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How To Diversify Your Physiatric Practice • Introduction • Life Care Planning • The Physiatrist as Physician Reviewer- Medical Necessity, Disability Assessment and Tales From The Dark Side • Break • Establishing a Quality Medicolegal Practice • Exciting Opportunities for Physiatrists in Health Plans

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Page 1: How To Diversify Your Physiatric Practice Introduction Life Care Planning The Physiatrist as Physician Reviewer- Medical Necessity, Disability Assessment

How To Diversify Your Physiatric Practice

• Introduction

• Life Care Planning

• The Physiatrist as Physician Reviewer- Medical Necessity, Disability Assessment and Tales From The Dark Side

• Break

• Establishing a Quality Medicolegal Practice

• Exciting Opportunities for Physiatrists in Health Plans

Page 2: How To Diversify Your Physiatric Practice Introduction Life Care Planning The Physiatrist as Physician Reviewer- Medical Necessity, Disability Assessment

Douglas A. Wayne, MD, CLCPAdvanced Orthopaedics

Director of Physical Medicine and Electrodiagnostic Center

Page 3: How To Diversify Your Physiatric Practice Introduction Life Care Planning The Physiatrist as Physician Reviewer- Medical Necessity, Disability Assessment

Disclosures

• Regional Medical Director for Corvel

• Associate Physician- Physician Life Care Planning

• Board Member of the American Academy of Physician Life Care Planners

Page 4: How To Diversify Your Physiatric Practice Introduction Life Care Planning The Physiatrist as Physician Reviewer- Medical Necessity, Disability Assessment

Years of Practice

• 4 years academic

• 2 years multispecialty spine

• 9 years solo practice

• 16 years in orthopedic group

Page 5: How To Diversify Your Physiatric Practice Introduction Life Care Planning The Physiatrist as Physician Reviewer- Medical Necessity, Disability Assessment

AAPMR Meetings

• Education (CME’s)

• Networking

• Equipment/ Technology

• Committee Work

• Strategic Planning

•Ideas (example)

Page 6: How To Diversify Your Physiatric Practice Introduction Life Care Planning The Physiatrist as Physician Reviewer- Medical Necessity, Disability Assessment

Practice Management

survival saying:

Don’t put all your eggs in 1 basket

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Page 7: How To Diversify Your Physiatric Practice Introduction Life Care Planning The Physiatrist as Physician Reviewer- Medical Necessity, Disability Assessment

DIVERSIFY DIVERSIFY

DIVERSIFY!

Page 8: How To Diversify Your Physiatric Practice Introduction Life Care Planning The Physiatrist as Physician Reviewer- Medical Necessity, Disability Assessment

Poll Question

• How many attendees have taken active steps to diversify their practice in the last 3 years?

• Yes

• N0

Page 9: How To Diversify Your Physiatric Practice Introduction Life Care Planning The Physiatrist as Physician Reviewer- Medical Necessity, Disability Assessment
Page 10: How To Diversify Your Physiatric Practice Introduction Life Care Planning The Physiatrist as Physician Reviewer- Medical Necessity, Disability Assessment

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Click icon to add picture

WHO YOU GONNA CALL????????????

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Page 11: How To Diversify Your Physiatric Practice Introduction Life Care Planning The Physiatrist as Physician Reviewer- Medical Necessity, Disability Assessment

Structural Acupuncture for

Physicians

Harvard Medical School 2005-2006

Page 12: How To Diversify Your Physiatric Practice Introduction Life Care Planning The Physiatrist as Physician Reviewer- Medical Necessity, Disability Assessment

Musculoskeletal Diagnostic Ultrasound

Approximately 100 hours of CME courses 2011-2013

Page 13: How To Diversify Your Physiatric Practice Introduction Life Care Planning The Physiatrist as Physician Reviewer- Medical Necessity, Disability Assessment

Life Care Planning

•University of Florida Life Care Planning Course 2013

•Certified by the International Commission on Health Care Certification 2014

Page 14: How To Diversify Your Physiatric Practice Introduction Life Care Planning The Physiatrist as Physician Reviewer- Medical Necessity, Disability Assessment

PM&R Journal Articles

Page 15: How To Diversify Your Physiatric Practice Introduction Life Care Planning The Physiatrist as Physician Reviewer- Medical Necessity, Disability Assessment

Life Care Planning: A Natural Domain of Physiatry

• Joe G. Gonzales, MD, FAAPMR, CLCP, Andrea Zotovas, MD, FAAPMR• This article is an introduction to life care planning and its relevance

to physiatry and physiatric practice. It includes a discussion of life care planning, physiatry’s role within its history and evolution, and life care planning methodologies. It also discusses life care planning education and certification, how the core competencies of the physiatrist are particularly relevant and applicable to life care planning, and life care planning’s capacity to complement and diversify a clinical physiatric practice.

