AMA Guides® Newsletter - Issue Archive

Articles

1. Life Care Plans

   Richard T. Katz

   Pages 3–8

   DOI: 10.1001/amaguidesnewsletters.2016.SepOct01

   Abstract

   In catastrophic injury cases, attorneys may request that a budget, often called a life care plan (LCP), be created to estimate expenses that a client will have in the future. The LCP is a budgeting process that requires a thorough understanding of a patient's condition, rehabilitation, and future needs to estimate what services and costs are likely to be needed in the future. The physician determines the extent and sequelae of the patient's physical and cognitive impairments; estimates a prognosis; estimates the need for and benefit of further medical and rehabilitative interventions; and then calculates the costs of future personal needs. Such a model first requires an accurate prognostication of the patient's life expectancy. Various costs projections are evaluated to estimate costs related to supplies, medications, physician and therapist services, and home and transportation modifications. Finally, such costs must be placed in an economic model in order to determine how the costs of inflation will modify the LCP. A competently formulated LCP can be a useful tool in estimating the future costs in catastrophic patient care. The article also presents a case example using a spinal cord injury to demonstrate how an LCP can be constructed.
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2. Two Faulty Beliefs about Independent Medical Evaluators and Impartial Physicians

   Jennifer Christian

   Pages 9–10

   DOI: 10.1001/amaguidesnewsletters.2016.SepOct02

   Abstract

   Patients and their advocates tend to be skeptical about reports produced by independent medical evaluators (IMEs) and file reviewers. There are legitimate reasons for this skepticism, but the author points out two common but erroneous beliefs that create unnecessary distrust in disability benefits and workers’ compensation claim management systems. First, despite patients’ faith in their own doctors, treating physicians as a group are not a reliable source of accurate and unbiased information. Second, although justice attempts to be even-handed, impartial physicians should not find for both sides equally (ie, should not attempt to achieve parity in outcomes), particularly because any case sent for review has some feature that raised questions in the mind of an experienced observer. This experienced observer requires an impartial, expert physician advisor who can confirm that the treating physician is doing the right thing or validate the claims manager's concerns. When claims or case managers are doing a good job of selecting cases for referral, one should expect that most of their decisions will favor the insurer/defense. The more expert the claims/case managers are, the more likely the independent physicians will agree because the claims/case managers are accurately detecting real problems and concerns. In counseling their patients, physicians should not discredit the work of independent experts; doing so increases distrust, resentment, and anger and encourages passivity rather than problem-solving.
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3. Communicating with Patients, Employers, and Insurers

   Les Kertay

   Pages 11–15

   DOI: 10.1001/amaguidesnewsletters.2016.SepOct03

   Abstract

   Disability is a prototypically biopsychosocial phenomenon, and the majority of workplace absences resolve easily and with an expedited return to work. In a minority of worker absences, recovery is delayed less by clinical factors and more by psychosocial variables that can take up an inordinate amount of time from the health care provider (HCP) and also may drive up total costs. Multiple stakeholders participate in this process—the HCP, the patient, the employer, and the insurer—each of whom has overlapping but distinct perspectives and agendas. Often HCPs find themselves in the middle of a complex set of interactions in which competing agendas may be played out. By engaging in effective communications with key stakeholders, the HCP can play a key role in ensuring that the most appropriate clinical outcomes occur. Despite the complexity of the underlying variables, the principles of effective communication are relatively straightforward: Apply a biopsychosocial model rather than a purely biomedical one; bear in mind that key psychosocial variables involved in delayed recovery include variables on the part of the individual, the employer, and the HCP; recognize that psychosocial factors that contribute to delayed return to work are not impairments that require medial or psychological treatment; listen; reach out to employers; and develop nonadversarial relationships with claims adjusters whenever possible.
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4. Q&A: Toe Amputation

   Christopher R. Brigham, James B. Talmage

   Pages 15–16

   DOI: 10.1001/amaguidesnewsletters.2016.SepOct04