By Gregory L. Smith, MD, MPH
Life Care Plans (LCPs) and Medical Cost Analyses (MCAs) have been around for decades. These reports have traditionally been used for major catastrophic cases and have been very expensive and therefore used in a limited role. These reports specifically focus on the future medical and surgical costs, as well as costs associated with vocational, and daily activity issues.
Historically these reports have been written by vocational nurses, and persons trained specifically in how to write LCPs and MCAs. Often the authors of these reports had very little, if any medical/surgical training or experience.
In the past couple of years new LCPs and MCAs reports have become commonplace for non-catastrophic cases. Cases with a surgery, or several injection procedures are now reasonable cases for the attorney to get an LCP and MCA. In addition, these more medically focused reports are being provided by physicians that treat these conditions not non-physicians.
An MCA is a report that provides detailed discussion of expected future medical costs for provider visits, medications, durable medical equipment, diagnostic studies and procedures. The report is based on a review of the medical records from the treatment of the case. An MCA usually costs about $1500-2000, half of what an LCP costs. An LCP includes everything that is in an MCA but the physician writing the report also interviews the client to discuss issues of current symptoms, medication use, unevaluated conditions, and effects on work and daily life. The physician also calls the treating provider to discuss the appropriateness of care, the outcome from the procedures that have been done, and discuss future expected treatment, therapy and procedures. This information is added to report so that the report it much more robust.
Traditionally the providers treating the client write a final report when the client reaches Maximal Medical Improvement (MMI). The providers usually add a quick paragraph at the end of the MMI report and briefly outline the expected need for additional chiropractic sessions, physical therapy or surgical procedures in the future. These rough estimates of future medical costs are almost never supported by Guidelines, and Evidence-Based Medicine practices or standard references of medical costs by CPT code and region of the US.
The physicians writing these new LCP and MCA reports focus entirely on future medical and surgical needs. They use the nationally recognized Evidence-Based Medicine treatment guidelines, such as ODG – Treatment Guidelines, Medical Treatment Utilization Schedule (MTUS), American College of Occupational and Environmental Medicine (ACOEM) Treatment Guidelines and New York State Medical Treatment Guidelines to support their opinions and recommendations.
These national Guidelines provide specific and detailed recommendations for treatment of almost every type of injury as well as chronic pain psychological treatment. They provide clear guidance on the number of therapy and chiropractic visits, as well as future use of medications, and injections and when to approve surgery.
By using these Guidelines, physician’s are now able to easily apply the opinions and costs in these reports that are now much more well founded, and supported by large data sets of patients with similar conditions and injuries.
Expected medical and surgical costs are now easily supported by using large databases that are broken down city or state and provide average retail costs of visits, medications, diagnostics, durable medical equipment and procedures.
The physicians documenting the future medical costs can now support each cost with a specific and nationally recognized treatment Guideline. They can now support the costs of medications, durable medial equipment, procedures, diagnostic studies and procedures with average retail costs in the area.
The net result if that LCPs and MCAs are now quickly, and inexpensively available for attorneys to use on cases where they may not have thought of using this type of report. The well documented and Guideline supported costs help provide a more fair appraisal for settlement purposes.
The following is an example Medical Cost Projection Table that is provided at the end of these new style LCPs and MCAs.
Disclaimer: This plan is based on past, present and anticipated medical needs. Projections are based on review of the medical records available at the time of this report. Costs are based on present day values.
ODG – Official Disability Guidelines: Evidence-Based Decision Support, current version as of the date of this report.
M2018 – Medical Fees (2018) Practice Management Information Corporation (PMIC)
ICSI – Institute for Clinical Systems Improvement
Drugs.com – www.Drugs.com
AAPM – American Academy of Pain Management
Milliman – Milliman – Utilization and Cost of Lumbar Spinal Stenosis in Commercially Insured Population