• PM&R 2014;6:184-187

Page 16: How To Diversify Your Physiatric Practice Introduction Life Care Planning The Physiatrist as Physician Reviewer- Medical Necessity, Disability Assessment

Expert Testimony: Implications for Life Care Planning PM&R 7 (2015) 68-78

• Contributors:

• Richard T. Katz, MD

• Richard P. Bonfiglio, MD

• Richard D. Zorowitz, MD

• Feature Editor: Kristi L. Kirshner, MD

Page 17: How To Diversify Your Physiatric Practice Introduction Life Care Planning The Physiatrist as Physician Reviewer- Medical Necessity, Disability Assessment

The Life Care Planning and Case Management Handbook, 3rd Edition

• For a Life Care Plan to appropriately provide for all the needs of an individual, the plan must have a strong medical foundation. Physicians specializing in physical medicine and rehabilitation (physiatrists) are uniquely qualified to provide a strong medical foundation for life care planning based on their training and experience in providing medical and rehabilitative services to individuals with disabilities. Physiatrists are, by their training, experienced in dealing with individuals who have catastrophic functional problems. Additionally, physiatrists are trained to anticipate the long term needs of their patients.”

Page 18: How To Diversify Your Physiatric Practice Introduction Life Care Planning The Physiatrist as Physician Reviewer- Medical Necessity, Disability Assessment

Clinical Objectives of Life Care Planning

1. Diminish or eliminate physical and psychological pain and suffering.

2. Strive to achieve and maintain the highest level of function, given an individual’s unique circumstance.

3. Prevent complications to which an individual’s unique physical/mental conditions predispose them.

4. Give the individual the best possible quality of life in light of their condition.

Page 19: How To Diversify Your Physiatric Practice Introduction Life Care Planning The Physiatrist as Physician Reviewer- Medical Necessity, Disability Assessment

The Basic Questions of Life Care Planning

1. What is the subject’s condition?

2. What medically-related goods and services does the subject’s condition require?

3. How much will those goods and services cost over time?

Page 20: How To Diversify Your Physiatric Practice Introduction Life Care Planning The Physiatrist as Physician Reviewer- Medical Necessity, Disability Assessment

Who Hires Life Care Planners?

•Attorneys (Plaintiff and Defense)

• Trusts

• Insurance Companies

• Self Insured employers

Page 21: How To Diversify Your Physiatric Practice Introduction Life Care Planning The Physiatrist as Physician Reviewer- Medical Necessity, Disability Assessment

Common Uses for Life Care Plans

•Litigation• Hospital discharge planning

• Case management planning

• Elder care planning

Page 22: How To Diversify Your Physiatric Practice Introduction Life Care Planning The Physiatrist as Physician Reviewer- Medical Necessity, Disability Assessment

Catastrophic Life Care Plans

• Catastrophic Life Care Plans are what most individuals think of when they think of Life Care Plans.

• Catastrophic Life Care Plans are for individuals who have suffered permanent physical and/or mental impairment, and who have lost significant capacity to perform some or all of the basic functions of daily living.

• Conditions commonly requiring Catastrophic Life Care Plans include: birth defects, major burns, multiple trauma, spinal cord injuries, traumatic brain injuries, and others.

Page 23: How To Diversify Your Physiatric Practice Introduction Life Care Planning The Physiatrist as Physician Reviewer- Medical Necessity, Disability Assessment

Non- Catastrophic Life Care Plans

• Non-catastrophic Life Care Plans are for people who have suffered permanent, substantial, chronic, and/or structural physical impairment, but who have not lost significant capacity to perform the basic functions of daily living.

• > 80% of all injuries which require Life Care Plans are non-catastrophic in nature.

• Conditions commonly requiring Non-catastrophic Life Care Plans include: amputations, burns, cervical injuries, lumbar injuries, thoracic injuries, upper/lower extremity issues, and others.

• Most attorneys do not realize non-catastrophic plans are available.

Page 24: How To Diversify Your Physiatric Practice Introduction Life Care Planning The Physiatrist as Physician Reviewer- Medical Necessity, Disability Assessment

Life Care Plan Average Values

Average Catastrophic Life Care Plan = $4,789,379

Average Catastrophic Life Care Plan per year of care $124,164

Average Non-Catastrophic Life Care Plan = $403,148

Average Catastrophic Life Care Plan per year of care $15,930

Page 25: How To Diversify Your Physiatric Practice Introduction Life Care Planning The Physiatrist as Physician Reviewer- Medical Necessity, Disability Assessment

Future Medical Requirements

• Physician Services

• Routine Diagnostics

• Medications

• Laboratory Studies

• Rehabilitation Services

• Equipment & Supplies

• Nursing & Attendant Care

• Environmental Modifications & Essential Services

• Acute Care Services

Page 26: How To Diversify Your Physiatric Practice Introduction Life Care Planning The Physiatrist as Physician Reviewer- Medical Necessity, Disability Assessment

How to learn more or get started with LCPs

• Attend meetings/workshops at AAPMR

• The Life Care Planning and Case Management Handbook, 3rd Edition

• Institute of Rehabilitation Education and Training

• American Academy of Physician Life Care Planners

Page 27: How To Diversify Your Physiatric Practice Introduction Life Care Planning The Physiatrist as Physician Reviewer- Medical Necessity, Disability Assessment

American Academy of Physician Life Care Planners

• AAPLCP's mission is to champion the practice of Life Care Planning by physicians, to elevate the discipline of Life Care Planning through physician participation, and to educate physicians, the Life Care Planning community, and the public about physicians' central role in the practice of Life Care Planning.

