Lif ife e Ca Care re Pl Plan vs. n vs. Me Medica dical l Co Cost st Pr Projection: ojection: Cl Claims ims Ma Mana nageme gement nt To Tool ols
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 X future care Reserve Setting X Case Management X
MEDICAL COST : LIFE CARE: Legal document – active Reserve planning - litigation and reactive proactive Can occur at any point in Occurs toward the end of treatment active treatment Assessment based on Assessment based on in- medical records review and person interview, review provider communication of medical records and In-person meeting is provider communication optional Extensive legal document Medical research covering a with medical research portion of care
Written plan for future care to avoid duplication of services Provides guide for cost effective management of 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 AIDS Burns Spinal Cord Injuries Traumatic Brain Injury Toxic Exposure Amputations Ventilator Dependency Crush Injuries Transplants Multiple Trauma Cerebral Palsy Blindness 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 onolog ogy y of the Medical al Record ord Review ew Past Medical al History ory 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 on 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/ Lifeti fetime me Purp rpose se Time mefra frame me Reso sourc rce Frequ equenc ncy Unit it Cost st Item em Cost st June 3, 2013 $377,467.27 UW Hospital To treat through July facility acute injury 9, 2013 charges UW Madiso son One time $533,469.86 $156,002.59 physician fees To provide July 9, 2013 Craig Hospital Craig ig in-patient $6,208.03 One time $478,018.31 admission Hospit ital al rehab post per day cost acute injury Addit itiona ional l Informa ormation 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/ Freque quency cy Unit Cost Lifetime Cost Purpo pose se Timefram frame Resource urce Item $377,467.27 June 3, 2013 facility UW Hospital To treat through July charges acute injury UW Madiso son 9, 2013 One time $156,002.59 $533,469.86 physician fees To provide in-patient July 9, 2013 Craig Hospital Craig ig $6,208.03 rehab post admission One time 474,562.10 Hospit ital al per day cost acute injury Addit ition ional al Inform ormation ation: Craig ig Hosp spita tal cos osts 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 TABLE LE 1Yr COST ESTIMATE Evaluat uatio ions $221.25 Evaluati tion ons $221.25 $221.25 Out-Pat atient nt Medica ical l Care $995.99 Out-Pati tient ent Medica cal Care $995.99 $995.99 Hospit italiz alizatio ions/ ns/Pro Procedure cedures 1,008,031.90 Hospi pita talizat zations/ s/Proc rocedu edures es 1,008,03 031. 1.90 90 Laborat ratory ry and Diagnost stic ic Testing ng $5,072.06 Laborato tory ry and Diagnos osti tic c Testi ting $5,072.0 .06 Medica icatio ions ns $4,310.63 Medicati tion ons $4,310.6 .63 Therapy apy $745.01 Therapy py $745.01 $745.01 Durable able Medica cal l Equip ipment $7,821.66 Durable e Medical Equipment ent $7,821.6 .66 Medica ical l Supplie plies $4,713.03 Medical Supplies es $4,713.0 .03 Wheelch chairs, airs, Acce cesso ssorie ries, s, Maintena nanc nce $12,351.17 Wheelchairs, rs, Accesso ssories ries, Mainten tenance $12,351. 1.17 17 Orthotics, ics, Prosthetics ics $125.00 Orthotic tics, s, Prost sthetic etics $125.00 $125.00 Facility lity Care re $33,962.45 Facility Care $33,962. 2.45 45 Home Care re $239,197.77 Home Care $239,197. 97.77 77 Educa catio ion 0 Educati tion on 0 Assist istive ive technolo logy y / Indepe pende ndent nt Living ng Suppo pport rt $1,010.00 Assisti sistive ve technol ology ogy / Independ enden ent t Living Support rt $1,010.0 .00 Home Modific ficatio tions, s, Furnish shings gs $8,474.5 .57 Home Modifi ifica catio ions, s, Furnish ishing ings $8,474.57 Case Managemen ement $4,800.0 .00 Case Management nt $4,800.00 Transpo porta rtati tion on $5,562.2 .21 Transp sport rtat atio ion $5,562.21 Health th Maintena enance 0 Health Maintena nanc nce 0 TOTAL $1,337,3 ,394. 94.70 70 TOTAL $1,337,394.70
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
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