binder and binder

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Rich Go

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hi. there was a thread on this in 2012, but was wondering if you had any new ideas...

what should you do with those 20-page binder and binder ssdi medical questionnaire forms and requests for narrative report? how can you avoid completing it without alienating the patient?

thanks...

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hi. there was a thread on this in 2012, but was wondering if you had any new ideas...

what should you do with those 20-page binder and binder ssdi medical questionnaire forms and requests for narrative report? how can you avoid completing it without alienating the patient?

thanks...

Tell the patient you do not get involved in disability issues because of the paperwork and reports. Tell them you send people for FCEs (that they will need to pay for) and those results are what the disability lawyer gets.
 
where do you send patients to get fce's?
how does this avoid upsetting the patient?
if you ask for money up front, how does this avoid upsetting the patient?

thanks...
 
where do you send patients to get fce's?
how does this avoid upsetting the patient?
if you ask for money up front, how does this avoid upsetting the patient?

thanks...

You seem to very concerned any not upsetting the patient. You are not working at McDonald's. You are not a customer service rep for the phone company. If you want to do work pro bono, go for it. Nobody else does.
 
where do you send patients to get fce's?
how does this avoid upsetting the patient?
if you ask for money up front, how does this avoid upsetting the patient?

thanks...

You tell them at their initial appt that you are a pain physician and your primary concern is with their pain and functionality, not disability assessment. Their pcp might do it, or go see a physical therapist, who often do FCE and work functionality.

I tell them that I refuse to get involved precisely because I don't want them to get upset at me, because I want them to go back to work....
 
hi. there was a thread on this in 2012, but was wondering if you had any new ideas...

what should you do with those 20-page binder and binder ssdi medical questionnaire forms and requests for narrative report? how can you avoid completing it without alienating the patient?

thanks...

throw them in the trash...
 
Disaability evals fall into two groups.

#1 established patients of mine that I think are actually disabled. These are very rare, and their family doctor usually has already filled out the papers. If it came to me I would fill them out and not charge a fee unless it really took me a long time.

#2 patients of mine that I do not think are disabled. I kindly tell them I do not think they qualify for disability, so they should not ask me to fill out the forms. Works every time.

I see no reason to fill out 15 pages saying what they can do, and that they can work.The attorneys just throw that in the trash.
 
throw them in the trash...
I did this the one time I got something like this. Never got another one. Never regretted it.
Also a nurse gave me something at the hospital, some kind of similar form. I kept eye contact with her as I deposited it in the shredder. At that moment I felt free...
 
Yes many of my partners simply throw them away and pretend like nothing happened. Eventually everyone gets the picture.

I like to have the talk, because if they want on disability, once we have had the talk they will quit coming to my office and go bother some other physician.
 
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350? you are cheap. 600 bucks and hour!

dont quote me on this, but i was told that any payments 600 bucks or more need to be declared to the IRS. i suppose they all need to be declared, but there is something special about that $600 dollar figure. maybe one of the more learned money people can comment.
 
1) Binder and Binder doesn't pay for those reports - if you look at fine-print you have to get your money directly from the patient --- good luck getting a disabled patient to pay you $400-800 for filling that out.

2) I generally throw them in the trash --- almost all of my patients who don't get disability on first try (ie: have to appeal w/ lawyers) generally are not really that disabled to begin with

3) Interesting NPR story about this... the States are actually contracting with these Soc. Sec. lawyers to get patients on to disability - one contract I heard was that they pay $2,300 to the lawyers PER patient they get on to disability (which DOESN"T include the amount the lawyer makes from the patients first SS check - usually between 4-5k)... The States are motivated to do so, since it takes the patient off their welfare/medicaid roles.... so the State ends up saving money in the long run by shifting this patient into the federal system...

only in America --- the lawyers love it, because they hire some paralegals to file all the paperwork and there is typically very little lawyering actually involved.
 