Page 28: How To Diversify Your Physiatric Practice Introduction Life Care Planning The Physiatrist as Physician Reviewer- Medical Necessity, Disability Assessment

American Academy Physician Life Care Planners Membership

• Affiliate- Non physician member

• Associate- MD or DO member

• Diplomat- Board certified physiatrist who is also a CLCP, certified by the International Commission on Health Care Certification and has passed the CPLCP (Certified Physician Life Care Plan) examination.

Page 29: How To Diversify Your Physiatric Practice Introduction Life Care Planning The Physiatrist as Physician Reviewer- Medical Necessity, Disability Assessment

Physiatric Life Care Planning

• Author Life Care Plans

• Collaborate with a Life Care Planner

• Perform the physiatric evaluation to be used in a life care plan.

• Refute Life Care Plans

• Critique Life Care Plans

Page 30: How To Diversify Your Physiatric Practice Introduction Life Care Planning The Physiatrist as Physician Reviewer- Medical Necessity, Disability Assessment

Marketing

• Talk to nurse Life Care Planners to let them know of your interest and expertise

• Talk to attorneys

• Web based marketing

Page 31: How To Diversify Your Physiatric Practice Introduction Life Care Planning The Physiatrist as Physician Reviewer- Medical Necessity, Disability Assessment

Case Example

• 42 year old right handed male construction worker with a fall at work and sustained right Humeral head/neck fracture S/P ORIF, lower trunk complete plexopathy and neuropathic pain.

• Patient with ongoing severe pain, Right upper extremity dysfunction and inability to return to work 2 years post injury.

• Create a LCP for this individual

Page 32: How To Diversify Your Physiatric Practice Introduction Life Care Planning The Physiatrist as Physician Reviewer- Medical Necessity, Disability Assessment
Page 33: How To Diversify Your Physiatric Practice Introduction Life Care Planning The Physiatrist as Physician Reviewer- Medical Necessity, Disability Assessment

Case Example

• Medical Record Review

• History and Physical with Diagnostic Conclusions

• Future Medical Requirements

• Set parameters for cost analysis

• Vendor survey’s

• Conclusions and Bottom Line Number

Page 34: How To Diversify Your Physiatric Practice Introduction Life Care Planning The Physiatrist as Physician Reviewer- Medical Necessity, Disability Assessment

Case example: Future Medical Requirements

• Physician Services

• Routine Diagnostics

• Medications

• Laboratory Studies

• Rehabilitation Services

• Equipment & Supplies

• Nursing & Attendant Care

• Environmental Modifications & Essential Services

• Acute Care Services

Page 35: How To Diversify Your Physiatric Practice Introduction Life Care Planning The Physiatrist as Physician Reviewer- Medical Necessity, Disability Assessment

Poll question

• Case example: Acute care Services

• How many of you would….?

• 1. Specify a TSR during this patient’s lifetime? Yes or No

• 2. Specify a Spinal Cord Stimulator? Yes or No

• 3. Specify Morphine Pump? Yes or No

• 4. Specify a Hand Transplant? Yes or No

Page 36: How To Diversify Your Physiatric Practice Introduction Life Care Planning The Physiatrist as Physician Reviewer- Medical Necessity, Disability Assessment

Life Care Plans and Average Values(Non-Catastrophic Injury Classifications

Average Non- Catastrophic Amputations = $939,621

Average Non- Catastrophic Amputations per year of care

$33,765

Average Non- Catastrophic Brachial Plexus= $632,229

Average Non- Catastrophic Brachial Plexus per year of care

$33,134

Page 37: How To Diversify Your Physiatric Practice Introduction Life Care Planning The Physiatrist as Physician Reviewer- Medical Necessity, Disability Assessment
Page 38: How To Diversify Your Physiatric Practice Introduction Life Care Planning The Physiatrist as Physician Reviewer- Medical Necessity, Disability Assessment

Sample Category Cost Analysis: Routine Diagnostics

© Physician Life Care Planning, LLC – All Rights Reserved - 2014

Page 39: How To Diversify Your Physiatric Practice Introduction Life Care Planning The Physiatrist as Physician Reviewer- Medical Necessity, Disability Assessment

Sample Cost Summary

© Physician Life Care Planning, LLC – All Rights Reserved - 2014

Page 40: How To Diversify Your Physiatric Practice Introduction Life Care Planning The Physiatrist as Physician Reviewer- Medical Necessity, Disability Assessment

Round Table DiscussionSaturday 5:30- 6:30pm

Practice track roomJoe G. Gonzales, MD, FAAPMR, CLCP

Thank you


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