Taking the Guesswork Out of Establishing Lifetime Care Needs and Cost

Life Care Planning, a natural extension of medical case management, represents the application of a meticulous approach to forecasting events and subsequent costs as they pertain to the ill/injured individual. Based on the recommendations of an interdisciplinary team of specialists, a well-constructed plan details the medical care needs on the ill/injured individual. Research is performed to determine the costs of each needed service or supply. The plan is then forwarded to an economist where the costs are reduced to a single, present value sum.

In order to compile an accurate Life Care Plan, one must have a clear understanding of the nature of the injury, the associated problems and the most appropriate approach for alleviation and/or remediation of same. Identification of and collaboration with the appropriate professional disciplines is critical, as is the ability to articulate and substantiate (i.e., provide expert testimony) the content of the plan once developed.

The care needs in the Life Care Plan should relate directly to the individual and his/her particular disability and thus are exclusive of “normal” everyday life/health care needs experienced by the well or healthy. However, recognition must be given to the fact that the health needs of people with disabilities may differ from the health care needs of others, and that physician visits are reported in the literature to be two to three times more frequent for disabled individuals.

Today, no one has the luxury of guessing at what that total might be. Please call us to discuss the specifics of your case.

Legal Services

The professionals at Certified Lifecare serve as consultants to the attorney. They assist with the overall case coordination and facilitation, and utilize a collaborative specialty team approach to ensure an accurate, credible depiction of damages.

The process of preparing a Life Care Plan includes:

1. Obtaining and reviewing all medical records
2. Conducting an in depth plaintiff evaluation when and where possible
3. Interviewing the current treatment team and family members
4. Delineating the existing and potential future problems
5. Determining the interdisciplinary expertise needed to present a credible case
6. Collaborating with the treatment/expert team to prepare a detailed Life Care Plan
7. Providing testimony to support the Life Care Plan

Workers’ Compensation

Few mistakes are more costly in Workers’ Compensation than under-reserving on a catastrophic or chronic injury/illness. Over-reserving can be almost as painful. Today, the setting of accurate reserves is the only practical way to ensure the continued financial health of an organization. Whether you retain the risk and manage the costs or decide to settle out, an accurate reserve estimate is critical to sound decision-making.

A Lifetime Medical Reserve Study will provide you with an accurate estimate of the cost of care, based on the recommendations of the treatment/expert team. It is less costly than a full Life Care Plan and is intended for “in-house use only”. (If litigation is anticipated or expert testimony is desired, a full LCP would be required)

The Lifetime Medical Reserve Study includes:

• Review of the current medical records
• A matrix diagram summarizing the recommendations of the current treatment team and detailing costs of recommended services and supplies
• A present value economic analysis

The Life Care Plan is a detailed and intensely researched plan of care for the future of an injured individual. The Life Care Planning process is collaborative. Multiple resources are utilized to substantiate costs of the recommended care in the Life Care Plan for use in deposition or trial. Expert testimony is provided in conjunction with the life care plan, as needed.

A Medical Cost Projection is a brief estimate of future care needs with related costs based predominately on the experience and expertise of the life care planner retained. The Medical Cost Projection is often used in mediation or settlement negotiations and is less research intensive than a Life Care Plan. Additional research and substantiation is required to convert this document to a Life Care Plan for use in deposition or trial.

An onsite assessment/interview with an individual and their family members along with review of pertinent medical records is conducted to determine the level and hours of care provided to an injured individual.

Case Management Consulting Services

If you are establishing a case management department or practice, we invite you to benefit from our experience and expertise. A case management department itself is a costly item both in terms of capital expenditure and personnel.

Consulting Services are designed to help you maximize the return on your investment in this vital area of health care management and to avoid the costly process of learning by “trial and error”. Typical issues we are engaged to address include, but are not limited to:

• Identifying realistic goals and objectives for case management
• Designing a case management process and establishing operating procedures
• Targeting early identification and referral of appropriate cases
• Training and supervision of case managers
• Establishing a format for Cost/Benefit Analysis

Optimizing Outcome and Controlling Costs

Our qualified case management nurse specialists have the requisite expertise and experience that ensures coordination of appropriate care for both adults and children.

The diagnoses with which we are accustomed to working include, but are not limited to:

• Immunodeficiency Syndrome
• AIDS Related Complications
• Amputations
• Anorexia Nervosa
• Anoxic Brain Injury
• Burns
• Cancer
• Carpal Tunnel Syndrome
• Cerebral Palsy
• Cerebral Vascular Accident
• Chronic Pain Syndrome
• Congenital Anomalies
• Diabetes Mellitus
• Erbs Palsy
• Failed Back Syndrome
• Fractured Hip/Knee/Legs, etc.
• Guillain Barre’ Syndrome
• Head Injury – Closed/Open
• Lymphoma
• Multiple Sclerosis
• Myocardial Infarction
• Near Drowning
• Organ Transplant
• Paraplegia/Paraparesis
• Pulmonary Disease
• Quadriplegia/Quadparesis
• Reflex Sympathetic Disorder
• Soft Tissue Injury
• Spinal Cord Injury
• Thrombophlebitis
• Toxic Exposure
• Traumatic Brain Injury
• Traumatic Stress Disorder

Additional referral indicators may include:

• Digression from standard of practice
• Unlimited or high dollar liability policies
• Evidence of complications (e.g., infection, decubitus)
• Multiple treatment providers
• Ventilator dependance
• Hi recidivism rates / multiple hospital admissions
• Unanticipated ICU / CCU confinement
• High claim dollars expenditure
• Need for specialized resources
• Questions regarding treatment or appropriate care

Determination of Case Merit

Medical record organization, chronology, review, and analysis are essential components to the delineation of case facts and the determination of case merit. Through utilization of specific medical/legal review process, critical gaps and/or reporting omissions, as well as overlooked and/or improperly handled patient symptoms are identified and described in respect to standard of care. Our professionals then consult with the referring attorney to discuss case elements (e.g., merit, etc.) and assist with determination of the appropriate course of action.

The following services/products are available:

Expert Testimony: Damages/Reasonableness of Past Meds

Life Care Planning / Life Care Plan (opposing expert) Critique

Mini/Preliminary Life Care Plan/Cost Projection for Mediation/Settlement Conference

Expert Witness Identification

Medical Record Review/Analysis/Impression/Organization/Summarization

Video Services (Day in the Life; Settlement Documentary/Brief; IME Evaluation; NDT / PT Evaluation; etc.)

Medical Bill Auditing/Reasonableness Analysis

Independent Medical Evaluation (IME) Attendance

Questions: Deposition/Cross Examination

Medicare Set Aside Trust Analysis

A Picture is Worth a Thousand Words

It has often been said that “a picture is worth a thousand words”. This is especially true in the courtroom where a picture can serve as a welcome reprieve from the many thousands of words used throughout a trial. One need only substitute the terms “demonstrative evidence” or “non-testimonial evidence” for the word “picture” and the scenario is set.

For years, litigants have used props, demonstrations, exhibits, and the like to aid in testimony. The purpose of such demonstrative evidence ranges anywhere from “… maintaining jurors interest to assuring that the jury recognizes exactly what the lawyer wants it to know and remember.” The premise for using this supplemental evidence is that it is more effective (in terms of learning and information retention) to show the jurors the evidence or exhibit rather than to simply tell them about it.

The use of “Day In The Life” videos is significant for many reasons. Providing a “window” into the world of the paraplegic, for example, allows the jury to be transported into the home for a firsthand view of the daily routine of the injured party and in so doing evokes a heightened appreciation for their predictament.