I am very passive aggressive re: Disability forms. I usually stick them in a pile of papers on my desk and let them compost for a while, sometimes I lose them.

I love the shredder one above, classic

If I think the pt is truly disabled I'm on it though
 
I have to say that in my short career - I have only seen ONE patient not get disability on first try who actually should have been declared disabled (severe MS to the point of being quadraparetic - even unable to feed herself - needs 24 hour/day full time assistance)...

people w/ real disabilities tend to get through on the first pass --- i tend to agree w/ almost all of the denials...

most of my patients who are "disabled" - would be out working if they didn't have this system to support them..

in fact, i love how some of my "disabled" patients are making good money under the table (car body work, collecting seashells and making frames out of seashells to sell online, babysitting, and the list goes on).

i also love my patients who were "disabled" - but are now doing fine, but remain on disability and are very fearful of losing their benefits. I thought that disability is only if there is no expectation of working the next 12 months because of a disability.

I can't tell you how many post CABG patients in their 50s are on disability --- why? because i had a heart attack... do you have chest pain? not anymore... what's stopping you from working? well, i had a heart attack (blank stare).
 
I can't tell you how many post CABG patients in their 50s are on disability --- why? because i had a heart attack... do you have chest pain? not anymore... what's stopping you from working? well, i had a heart attack (blank stare).

I'm not sure how SSDI is determined. Do they base it on previous occupation only? If you were a construction worker who had a MI, maybe that line of work is too physically demanding to continue. What if you can work a deskjob answering phones (customer service)?
 
I'm not sure how SSDI is determined. Do they base it on previous occupation only? If you were a construction worker who had a MI, maybe that line of work is too physically demanding to continue. What if you can work a deskjob answering phones (customer service)?

SSDI is ability to work period. If someone can't still lift rocks all day long after they had 2 lumbar fusions, they can still answer phones, or work a variety of desk jobs.--------- I love explaining that to patients.

I also bring up examples of patients that worked full time after a major stroke (are hemiplegic), and patients that are quads, but still work full time jobs.

They shut the hell up after that.
 
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Over and over again, I'd listen to someone's story of how back pain meant they could no longer work, or how a shoulder injury had put them out of a job. Then I would ask: What about a job where you don't have to lift things, or a job where you don't have to use your shoulder, or a job where you can sit down? They would look at me as if I were asking, "How come you didn't consider becoming an astronaut?"
 
In my limited experience, in general, if you need a lawyer to get disability, you don't need disability.

I have to say that in my short career - I have only seen ONE patient not get disability on first try who actually should have been declared disabled (severe MS to the point of being quadraparetic - even unable to feed herself - needs 24 hour/day full time assistance)...

people w/ real disabilities tend to get through on the first pass --- i tend to agree w/ almost all of the denials...

most of my patients who are "disabled" - would be out working if they didn't have this system to support them..

in fact, i love how some of my "disabled" patients are making good money under the table (car body work, collecting seashells and making frames out of seashells to sell online, babysitting, and the list goes on).

i also love my patients who were "disabled" - but are now doing fine, but remain on disability and are very fearful of losing their benefits. I thought that disability is only if there is no expectation of working the next 12 months because of a disability.

I can't tell you how many post CABG patients in their 50s are on disability --- why? because i had a heart attack... do you have chest pain? not anymore... what's stopping you from working? well, i had a heart attack (blank stare).
 
My favorites are the kids who were diagnosed with ADHD is a 12 year old and are on disability for the same thing when they see me at 24 with back pain. Go America!
 
I had a patient once, who when I asked him why he was on disability, looked at me strange, as if I had asked him the craziest question he had every heard. I asked him again, "What has left you disabled?" and he said, "I'm just on disability," and seemed irritated.
 
I had a patient once, who when I asked him why he was on disability, looked at me strange, as if I had asked him the craziest question he had every heard. I asked him again, "What has left you disabled?" and he said, "I'm just on disability," and seemed irritated.

