PI PRACTICES

[Nonphysiologic]

Hello all,

Is there anyone here that sees at least 50% personal injury patients? And if so what kind of electronica medical record do you use?

Also I would appreciate any advice and or guards to personal injury patients. For example what to be careful for. I understand that sometimes we don’t get paid until much later if at all but other than that I want to see what are other potential pitfalls. So far besides the two that I mentioned just now also the fact that lawyers might be pushing you to do procedures it seems like it’s a pretty decent Gig because there are very little if any opioids prescribed and the patients are acute or subacute and not chronic, and it seems to be very lucrative. It definitely seems like it will come to an end soon and there will be a fee schedule but it still seems to be better than regular insurance and private insurance. Any thoughts?


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[lobelsteve]

Providing as much care as required to make sure the settlement is as big as possible.
Nothing about this sounds like legitimate medical care, because it isn't. And that is what makes it PI.

 

[cowboydoc]

I'd check a chiro forum.

 

[SommeRiver]

Run away from this bc you WILL be pressured by attornies to do any number of things you know are inappropriate. They will try and influence you, and while you may feel you can't be manipulated they'll try anyways. Lawyers represent the courts and legalities and in some cases lawsuits and scary words, but they live in that arena and are comfortable in that arena and doctors are not.

I'm not sure I worded that correctly on my phone but I would sum it up by saying I would steer clear of this bc the lawyers will screw with you, and you're not the first doctor they've encountered. If they don't feel you're on their team you wouldn't be involved so be careful.

 

[unchockey21]

Taking care of patients with ulterior motives, who already have a lawyer, and aren’t afraid to sue. I can’t possibly see what could go wrong.

In all seriousness, if you do go that route. Your documentation better be ironclad and I would practice extremely conversatively (which goes against what the lawyers and patients will push for).

 

[SommeRiver]

I know a guy personally who markets himself to law firms for business. He is "sympathetic" to whichever firm is paying him.

 

[nvrsumr]

The money is in the permanent disability and future medical needs that u will write for Infinitum or lose all referrals.

 

[Agast]

My patient was originally under personal injury after MVA and I had to explain to them why no other pain doctor would do a cervical and lumbar epidural steroid injection at the same time like the old pain doc did

 

[244913]

there was another thread about this which might have gotten shut down. I will say again that being a fluffer for PI firms is my idea of the 7th circle of Hell. Most people involved with PI deserve to end up there.

 

[callmeanesthesia]

there was another thread about this which might have gotten shut down. I will say again that being a fluffer for PI firms is my idea of the 7th circle of Hell. Most people involved with PI deserve to end up there.

I think you mean 4th circle of hell, or maybe 8th...

 

[Biohazard685]

Hello all,

Is there anyone here that sees at least 50% personal injury patients? And if so what kind of electronica medical record do you use?

Also I would appreciate any advice and or guards to personal injury patients. For example what to be careful for. I understand that sometimes we don’t get paid until much later if at all but other than that I want to see what are other potential pitfalls. So far besides the two that I mentioned just now also the fact that lawyers might be pushing you to do procedures it seems like it’s a pretty decent Gig because there are very little if any opioids prescribed and the patients are acute or subacute and not chronic, and it seems to be very lucrative. It definitely seems like it will come to an end soon and there will be a fee schedule but it still seems to be better than regular insurance and private insurance. Any thoughts?


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Don't do it.

If you are doing it, then meet the attorneys personally and get a feel to see if they are the greedy type or actual advocates. Majority will be greedy.

Screen your patients carefully. Some will have legit issues some are looking for a lotto ticket.

Don't change your standards for the patients. Treat them all the same.

I personally would never get involved with opioids/controlled substances and a patient that's involved in litigation.

 

[promethius]

I was recently approached by a law firm regarding seeing their personal injury clients. Most of the physicians I know who see personal injury cases do so on a lien basis. However, this firm says that they feel it is better for all parties involved to pay on a regular basis under an agreed-upon contracted rate with their funding company. The rates they are proposing are comparable to Medicare rates. What are your thoughts on this payment structure for seeing personal injury patients?

 

[swamprat]

I was recently approached by a law firm regarding seeing their personal injury clients. Most of the physicians I know who see personal injury cases do so on a lien basis. However, this firm says that they feel it is better for all parties involved to pay on a regular basis under an agreed-upon contracted rate with their funding company. The rates they are proposing are comparable to Medicare rates. What are your thoughts on this payment structure for seeing personal injury patients?

def not. Look at the fee schedule for pip in ur state and tell them that’s the rates u want. No point in seeing personal injury cases at Medicare rates

 

[Laryngospasm]

I was recently approached by a law firm regarding seeing their personal injury clients. Most of the physicians I know who see personal injury cases do so on a lien basis. However, this firm says that they feel it is better for all parties involved to pay on a regular basis under an agreed-upon contracted rate with their funding company. The rates they are proposing are comparable to Medicare rates. What are your thoughts on this payment structure for seeing personal injury patients?

