Me Medica dical l Co Cost st Pr Projection: ojection: Cl - - PowerPoint PPT Presentation

Lif ife e Ca Care re Pl Plan vs. n vs. Me Medica dical l Co Cost st Pr Projection:

• jection:

Cl Claims ims Ma Mana nageme gement nt To Tool

• ls

 Nurse Case Manager  Life Care Planner

Lynn works for: Stubbe & Associates

Miller Park Crain Accident

 Life Care Plans…

• What is a life care plan and Medical Cost

Projection?

• Who is qualified to complete?
• What is the industry standard?
• How to use a life care plan or Medical Cost

Projection?

 Similar but different….

Need LCP MCP Litigation X Financial Planning X X Vocational Planning X X Medical Guidelines for future care X Reserve Setting X Case Management X

LIFE CARE: MEDICAL COST :

 Legal document – active

litigation and reactive

 Occurs toward the end of

active treatment

 Assessment based on in-

person interview, review

• f medical records and

provider communication

 Extensive legal document

with medical research

 Reserve planning -

proactive

 Can occur at any point in

treatment

 Assessment based on

medical records review and provider communication

 In-person meeting is

• ptional

 Medical research covering a

portion of care

 Written plan for future care to avoid

duplication of services

 Provides guide for cost effective management

• f medical care

 Provides communication among providers  Keeps lines of communication open  Medical needs and costs are forecasted

annually and for lifetime

 Provides a pricing guideline  Research based- nationally accepted

standards of care

 The Life Care Planner utilizes the nursing

process, collects and analyzes client specific data to prepare the dynamic document.

 The plan is an organized estimate of what is

reasonable and necessary for current and future healthcare needs for a particular individual over an estimated life span.

Spinal Cord injuries Burns Traumatic Brain Injury Amputations Crush Injuries Multiple Trauma Blindness AIDS Spinal Cord Injuries Toxic Exposure Ventilator Dependency Transplants Cerebral Palsy Chronic Pain

 Assessment  Diagnosis (Issue Identification)  Outcome Identification  Planning  Implementation  Evaluation

 Interview  Medical Record Review  LCP Assessment  Written Communication with Providers  Outcome Identification /Medical Research  Recommendations /Cost Research  Written Plan

 Introduc

roduction, tion, Case Summary ary

 Life Expect

ctancy ancy / Rated Age

 Chronol

• nolog
• gy

y of the Medical al Record

• rd Review

ew

 Past Medical

al History

• ry

 Summar

mary of Care

 Funct

ction ional l Status us, , Limita itations tions

 Antic

icip ipate ated Treatment tment

 Potentia

ntial l Compli licat catio ions ns

 LCP Recomm

mmend endations tions

 Medical Care, Physician Appointments  Procedures, Hospitalizations,

Surgeries

 Education, Evaluations, Therapy  Laboratory and Diagnostic Testing  Medications  Supplies, Equipment  Orthotics, Prosthetics  Aides for Independent Living  Home Furnishings  Home Care

 Facili

lity ty Care

 Case Managem

ement nt

 Transpor

portati tation

• n

 Vocationa

ional l Needs

 Health

h and Strength th Maintenan nance ce

 Archite

itect ctur ural al Renova vation tions

 Summary of C

f Costs ts

 MCP may be limited or task specific  Often used in less serious types of injuries or

for a specific period of time

 May be requested for one procedure only

such as a surgery or spinal cord stimulator

 Not a legal document  Requires less time to complete

 Certified Nurse Life Care Planner  Certified Life Care Planner  Legal Document vs Plan in Progress  Home Visit  Begin early in injury vs when claimant

is stabilized

CASE DISCUSSION

 DOI 6/3/13 – MVA (Roll-Over motor vehicle accident)  65 year old worker  Occupation – Dump Truck Driver  Taken by Flight for Life to UW Madison Hospital

and admitted to ICU

 Initial diagnosis – cervical spine fracture  Multiple surgeries

• C3 Laminoplasty
• C5 Laminectomy
• C5-6 reconstruction and fusion

 Permanent Cervical Paralysis  Complicated by

• Decreased oxygen saturation
• Angina
• Pleural effusion
• Congestive heart failure
• Confusion
• Pneumonia
• Insomnia

