be that doctor.

I run a program called the SmartInjuryDoctors programs and that’s why doctors are attracted to the program because that’s what they want to be. Marketing does one really neat thing; it repels what you don’t want, and it attracts what you do want.

You must decide professionally what you want to be in, how you want to be perceived. Because once you make that decision and once you start going down to that path, you will attract what you want to attract. Right now, if you’re getting things that you don’t like, you need to look at how you’re being perceived and what you’re putting out because that’s what you’re attracting. I like to always work with high level people. That’s what I like to work with, and I think you will too.

The three components of your business are you, your staff, and marketing. They are key things to being able to grow your injury practice now and for the next decade or decades to come.

For more information on Spinal Ligament Injuries please check us out at https://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?

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

contact@smartinjurydoctor.com

Leave A Message

CONTACT US

Smart Injury Doctors
701 Richards Ave
Clearwater Florida 33755

labell@biocyberneticsinc.com
Call Lee Ann at 1-800-940-6513, ext 700

SEARCH THIS SITE

© 2019 Biocybernetics Inc.

What Practice Guidelines Should You Be Using?

What Practice Guidelines Should You Be Using?

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 https://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?

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

contact@smartinjurydoctor.com

Leave A Message

CONTACT US

Smart Injury Doctors
701 Richards Ave
Clearwater Florida 33755

labell@biocyberneticsinc.com
Call Lee Ann at 1-800-940-6513, ext 700

SEARCH THIS SITE

© 2019 Biocybernetics Inc.