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Tipology is where you'll be visiting often.  Not only to learn new ways to enhance your practice for higher profitability, but also to share your own knowledge and experiences if you'd like.  

When it comes to Practical PI, our goal is simple.  We seek to provide you, the health care provider, with the "best of the best" solutions and resources in the arena of personal injury.  Specific answers and solutions that are PROVEN, PRACTICAL AND SIMPLE.  Resources that focus on various areas of need, including:  

PI Collections

The area of PI Collections has to do with the question -- How can you, as the provider, vastly improve your ability to collect -- i.e., GET PAID -- for the services you render in the personal injury arena?  In other words, how can you correct and prevent the recurring payment problems that commonly arise in this area ... and thereby grow your practice with confidence?  ProviderLAW's PI Collections suite currently includes:  An 8-Module Seminar Series, Weekly Reimbursement Webinars, Assignment & Lien Program, Full Subscription, Founding Subscription, and other services.  Our Forms Packet includes an array of highly-integrated, model insurance forms essential to your ability to collect.  Forms available in both English and Spanish!  To learn more, check out our Practical PI Seminars...

Three Major Myths When It Comes to Collections in Personal Injury Cases

By Keith Pendleton, JD, ProviderLAW Corporation

There are 3 major myths that must be understood -- and dispelled -- if you are to improve your collections in the arena of personal injury.  Those who've done so have not only become highly successful in their collections... many have built up substantial practices along the way.  If you have any doubts about any of what I’m about to share with you, I invite you to call and discuss further.  I also encourage you to attend a Practical PI Seminar in your area.

Collections Myth #1 – “Collecting in Personal Injury is Difficult.” 

This is ABSOLUTELY NOT TRUE.  In fact, nothing could be farther from the truth.  Outfitted with a few basic laws and tools, your practice can do exceedingly well on your collections -- so much so that you'll wonder why you didn’t build up your practice in this arena years ago.  This is true in virtually all States.  It’s also true irrespective of whether the patient has an attorney or not, a point I’ll come back to below.  Many of you may not be aware of this, but when it comes to personal injury collections, you actually have the firepower of a major aircraft carrier, sitting right there, ready to help you collect on your bills.  You and your staff just don’t know it.  I encounter practices all of the time that are collecting 30-50 cents on the dollar.  Yet, when asked, “Would you rather work smarter and get paid for what you do… or harder and collect the same amount?”  the answer is virtually unanimous.  Most practices, if given the choice, would much prefer to cut back on volume and simply get paid for what they do.  Thankfully, though, this doesn’t have to be your choice.  You can actually get paid at very high collection rates for what you do and at the same time, build up a substantial practice in this arena.  My colleagues will show you how to build up your practice.  My predominant focus is making sure you get paid for what you do… regardless of what State you’re from.

Collections Myth #2 – “If I Try to Improve My Collections, Attorneys Won’t Refer to Me.”  

The falsity of this myth makes it the most misleading of the three.  First, there are MANY ways to build up your practice in arena.  But I’ll give you my own example to illustrate.  About five years ago, a certain physical therapist I know didn’t treat personal injury patients.  “I’ve heard that collecting in PI is too difficult,” he said (Myth #1 above).   I explained that actually collecting in personal injury is not difficult at all.  So this physical therapist decided to try out some test cases.  When he found that what I said was true, he set about building his PI practice.  Today, 5 years later, he has a booming practice in this arena.  Now bear in mind -- this therapist doesn't overcharge.  He doesn't overtreat.  But he does expect to be paid in-full.  So how did he do it?  He focused on ALL of the various ways of building his practice in this arena ... and not just attorney referrals.

But here’s another reason why this myth is so misleading.  Reputable personal injury attorneys don’t base their referral decisions primarily on who cuts their bills, or by how much.  Instead, they base their decisions primarily on what’s best for their clients.  When it comes to what’s best for their clients, here are the primary factors that come into play:  (1) Who are the best practitioners?  (2) Who actually understands the patients’ underlying conditions?  (3) Who can easily explain in simple terms the nature of the patients’ underlying condition, as well as how their care helped?  Ultimately, these are the primary factors which help the attorney obtain the settlement which the patient deserves.  In other words, reputable attorneys base their decision primarily on value -- not on whether you cut your bills, or by how much.  Below, you will find articles by my colleagues Jeff Cronk, DC, CICE (Spinal Kinetics), and Kim Christensen, DC, DACRB (OutcomesAssessment.org) that will help to explain this further.