They want you to do PI work for Medicare rates? Lol! Do they also want you to do court appearances for 50$?

 

[Ducttape]

bad idea. lawyers are usually cheap, but these are "Medicare rate" cheap.

 

[gaseous_clay]

The funding company, which is owned by the attorney, is going to get most of the profits while they pay you Medicare rates. The attorney is the only one who benefits in this situation. I would tell them to lien it or pick another funding company that pays you more than Medicare. There are a ton of them out there.

 

[NJPAIN]

I was recently approached by a law firm regarding seeing their personal injury clients. Most of the physicians I know who see personal injury cases do so on a lien basis. However, this firm says that they feel it is better for all parties involved to pay on a regular basis under an agreed-upon contracted rate with their funding company. The rates they are proposing are comparable to Medicare rates. What are your thoughts on this payment structure for seeing personal injury patients?

This is a relatively new concept. You get paid immediately rather than waiting for a settlement under LOP. But, you get paid next to nothing. Funding company takes risk of loss if case is lost but they get interest on the loan. They won’t cover any high implant cost cases because there is too much to loose. They are going as far as to contract to produce cheap spinal to cover spinal surgery because that is good for the case. Winners are “patient” and lawyers. Care to support case gets done and instead of some large sum to pay out after settlement based on LOP, they pay off the loan and have their nice fat settlement.
You need a really strong stomach to deal with most PI attorneys and their chiropractic playmates. I have one or two local attorneys who do some PI that send me a case here and there. They have a conscience, want the correct care for the client and know that it’s wrong to fabricate a case from nothing. They are a rarity.


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[Laryngospasm]

The PI chiros are the best!

 

[iwumd07]

It depends on where you practice and who you work with. I don’t work with firms who are shady and push any type of care/treatment. For the most part, I enjoy the PI work I do because I can quickly evaluate and diagnose my patients and come up with an overarching care plan wary in the pain process, rather than having a patient dumped on my by chiro or PT 1-2 years down the road and nothing has been done for these patients. I can also protect them from other providers who just push opioids as the sole treatment option.
Also, a huge chunk of my non-PI patients have chronic pain that ultimately began after a bad accident, and they ended up in my clinic because they never had appropriate treatment. So it’s also a bit of preventative care in that sense too, or at least I’d like to think so.
It’s nice to see that people actually improve after doing epidurals for acute lumbar radiculopathy with a correlating acute disc herniation, rather than being the guy who sees them 5 years down the road when “the roxies don’t work no more”.

I use eClinicalWorks. It’s not the best by any means, but I’ve spent lots of time to make it work for us for the most part.

 

[SommeRiver]

The PI chiros are the best!

Ever read their notes?

Absolutely thrilling!

 

[iwumd07]

This is true.

 

[RM38]

I see several PI patients a week and we use a funding company that pays at least 200% of Medicare. Patients are usually young with limited to no medical co-morbidity. Visits are usually straightforward and most patients really just have mayofascial pain. I would say I probably inject less than 35 percent of the people I see. Insurance has to approve everything and we get paid quickly. Also very rarely write for opioids and only if I think patient had more significant issue. Not had a lawyer get pushy with me yet, but I am sure that will happen eventually.

 

[drpainfree]

I see several PI patients a week and we use a funding company that pays at least 200% of Medicare. Patients are usually young with limited to no medical co-morbidity. Visits are usually straightforward and most patients really just have mayofascial pain. I would say I probably inject less than 35 percent of the people I see. Insurance has to approve everything and we get paid quickly. Also very rarely write for opioids and only if I think patient had more significant issue. Not had a lawyer get pushy with me yet, but I am sure that will happen eventually.

hold on, your post is full of contradiction...what do you mean you "use" a funding company that pays 200% of medicare rate, yet, no lawyer got pushy on you...my understanding when you work with funding company, you get paid by funding company directly and quickly (in your quote, 200% medicare rate), you do not deal with lawyers anymore...also what do you mean by "insurance has to approve everything"...this is PI case, you don't need to or want to go through insurance...

 

[promethius]

def not. Look at the fee schedule for pip in ur state and tell them that’s the rates u want. No point in seeing personal injury cases at Medicare rates

My state does not have a PIP fee schedule.