 Transferred to Craig Hospital for

rehabilitation

Treat eatme ment nt/ Item em Purp rpose se Time mefra frame me Frequ equenc ncy Unit it Cost st Lifeti fetime me Cost st Reso sourc rce

UW Madiso son To treat acute injury June 3, 2013 through July 9, 2013 One time $377,467.27 facility charges $156,002.59 physician fees $533,469.86 UW Hospital Craig ig Hospit ital al To provide in-patient rehab post acute injury July 9, 2013 admission One time $6,208.03 per day cost $478,018.31 Craig Hospital

Addit itiona ional l Informa

• rmation

tion:

Craig ig Hospital al costs s averag raged d $6,208 08.03 3 per r day.

• y. Averag

rage length of stay for quadr driple iplegic ic was 10-12 weeks. s.

 Similar claim example as Example #1

• DOI 6/3/14
• 65 year old dump truck driver involved in roll-over

MVA resulting in cervical injury and paralysis

 Request is to capture first year of medical

cost projections

Treatment/ Item Purpo pose se Timefram frame Freque quency cy Unit Cost Lifetime Cost Resource urce UW Madiso son To treat acute injury June 3, 2013 through July 9, 2013 One time $377,467.27 facility charges $156,002.59 physician fees $533,469.86 UW Hospital Craig ig Hospit ital al To provide in-patient rehab post acute injury July 9, 2013 admission One time $6,208.03 per day cost 474,562.10 Craig Hospital

Addit ition ional al Inform

• rmation

ation:

Craig ig Hosp spita tal cos

• sts

ts avera erage ged $6,208. ,208.03 03 per r day.

• y. Avera

erage ge lengt ngth h of stay y for r quadriple riplegic gic was s 10-12 12 week eks.

• s. Clie

ient nt stayed yed for r 20 week eks. s.

TABLE ONE YEAR COST T ESTIMAT MATE Evaluat uatio ions $221.25 Out-Pat atient nt Medica ical l Care $995.99 Hospit italiz alizatio ions/ ns/Pro Procedure cedures 1,008,031.90 Laborat ratory ry and Diagnost stic ic Testing ng $5,072.06 Medica icatio ions ns $4,310.63 Therapy apy $745.01 Durable able Medica cal l Equip ipment $7,821.66 Medica ical l Supplie plies $4,713.03 Wheelch chairs, airs, Acce cesso ssorie ries, s, Maintena nanc nce $12,351.17 Orthotics, ics, Prosthetics ics $125.00 Facility lity Care re $33,962.45 Home Care re $239,197.77 Educa catio ion Assist istive ive technolo logy y / Indepe pende ndent nt Living ng Suppo pport rt $1,010.00 Home Modifi ifica catio ions, s, Furnish ishing ings $8,474.57 Case Management nt $4,800.00 Transp sport rtat atio ion $5,562.21 Health Maintena nanc nce TOTAL $1,337,394.70

TABLE LE Evaluati tion

• ns

Out-Pati tient ent Medica cal Care Hospi pita talizat zations/ s/Proc rocedu edures es Laborato tory ry and Diagnos

• sti

tic c Testi ting Medicati tion

• ns

Therapy py Durable e Medical Equipment ent Medical Supplies es Wheelchairs, rs, Accesso ssories ries, Mainten tenance Orthotic tics, s, Prost sthetic etics Facility Care Home Care Educati tion

• n

Assisti sistive ve technol

• logy
• gy / Independ

enden ent t Living Support rt Home Modific ficatio tions, s, Furnish shings gs Case Managemen ement Transpo porta rtati tion

• n

Health th Maintena enance TOTAL 1Yr COST ESTIMATE $221.25 $221.25 $995.99 $995.99 1,008,03 031. 1.90 90 $5,072.0 .06 $4,310.6 .63 $745.01 $745.01 $7,821.6 .66 $4,713.0 .03 $12,351. 1.17 17 $125.00 $125.00 $33,962. 2.45 45 $239,197. 97.77 77 $1,010.0 .00 $8,474.5 .57 $4,800.0 .00 $5,562.2 .21 $1,337,3 ,394. 94.70 70