Here’s one last reason why the myth, “But attorneys won’t refer to me,” is so misleading.  Many providers report having 1 or 2 attorneys that actively refer to them on a regular basis.  My question is -- how many attorneys beyond that are actively referring to you?  I have spoken with so many providers who for the past 10 years have hung their entire referral strategy -- and collections practices -- on the notion that if they keep agreeing to cut their bills, the referrals from "all of the other attorneys" will start coming.   A façade which for the most part has not come to pass.  My advice to you is simple:  (1) learn how to collect for what you do, (2) learn all of the various ways to build your practice in this arena, including how to get paid in unrepresented cases (see below), and (3) start becoming the BEST OF THE BEST in trauma care and diagnosis and build your referral strategy based on value, not on 30-50 cents on the dollar.  Many of you already treat conditions stemming from traumatic events.  Why shouldn’t you become the best of the best?

Collections Myth #3 – “There’s No Way to Get Paid in Unrepresented Cases.” 

Again, TOTALLY UNTRUE.  In fact, I know of health care providers who’ve become so effective at collecting in unrepresented cases that they actually prefer unrepresented cases!  What’s more, it’s estimated that in “Fault” States, patients elect NOT to be represented by an attorney 40-60% of the time.  If you limit treatment to just those cases where “the patient has a certain attorney,” you are turning away cases that you don’t need to turn away.  By the way, if you happen to practice in a No-Fault State, there is a counterpart to all of this.  I’ll come back to this in just a moment.  The key to getting paid in unrepresented cases is to understand the laws and tools you need for ensuring a right of direct payment from fault-based payers such as liability, uninsured motorist, and underinsured motorist coverage.  This is not difficult to do at all.  Now, if you’re in a No-Fault State, it may be true that most of your patients elect representation.  That being said, in many instances you can position your practice to collect your full fees on the back end from the settlement with the at-fault party.  In other words, if PIP delays or denies, you can position your practice to collect those delays and denials from the liability settlement proceeds.

To summarize:  (1) Learn how to collect for what you do, (2) learn all of the various ways to build your practice in this arena, including how to get paid in unrepresented cases, and (3) start becoming the BEST OF THE BEST in trauma care and diagnosis.

If you have any doubts about what I've shared with you, I invite you to call and discuss further.  I also encourage you to attend a Practical PI Seminar in your area.

Keith Pendleton, JD
Direct:  888-852-2654

PI Diagnosis

Do you treat spinal soft-tissue injuries and spinal chronic pain?  In the following article, Dr. Jeff Cronk DC, CICE explains the need for providers who treat such injuries – irrespective of specialty or profession -- to perform standardized spinal ligament assessments.  No longer the sole domain of any one profession or specialty, standardized spinal ligament assessments represent where the health care industry is going.  “For the first time,” writes Dr. Cronk, “one test, establishing patient-specific results, can be understood and interpreted the same by every Spinal Care Provider in the Spinal Care Industry.”  Dr. Cronk invites anyone with questions to call him directly at Spinal Kinetics West at 715-833-8533.  Alternatively, you are encouraged to check out the FREE “evidenced based” educational program which is available to all providers for 24/7 viewing.

Diagnosing Spinal Soft-Tissue Injuries – and Chronic Spinal Pain – Necessarily Requires a Standardized Assessment of the Spinal Ligaments Themselves

By Jeffrey A. Cronk, DC, CICE, Director of Education, Spinal Kinetics

The diagnosis of spinal soft-tissue injuries – one of the most common causes of acute and chronic spinal pain -- must necessarily entail a standardized assessment of the spinal ligaments themselves....  Yet, here are a few facts:  

•  The majority of the providers who treat these types of injuries do not utilize a standard, rational algorithm to work up and document these injuries.

•  Many providers have no idea of how to clinically determine the severity of a spinal sprain … let alone how to rule in or rule out the severe sprain findings associated with long-term impairment.

•  Even fewer providers in the market today understand how to simply correlate and identify spinal instabilities.

At Spinal Kinetics we see this problem every day and we intend to change it for the benefit of all of the professions.  More importantly, we intend to change it for the benefit of all patients.

Non-Use of a Standard Rational Algorithm to Work Up and Document These Injuries

Want to test this statement for yourself?  Take the records from various providers who’ve treated a spinal injury from, say, a whiplash mechanism, and you will find that it has been worked up in completely different fashion at each office.  It has been worked up one way by the medical provider, a completely different way by the orthopedic hospital, and yet another at the chiropractic office.  Examine the records from office of office of, say, the chiropractic profession, or medical profession, and you will discover the same thing – the work up at each office is all completely different.  Providers who treat spinal soft-tissue injuries have not been utilizing a uniform standard in the way they work up these injuries, and this fact alone has resulted in very poor, long-term results for the patient populations that these providers support as evidenced by the epidemic levels of spinal chronic pain that exist in the U.S. today. 

Again, at Spinal Kinetics we see this problem every day and we intend to change it.