My questions are (1) what is the general consensus regarding using a funding company instead of taking a lien for seeing personal injury patients? and (2) if you agree to use a funding company, what is the minimum (i.e. relative to Medicare rates) you would accept to see personal injury patients?

 

[RM38]

hold on, your post is full of contradiction...what do you mean you "use" a funding company that pays 200% of medicare rate, yet, no lawyer got pushy on you...my understanding when you work with funding company, you get paid by funding company directly and quickly (in your quote, 200% medicare rate), you do not deal with lawyers anymore...also what do you mean by "insurance has to approve everything"...this is PI case, you don't need to or want to go through insurance...

I guess I should clarify when I say insurance I mean funding company that is acting like insurance in these PI cases. They have to pre-approve or deny everything we do, even follow up visits and UDS if needed. The negative is that they can sometimes take months to approve an MRI which is annoying when I am trying to see what may be going on and they keep calling asking to be seen because they are either out of the medicine I gave them (usually just NSAIDS and MR) or are wanting something else done. We get paid within 30 days, so that is good. Patients have all been to chiro before seeing me and I typically just ignore their notes other than the details about the crash. We do get contacted by the lawyers still on occasion, but it is usually just them more wanting to know if we are still actively treating the patient or not.

 

[NJPAIN]

Is that a joke? Do they get paid medicare rates? Tell them you would charge the same rates they charge per hour plus a certain percentage of settlement. Lawyers always try to screw us but they have no shame charging outrageous fees that few can afford.

Such dirtbags. One just sent me a letter threatening to turn me in for violating HITECH act. They have patient request records under HITECH to be sent to attorney so it costs them less. Sends me letter stating I can’t collect $40 for record duplication. I must send records on CD or USB drive and can charge cost of labor and device. Then he incorrectly states I can charge max $6.50.


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[DrSpine]

Providing as much care as required to make sure the settlement is as big as possible.
Nothing about this sounds like legitimate medical care, because it isn't. And that is what makes it PI.

I hate this type of "care" as well. I didn't go into my field and my career to be part of some pyramid scheme, or be involved in nonsense.

 

[deleted880510]

PI can be a huge pain. I know of a lot of pain doctors who have been accused of RICO by the big auto insurance companies. Lot of these doctors accused of RICO can be shady, but I know of some who seem to be practicing appropriately. Big auto insurance companies have a lot of money and power and know how to intimidate and bully doctors.

How do you all deal with patients involved in acute accidents complaining of a lot of pain, and say the motrin and tylenol dont help them? Do you ever try em on a short course of Norco 5 or 7.5 ? Or is this just opening the floodgates to dependence and addiction?

 

[deleted185747]

Where can I find a PI fee schedule?

 

[Ducttape]

PI can be a huge pain. I know of a lot of pain doctors who have been accused of RICO by the big auto insurance companies. Lot of these doctors accused of RICO can be shady, but I know of some who seem to be practicing appropriately. Big auto insurance companies have a lot of money and power and know how to intimidate and bully doctors.

How do you all deal with patients involved in acute accidents complaining of a lot of pain, and say the motrin and tylenol dont help them? Do you ever try em on a short course of Norco 5 or 7.5 ? Or is this just opening the floodgates to dependence and addiction?

Please......I would do not prescribe opioids for MVC related pain.

The ER will give appropriate short term script of opioids but by the time we see them, they should be out of that acute phase (or seeing ortho for fracture). no need to continue or cause long term use..

 

[promethius]

So I am thinking of doing some moonlighting on the side with a pain management practice that does exclusively personal injury. As an independent contractor, what do you think is fair compensation for a flat daily rate where I will be seeing somewhere in the range of 15-20 personal injury patients a day with a variable mix of new patients and follow-ups. I am just talking about E/M patient encounters, as any injections will be compensated separately.

 

[Piebaldi]

So I am thinking of doing some moonlighting on the side with a pain management practice that does exclusively personal injury. As an independent contractor, what do you think is fair compensation for a flat daily rate where I will be seeing somewhere in the range of 15-20 personal injury patients a day with a variable mix of new patients and follow-ups. I am just talking about E/M patient encounters, as any injections will be compensated separately.

2k daily

 

[cowboydoc]

2k daily

You wouldn't get me to consider a side gig getting $100/pt. encounter in general, let alone for PI. Maybe I'm spoiled?

 

[NJPAIN]

So I am thinking of doing some moonlighting on the side with a pain management practice that does exclusively personal injury. As an independent contractor, what do you think is fair compensation for a flat daily rate where I will be seeing somewhere in the range of 15-20 personal injury patients a day with a variable mix of new patients and follow-ups. I am just talking about E/M patient encounters, as any injections will be compensated separately.