Sounds like his disability was being a ******.
 
In my limited experience, in general, if you need a lawyer to get disability, you don't need disability.
Then your experience is ill informed. The initially screeners are high school educated clerks. The application process is large volumes of forms. You can get dinged for all sorts of technicalities. It is a very flawed system.

Some of my most deserving patients have had to appeal multiple times to get appropriate status.
 
Then your experience is ill informed. The initially screeners are high school educated clerks. The application process is large volumes of forms. You can get dinged for all sorts of technicalities. It is a very flawed system.

Some of my most deserving patients have had to appeal multiple times to get appropriate status.

Hmmm, are you a lawyer by chance?
 
Then your experience is ill informed. The initially screeners are high school educated clerks. The application process is large volumes of forms. You can get dinged for all sorts of technicalities. It is a very flawed system.

Some of my most deserving patients have had to appeal multiple times to get appropriate status.

Figuring out who actually gets diability can be a bit complicated and a number of factors are used to make the determination. Age, previous work, number of years paying into social security, mental and phyiscal impairments, etc. are all factored in. It is not as simple as "can you sit at a desk?".

Often the most deserving patients do get disability if their treating physicians document their issues correctly. A big problem for these patients typically is the templated notes their doc puts in stating their exam is normal. You can imagine how many stroke cases there are were a busy pcp under the neuro exam states: "No focal deficits" because he/she doesn't change what is templated in their note.

I agree the system is deeply flawed with a lot of abuse and waste.
 
cracks me up to see that stuff in templated notes..... Head: NC/AT.....when the guy is freshly s/p hemicraniectomy....
 
What about if I play along and put their actual diagnosis - lumbar myofascial pain? That way the patient can't blame me if it doesn't go through for not trying?

...Or does myofascial pain actually go through?

:eyebrow:
 
What about if I play along and put their actual diagnosis - lumbar myofascial pain? That way the patient can't blame me if it doesn't go through for not trying?

...Or does myofascial pain actually go through?

:eyebrow:

Diagnosis doesn't matter a whole lot. Objective findings play a much larger role in decision making (thankfully!), at least on the physical evaluations. I have no idea how the psych stuff gets handled.
 
psych still seems to be the sure fire way of getting disability - i have seen 22 yo w/ anxiety/depression/adhd get disability on first try and 48 yo w/ paraplegia due to thoracic fx need 2 appeals...
 
psych still seems to be the sure fire way of getting disability - i have seen 22 yo w/ anxiety/depression/adhd get disability on first try and 48 yo w/ paraplegia due to thoracic fx need 2 appeals...

I've had two serious/chronicTBIs - frontal lobe gone on both MRI's - denied. Until I got involved.
 
So here's the question, how much are these people actually getting by being on disability? $500/mos, $1000/mos, $5000/mos?
 
Reminds me of a patient on rehab during residency. GSW to the Rt frontal lobe. He lost all inhibition and
would talk sexually all day long to the nurses. However, he also lost all initiative so he was harmless.
 
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psych still seems to be the sure fire way of getting disability - i have seen 22 yo w/ anxiety/depression/adhd get disability on first try and 48 yo w/ paraplegia due to thoracic fx need 2 appeals...

Agree that vast majority of psych disability is bull****.

However disability for paraplegia is also bull****. During internship, I worked with a woman doing a MEDICAL RESIDENCY (family medicine)with full paraplegia. She pulled her 60-80hrs/week just like other residents. Also personally know a total paraplegic guy who did medschool and PMR residency after his injury.

If you're a C6 or higher quad, then I would agree with disability.
However, a paraplegic asking for disability needs to buck up and get a desk job. I think my paraplegic friends who completed MEDICAL RESIDENCIES after losing function of their legs speak to that effect.

I would argue that 90% of those on disability don't deserve it. If their only options were being hungry out on the street or getting up in the morning and going to a desk job, I think most would buck up and go to work like the rest of us.