The “Why’s” and the “How’s” of Standardized Spinal Ligament Assessment

Spinal ligaments hold the spine in alignment under load so that the individual vertebrae do not misalign, and cause cord dysfunction, nerve dysfunction or pain.  When the spinal ligaments are damaged it results in mechanical deformities most commonly called a Spinal Subluxation, Chiropractic Subluxation, Inter-segmental Somatic Dysfunction or an Osteopathic Lesion. When these mechanical derangements are identified as a major contributing factor to an undesired clinical expression (symptom) in the patient they are called a “spinal instability” or a “clinical instability.”

The differential diagnosis of these conditions is almost entirely dependent on “inter-segmental motion evaluation.”  Inter-segmental motion analyses are most reliably produced with Quality Stress Radiography Images and Computerized Radiographic Mensuration Analysis (CRMA) to accurately and reliably produce the measured motion patterns.  

These resources make it possible for all providers – not just any one profession -- to more accurately determine and objectively document the location and severity of a spinal sprain, to rule in or rule out severe sprain findings indentified by the American Medical Association as “Alteration of Motion Segment Integrity,” as well as clinically establish spinal instabilities.

Additionally, these findings actually drive all the spinal specialty care paths, from the Conservative Chiropractic Care Path to most Invasive Spinal Fusion Surgical Path and everything else in between.

At Spinal Kinetics we intend to do three things:

•  Make  inter-segmental motion testing results understood by all spinal care providers

•  Produce accurate and reliable studies that help our Chiropractic Doctors drive and objectively establish their patients care needs as well as allow our Spinal Surgeons to more accurately determine their Surgical Plans.

•  Remain the leader in the innovation of the systems that evolve to improve accuracy and reliability in these computer assisted methodologies.

For the first time, one test, establishing patient-specific results, can be understood and interpreted the same by every Spinal Care Provider in the Spinal Care Industry.  When all Spinal Care providers are aligned they will produce much better results for the patients that they serve!

To further this reality we at Spinal Kinetics have produced a FREE “evidenced based” educational program which is available to all providers for 24/7 viewing at:  www.spinal-kinetics.com.  Simply click on the Blog Button on the far right tab and then go to our training videos button on the lower left.

To contact us directly either call our national number at 1-877-508-9729 or call our West U.S. Office at 715-833-8533 and we will answer any questions that you may have.

 
Dr. Steven P. Brownstein, MD, Owner Dynamic Medical Imaging, Owner Spinal Kinetics, Diplomat American College of Radiology, Honorary Fellow of the American College of Chiropractic Radiologists, Donator of Teaching Library to Palmer College, Major Contributor to Marchiori "Clinical Imaging", Major Contributor to Yochum and Rowe "Essentials of Skeletal Radiology", Instructor for Association of New Jersey Chiropractors (ANJC) for MRI Certification Program.

Dr. Jeffrey A. Cronk, DC, CICE is the Director of Education for Spinal Kinetics.  Dr. Cronk has a 16-year background in private practice as a chiropractor as well as 7 years direct involvement with running diagnostic companies that deliver Computerized Radiographic Mensuration Analysis (CRMA).  Dr. Cronk’s  8 years of clinical experience utilizing test results as a treating provider and 7 years (CRMA) delivery experience make him one of the most experienced providers in the nation when it comes to spinal ligament testing with CRMA.
 

Whiplash

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PI Outcomes Assessment

As a health care provider, one of the most powerful and effective things you can do is to incorporate an automated outcomes assessment tool into your practice. The benefits of such a tool go well beyond just assisting you with insurance ... or outfitting attorneys with what they need for settlement purposes.  A tool of this nature will aid you in your treatment itself.  OutcomesAssessment.org has developed an automated outcomes assessment tool which is extremely quick and easy-to-use, patient-friendly, and cost-effective ... all in one!  What's more, OutcomesAssessment.org has invested significant time, energy, and resources to ensure that you -- the health provider -- actually have permission and proper licensure to use copyrighted outcomes assessment forms in your practice.  This is not only vital ... it is for YOUR protection.  How many other companies seek to protect you in this way?  Learn more about OutcomesAssessment.org.

Outcomes Assessment in the Daily Practice

By Kim Christensen, DC, DACRB, OutcomesAssessment.org

In the modern health care environment, health care practitioners are required to be effective and efficient.  In soft-tissue arenas, we must do all we can to help decrease acute and chronic pain, as well as increase structural integrity.  Our treatment plans must move from passive care (adjustments and unassisted physiotherapy modalities) to active care (adjustments and conditioning/work hardening exercise programs) with appropriate structural support.
 
We are now very aware of the importance of assessing and reporting the outcomes of our treatment procedures.  The hallmark of an outcomes assessment is that it is quantifiable and comparable to previous and future evaluations.  This process has become an essential part of health care services, and especially of rehab programs.  
 