 Same accident as Example #1 Medical Cost

Projection

 65 year old dump truck driver involved in

roll-over accident resulting in cervical paralysis

 Following rehabilitation at Craig Hospital;

transferred back to skilled nursing facility

 Discharged: Home with 24/7 care as of

3/13/14

 Continued struggle with respiratory

insufficiency, DVTs, skin breakdown, sleep apnea, arrhythmias, bundle branch block and depression

 Sensitive to medications  Rated age done and median age determined

to be 74 with 11.8 year life expectancy

 Life care plan is an expansive document – will

show following charts to illustrate the cost/reserve information that can be obtained

Treatment/ Item Purpo pose se Timefram frame Freque quency cy Unit Cost Annual al Cost Lifetime Cost Resource urce

PM&R R off ffice ce visi sits 99213 99213

To manage medical and functional issues August 2013 throughout lifetime 3 times a year $139.78 $419.34 $4,948.21 WI fee schedule

Neurosur surger ery y

• ff

ffice ce visi sits 99214 99214

To assess and treat post spine injury August 2013 throughout lifetime 2 post discharge $210.15 $35.61 $420.30 WI fee schedule

Urology y off ffice ce visi sits 99213 99213

To manage issues relating to neurogenic bladder August 2013 throughout lifetime 2x/year and 5 additional $139.78 $338.78 $3,997.70 WI fee schedule

Psycho chology y visi sits 90804 90804

To assess/treat psychological issues August 2013 throughout lifetime 15 visits $131.10 $166.65 $1,966.50 WI fee schedule

Cardiologist st 99214 99214

To assess/treat cardiac complications August 2013 throughout lifetime 2 visits $210.15 $35.61 $420.30 WI fee schedule

Addition

• nal Inform
• rmation
• n:

Cra raig Hospital recom commen ends s an annual visit to Cra raig Hospi spita tal. . Clien ent t will need ed a loca cal PM&R M&R also so. . Neurosu

• surg

rger ery y will expect ect a couple e visits s post t disch charge e and then en aga gain if need eded ed. . Urol

• log
• gy

y visits s may y be more re frequen ent if urinary y tra ract ct infec ecti tion

• ns

s becom

• me

frequen

• ent. Psych

sychiatry/ ry/Psych sychol

• logy
• gy visits

s may y be need eded ed initi tially y and as clien ent ages.

• ges. Somet

etimes es refer errals s are e need eded ed to pulmon monol

• log
• gy,

y, podiatry ry and gen enera eral surg rgery ery for respi spirator tory y and skin brea eakdow

• wn issu

sues. es. Visi sit frequencies es are e based sed on the e recom commen endation

• ns made

e by Life e Care re Planning Case se Manageme ement Handbook

• ok.

.

Treatment/ Item Purpo pose se Timefram frame Freque quency cy Unit Cost Annual al Cost Lifetime Cost Resource urce Craig ig Hospit ital al

To provide in-patient rehab post acute injury August 2013 through October 9, 2013 One time See below $33,188.40 $391,623.21 Craig Hospital CorVel Corporation

Craig ig Hospit ital al

To provide

• ngoing

evaluation, address issues August 2013 throughout lifetime Annually $5,000 to $7,000 plus radiology costs $6,000.00 $70,800.00 Craig Hospital CorVel Corporation

Emergenc ncy y room Usage

To address urgent medical needs August 2013 throughout lifetime 1x/year $1,500 to $3,500 per visit $2,000.00 $23,600.00

Additi tion

• nal Infor
• rma

mati tion

• n:

Craig ig Hospital l costs s are $142,784.68 from 7/9/13 through 7/31/13, which is an average e of $6,208.03 per day.

• y. According

rding to CorVel, the agreed d upon reimburse bursement nt is 75% of bill lled charg rges. s.

Thank you!

Lynn Lepak, RN, BS, CDMS, CNLCP