A PM&R residency teaches you a great deal about who is truly disabled, which I point out the the whiners and slackers who ask me about disability.
They hate my examples of resilient folks still working 40hrs a week, (paraplegics, hemiplegics post CVA, double amputees, blind, deaf, etc. )

Their little mild-moderate disc degeneration is put in perspective after hearing about real loss of function.
 
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Agree that vast majority of psych disability is bull****.

However disability for paraplegia is also bull****. During internship, I worked with a woman doing a MEDICAL RESIDENCY (family medicine)with full paraplegia. She pulled her 60-80hrs/week just like other residents. Also personally know a total paraplegic guy who did medschool and PMR residency after his injury.

If you're a C6 or higher quad, then I would agree with disability.
However, a paraplegic asking for disability needs to buck up and get a desk job. I think my paraplegic friends who completed MEDICAL RESIDENCIES after losing function of their legs speak to that effect.

I would argue that 90% of those on disability don't deserve it. If their only options were being hungry out on the street or getting up in the morning and going to a desk job, I think most would buck up and go to work like the rest of us.

A PM&R residency teaches you a great deal about who is truly disabled, which I point out the the whiners and slackers who ask me about disability.
They hate my examples of resilient folks still working 40hrs a week, (paraplegics, hemiplegics post CVA, double amputees, blind, deaf, etc. )

Their little mild-moderate disc degeneration is put in perspective after hearing about real loss of function.

As mentioned earlier determining who gets disability accounts for many factors. You can get some idea of what qualifies by looking at the social security listings:

http://www.ssa.gov/disability/professionals/bluebook/AdultListings.htm

I agree that the vast majority of people applying for disability should not and do not qualify for it. With our chronic pain patients we get a very skewed selection of what is out there and I think that we need to keep that in perspective.

I was taken a little a back by your paraplegic comments...Sure, there is always going to be over achievers.... if you have the ability to get in to and make it through medical school and be paraplegic then a huge kudos, you are going to want the salary as a doctor way more than a disability check so there is a large incentive for you, and also true for other advance degree professions. If you are 55yr old, newly paraplegic and have an IQ of 80 with limited job skills what is really out there for you?

I think there is this perception that anyone can get a desk job or work at McDonald's which isn't the case for some people and typically isn't enough to support a person. One of the major benefits from disability is gaining health insurance. So yeah, your paraplegic could work for $10 an hour at some desk job but likely have limited to no health insurance and being PMR trained you know some the numbers for medical cost the first year out and subsequent years for SCI. Should we as tax payers be paying for that? I don't know, disability is a complex issue with no good answer. I do wish there could be some reform to clean up the waste that is built into it though.
 
If you are 55yr old, newly paraplegic and have an IQ of 80 with limited job skills what is really out there for you?

cashier.

customer service rep.

im sure he could find work at the DMV.

there are probably hundreds of other examples.

In the US, it really is a matter of choice: do you want to work and not make much money, or do you want to get disability and bring in a little bit less. If disability was not an option, that person would work.

I agree with the concept of disability, but the qualifying criteria really needs to refined
 
http://www.nytimes.com/2013/04/21/w...ate-ample-to-a-fault.html?pagewanted=all&_r=0


April 20, 2013
Danes Rethink a Welfare State Ample to a Fault
By SUZANNE DALEY
COPENHAGEN — It began as a stunt intended to prove that hardship and poverty still existed in this small, wealthy country, but it backfired badly. Visit a single mother of two on welfare, a liberal member of Parliament goaded a skeptical political opponent, see for yourself how hard it is.

It turned out, however, that life on welfare was not so hard. The 36-year-old single mother, given the pseudonym “Carina” in the news media, had more money to spend than many of the country’s full-time workers. All told, she was getting about $2,700 a month, and she had been on welfare since she was 16.