From the provider’s standpoint, we need to know whether our care is improving the patient’s well-being, and if so, by how much.  This helps us plan for further care or referral.  The patient also should have some way to assess the benefit (or lack thereof) of our treatment regimen, in order to make an informed decision about whether to continue treatment.  And finally, whoever is paying for this care deserves to be provided with an evaluation of the progress (or not) of the patient under our care.
 
Briefly, an outcomes assessment is defined as:  “a form of measurement of progress toward a specific goal”.  The many and varied types of evaluations that are done to assess the outcomes of chiropractic rehabilitation fall into two general areas: subjective and objective determinations.  Both can be very helpful in evaluating progress; they provide an insight into two different components of the healing process.  
 
For subjective evaluations, I recommend a combination of a Quadruple Visual Analog Scale for pain, the Neck/Back Bournemouth Questionnaires for measurements of a patient’s perception of progress, and the new Pain Disability Questionnaire (rated better than the Oswestry) for outcome documentation of function.  In the objective realm, I like to use Postural and Gait Evaluations as primary indicators of a patient’s progress.  

These assessments need to be performed on a regular schedule, generally not longer than monthly.

1.  Quadruple Visual Analog Scale (VAS)

The Quadruple Visual Analogue Scale (QVAS) is a reliable and valid method (1) for pain measurement. The QVAS is based on four specific factors:

       1.  Pain level at the time of the current office visit.
       2.  Typical or average pain since the last visit (or since the initial visit or, since the onset of the condition) depending on the chronicity of the condition.
       3.  Pain level at its best since the last visit, time of intake, or since the onset of the condition.
       4.  Pain level at its worst since the last visit, time of intake, or since the onset of the condition.

The scores from factor #1, #2, and #4 above are averaged and then multiplied by 10 to yield a score from 0 to 100. The final score is then categorized as “low intensity” (pain < 50) or “high intensity” (pain >50).

2.  Neck/Back Bournemouth Questionnaires

The Bournemouth Questionnaire is a comprehensive outcome measure for back pain.  The instrument has established validity, consistency, reliability and demonstrated responsiveness to clinical change. It is practical for use for both the efficacy and effectiveness of back pain treatments. It measures the following seven back pain model  traits:
 
       1. Pain Intensity       2. Daily activities       3. Recreational/social/family activities       4. Anxiousness       5. Depression       6. Work Activities       7. Pain Control 

A score of 0 to 10 is possible for each of the seven categories, which provides a total possible score of 70 where 70 represents the highest disability score possible and 0 represents the best spinal health score.

3.  Pain Disability Questionnaires

The Pain Disability Questionnaire (PDQ) is a comprehensive psychometric evaluation of functional status. The focus is primarily on disability and function. This instrument is designed for the full array of chronic disabling musculoskeletal disorders, rather than low back pain alone. The psychometric properties of the PDQ are excellent, demonstrating strong reliability, responsiveness, and validity.
 
The PDQ is made up of two factors: a Functional Status Component comprising a maximum of a 90 score and a Psychosocial Component comprising a maximum of a 60 score. This yields a total functional disability score ranging from 0 to 150.

4.  Postural and Gait Evaluation

In addition to the standard ortho/neuro and range of motion examinations done for chiropractic care, I find posture and gait evaluations to be very helpful objective evaluations when planning and measuring the impact of rehab.  Human posture is based on an erect column of functional segments, better designed for movement than for standing still.  Optimal posture allows for pain free movement with a minimum of energy expenditure and is a sign of vigor and harmonious control of the body.
 
Areas where there is poor postural or gait alignment indicate chronic biomechanical stress, and are frequently associated with painful or degenerative processes.  Chronic spinal problems may develop secondary to lower extremity misalignments, such as leg length discrepancies and pronation problems.  Any of these that are present will need to be addressed in order to resolve the patient’s current symptoms and to prevent future back problems.

Conclusion

The use of adjustments, rehabilitative exercises/supports and subjective/objective outcome measures are critical when a functional approach is taken.  Outcomes assessments keep everyone apprised of the progress (or lack thereof) of the patient in response to health care services.  
 
 
About the Author

Kim D. Christensen, DC, DACRB, CCSP, CSCS, directs the Chiropractic Rehab & Wellness program at PeaceHealth Hospital in Longview, Wash.  He has participated as team chiropractor to high school and university athletic programs, a postgraduate faculty member at numerous chiropractic colleges, past-president of the ACA Rehab Council, and a lecturer and author of many musculoskeletal rehabilitation texts.  Dr. Christensen can be reached via email: kchristensen@peacehealth.org.

PI Marketing

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