Case management attempts to better coordinate care for examinees with complex health-care needs. Record reviews and IMEs can contribute to case management by providing an objective basis for treatment decisions. The examiner is often asked questions regarding treatment options and appropriateness, applicable evidence-based practice guidelines, future care needs, expected endpoints of treatment, and return to work. The various contributors/decision makers in an examinee’s health care (e.g. treating physicians, other health-care providers, insurance or legal professionals, and the finder of fact (i.e. a judge, commissioner, or a jury) in legal proceedings) may find the opinions and conclusions expressed in a record review or IME report helpful.
A prolonged or even lifelong need for health-care services can be reasonably expected for an Individual who has sustained a catastrophic injury (e.g. a traumatic brain or spinal cord injury with residual disability) or who suffers from other chronic conditions. In such cases, a life care plan may be requested. In addition to a review and discussion of medical records and diagnostic studies and evaluation of the examinee’s current health-care conditions and treatment options, a life care plan addresses which health-care services (with related health-care costs) will be required for the remainder of the examinee’s treatment. As a certified life care planner (CLCP), Dr. Zünkeler is available to provide dynamic structured assessments of future care needs and costs and life care plans.
02. Health-care needs
To project future health-care costs, it is necessary to first define future health-care needs. An assessment of an examinee’s current and future health-care needs should be based on the following fundamental health-care tenets:
- decrease or eliminate suffering;
- reach and maintain the highest possible level of function and the best quality of life; and
- recognize, treat, and prevent complications.
03. Health-care costs
Future health-care costs depend on the nature, complexity, and duration of the examinee’s health condition and the region in which the examinee resides.
04. Surgery-related future cost projection
In the management of complex cases, the option of future surgery may have been discussed by treating providers. In such cases, it is sometimes necessary to determine the projected need-based costs of :
- future surgical intervention,
- potential surgical complications,
- postoperative and ongoing provider visits,
- diagnostic imaging and other studies,
- physical and occupational therapy,
- expected time away from work, and
- potential subsequent surgeries.
05. Life Care Plan
A life care plan formally establishes the basis for future care needs and costs, particularly in cases of severe disability due to a catastrophic injury or illness. A life care plan provides a systematic and dynamic needs-based assessment of future health-care costs. The main issues from the standpoint of a physician life care planner are:
- the examinee’s clinical condition,
- the services and goods the examinee needs going forward, and
- the cost of those goods and services.
In many cases of severe disability, the physician life care planner will need to visit the examinee at home or in a long-term care facility to obtain a first-hand impression of the examinee’s daily care routines, functional ability, and available assistive technology.
The presence of the examinee’s spouse or partner, parent or guardian, or legal representative is usually helpful. In some cases, photographs or video documentation of the functional ability of the examinee can help visually communicate the specific degree and severity of impairment and disability and may be integrated into or attached to the final life care plan document.
Dr. Zünkeler believes that the dignity and privacy of the examinee are of paramount importance. Therefore, to the extent necessary, the stepwise process of creating the life care plan is explained to the examinee and caregiver(s) or legal representatives. Written permission is obtained before any work is done. The life care plan is a dynamic document and may need to be updated as new information becomes available. Before completion, the life care plan is shared with the examinee and legal representative (and sometimes with the treating providers) to provide an opportunity for additional input .