In past years, Danes might have shrugged off the case, finding Carina more pitiable than anything else. But even before her story was in the headlines 16 months ago, they were deeply engaged in a debate about whether their beloved welfare state, perhaps Europe’s most generous, had become too rich, undermining the country’s work ethic. Carina helped tip the scales.

With little fuss or political protest — or notice abroad — Denmark has been at work overhauling entitlements, trying to prod Danes into working more or longer or both. While much of southern Europe has been racked by strikes and protests as its creditors force austerity measures, Denmark still has a coveted AAA bond rating.

But Denmark’s long-term outlook is troubling. The population is aging, and in many regions of the country people without jobs now outnumber those with them.

Some of that is a result of a depressed economy. But many experts say a more basic problem is the proportion of Danes who are not participating in the work force at all — be they dawdling university students, young pensioners or welfare recipients like Carina who lean on hefty government support.

“Before the crisis there was a sense that there was always going to be more and more,” Bjarke Moller, the editor in chief of publications for Mandag Morgen, a research group in Copenhagen. “But that is not true anymore. There are a lot of pressures on us right now. We need to be an agile society to survive.”

The Danish model of government is close to a religion here, and it has produced a population that regularly claims to be among the happiest in the world. Even the country’s conservative politicians are not suggesting getting rid of it.

Denmark has among the highest marginal income-tax rates in the world, with the top bracket of 56.5 percent kicking in on incomes of more than about $80,000. But in exchange, the Danes get a cradle-to-grave safety net that includes free health care, a free university education and hefty payouts to even the richest citizens.

Parents in all income brackets, for instance, get quarterly checks from the government to help defray child-care costs. The elderly get free maid service if they need it, even if they are wealthy.

But few experts here believe that Denmark can long afford the current perks. So Denmark is retooling itself, tinkering with corporate tax rates, considering new public sector investments and, for the long term, trying to wean more people — the young and the old — off government benefits.

“In the past, people never asked for help unless they needed it,” said Karen Haekkerup, the minister of social affairs and integration, who has been outspoken on the subject. “My grandmother was offered a pension and she was offended. She did not need it.

“But now people do not have that mentality. They think of these benefits as their rights. The rights have just expanded and expanded. And it has brought us a good quality of life. But now we need to go back to the rights and the duties. We all have to contribute.”

In 2012, a little over 2.6 million people between the ages of 15 and 64 were working in Denmark, 47 percent of the total population and 73 percent of the 15- to 64-year-olds.

While only about 65 percent of working age adults are employed in the United States, comparisons are misleading, since many Danes work short hours and all enjoy perks like long vacations and lengthy paid maternity leaves, not to speak of a de facto minimum wage approaching $20 an hour. Danes would rank much lower in terms of hours worked per year.

In addition, the work force has far more older people to support. About 18 percent of Denmark’s population is over 65, compared with 13 percent in the United States.

One study, by the municipal policy research group Kora, recently found that only 3 of Denmark’s 98 municipalities will have a majority of residents working in 2013. This is a significant reduction from 2009, when 59 municipalities could boast that a majority of residents had jobs. (Everyone, including children, was counted in the comparison.)

Joachim B. Olsen, the skeptical politician from the Liberal Alliance party who visited Carina 16 months ago in her pleasant Copenhagen apartment, is particularly alarmed. He says Sweden, which is already considered generous, has far fewer citizens living on government benefits. If Denmark followed Sweden’s example, it would have about 250,000 fewer people living on benefits of various sorts.

“The welfare state here has spiraled out of control,” Mr. Olsen said. “It has done a lot of good, but we have been unwilling to talk about the negative side. For a very long time it has been taboo to talk about the Carinas.”

Already the government has reduced various early-retirement plans. The unemployed used to be able to collect benefits for up to four years. Now it is two.

Students are next up for cutbacks, most intended to get them in the work force faster. Currently, students are entitled to six years of stipends, about $990 a month, to complete a five-year degree which, of course, is free. Many of them take even longer to finish, taking breaks to travel and for internships before and during their studies.

In trying to reduce the welfare rolls, the government is concentrating on making sure that people like Carina do not exist in the future. It is proposing cuts to welfare grants for those under 30 and stricter reviews to make sure that such recipients are steered into jobs or educational programs before they get comfortable on government benefits.

Officials have also begun to question the large number of people who are receiving lifetime disability checks. About 240,000 people — roughly 9 percent of the potential work force — have lifetime disability status; about 33,500 of them are under 40. The government has proposed ending that status for those under 40, unless they have a mental or physical condition that is so severe that it keeps them from working.

Instead of offering disability, the government intends to assign individuals to “rehabilitation teams” to come up with one- to five-year plans that could include counseling, social-skills training and education as well as a state-subsidized job, at least in the beginning. The idea is to have them working at least part time, or studying.

It remains possible that the cost-cutting push will hurt the left-wing coalition that leads the government. By and large, though, the changes have passed easily in Parliament and been happily endorsed by conservatives like Mr. Olsen, who does his best to keep his meeting with Carina in the headlines.

Carina was not the only welfare recipient to fuel the sense that Denmark’s system has somehow gotten out of kilter. Robert Nielsen, 45, made headlines last September when he was interviewed on television, admitting that he had basically been on welfare since 2001.

Mr. Nielsen said he was able-bodied but had no intention of taking a demeaning job, like working at a fast-food restaurant. He made do quite well on welfare, he said. He even owns his own co-op apartment.

Unlike Carina, who will no longer give interviews, Mr. Nielsen, called “Lazy Robert” by the news media, seems to be enjoying the attention. He says that he is greeted warmly on the street all the time. “Luckily, I am born and live in Denmark, where the government is willing to support my life,” he said.

Some Danes say the existence of people like Carina and Mr. Nielsen comes as no surprise. Lene Malmberg, who lives in Odsherred and works part time as a secretary despite a serious brain injury that has affected her short-term memory, said the Carina story was not news to her. At one point, she said, before her accident when she worked full time, her sister was receiving benefits and getting more money than she was.

“The system is wrong somehow, I agree,” she said. “I wanted to work. But she was a little bit: ‘Why work?’ ”

Anna-Katarina Gravgaard contributed reporting.
 
those social experiments never work because eventually you run out of money.

patients should self-insure for unemployment, disability, retirement - instead of relying on government - sure government can support those who need a jump start to get self-insured. But I bet that there would be a LOT less fraud...
 
We should self insure for health insurance as well. However this doesn't apply anymore.

I heard rand Paul talk about a plan of buying a 30-40 year health policy when you are young and healthy that could last until Eligible for mcare. Similar to buying term life insurance. You could take it with you from job to job and state to state. Would seriously reduce preexisting conditions. You pay level term, relatively more when you are healthy but relatively less when you get old and debilitated. Good idea as a starting point. However irrelevant now.
 
3) Interesting NPR story about this... the States are actually contracting with these Soc. Sec. lawyers to get patients on to disability - one contract I heard was that they pay $2,300 to the lawyers PER patient they get on to disability (which DOESN"T include the amount the lawyer makes from the patients first SS check - usually between 4-5k)... The States are motivated to do so, since it takes the patient off their welfare/medicaid roles.... so the State ends up saving money in the long run by shifting this patient into the federal system...

Heard that NPR story and found it interesting too. Here's the link if anyone is interested:
http://apps.npr.org/unfit-for-work/
 
I saw a guy who was on disability for a one leg below knee amputation wearing a prosthesis. He was in the SSDI office for his annual "review" he came skipping in, jovial mood, living high, thinking that he did not have to up-play his "disability" he even hopped on his prosthetic leg for me.

I'm pretty sure he is no longer on disability and I hope he is still happy at his new job 🙂

Just goes to show that people on disability will try to keep it going for as long as possible.
 
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