Very time consuming because every one of them complains of pain from head to toe and their chiropractic notes likewise document pain everywhere. I’d be surprised if 10% of them will have a procedure. They just want to complain and get adjusted every 48 hours.


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[Laryngospasm]

I have done this type of practice before rather extensively and you would be surprised how many will get procedures. That may well be because it increases the size of the settlement due to x number of procedures required every x years but they don’t shy away from procedures. The settlements are based on expected cost of medical treatment. And no 100$ per patient is not enough.

 

[cowboydoc]

k maybe im confused. What do you think you should make?

I’m thinking 2-3 times that.

 

[promethius]

I have done this type of practice before rather extensively and you would be surprised how many will get procedures. That may well be because it increases the size of the settlement due to x number of procedures required every x years but they don’t shy away from procedures. The settlements are based on expected cost of medical treatment. And no 100$ per patient is not enough.

I agree with that assessment. Seems like the majority of PI patients would want to undergo procedures for the reason you mentioned. I know with liens, it can make predicting reimbursement difficult. However, with your extensive experience with personal injury, what do you think is a fair flat daily compensation rate for seeing 15-20 E/M personal injury encounters? You are welcome to send me a message if you rather not say in the open forum.

 

[deleted880510]

any tips on documentation (ordering MRIs, EMGs, DME, etc) for auto injury patients?

 

[iwumd07]

any tips on documentation (ordering MRIs, EMGs, DME, etc) for auto injury patients?

I document things the same way I do for a non-auto injury patient.

 

[promethius]

So I recently have a few patients coming to me who have been involved with motor vehicle accidents. They want to use their insurance to see me instead of going through personal injury. What are the pros and cons of seeing personal injury patients through their insurance? I am assuming their insurance makes a difference, with the lower reimbursing the insurance, the less likely you are to see them under their insurance rather than taking a lien. I am assuming lawyers would prefer patients to use their insurance whenever possible, as the patient's insurance will cover the visit and treatments without a lien's being involved. Do insurances have disclaimers that say they will not cover treatment for injuries sustained from auto accidents, work-related incidents, etc.?

I have also had patients who I have been treating for chronic pain with opiates under their insurance, but they get into a motor vehicle accident, and their lawyer refers them to either another pain physician or an orthopedic surgeon who starts giving them injections purportedly under a lien while I am the one prescribing them pain medications. What do you do with those patients in this scenario?

 

[nvrsumr]

In many states damages are calculated off your charges not what you are paid. After settlement the insurance company is repaid what they paid you.

If you want to “play ball” the attorney may pay you for depositions and future needs reports on the patient

Some attorneys prefer to have you take a lien so financial incentives are perfectly aligned

 

[Ferrismonk]

So I recently have a few patients coming to me who have been involved with motor vehicle accidents. They want to use their insurance to see me instead of going through personal injury. What are the pros and cons of seeing personal injury patients through their insurance? I am assuming their insurance makes a difference, with the lower reimbursing the insurance, the less likely you are to see them under their insurance rather than taking a lien. I am assuming lawyers would prefer patients to use their insurance whenever possible, as the patient's insurance will cover the visit and treatments without a lien's being involved. Do insurances have disclaimers that say they will not cover treatment for injuries sustained from auto accidents, work-related incidents, etc.?

I have also had patients who I have been treating for chronic pain with opiates under their insurance, but they get into a motor vehicle accident, and their lawyer refers them to either another pain physician or an orthopedic surgeon who starts giving them injections purportedly under a lien while I am the one prescribing them pain medications. What do you do with those patients in this scenario?

Sorry I can't be more help for your broader questions, but I have a strict policy that if I give opiates, all interventional treatment must also be through my office.

 

[painfree23]

Sorry I can't be more help for your broader questions, but I have a strict policy that if I give opiates, all interventional treatment must also be through my office.

I get what ur trying to do , but How do u explain that to patients when they ask why?

 

[NJPAIN]

I get what ur trying to do , but How do u explain that to patients when they ask why?

Honesty is the best policy. Patients will understand that but they will see right through a BS story. Writing opioids - significant liability with little reward. If there is something to balance that out then it is reasonable for you to expect that to come to you.

 

[SommeRiver]

Around 6 months ago (covid-19 screwed up my timeline) I had a pt tell me she wanted to go ahead get the referral for a "neck surgery."

"You don't have a surgical neck."

"Well my lawyer says I need to spend over 100k by end of May."

....I made up the 100k number bc I can't remember what the number was, but it was 6 figures....

"Were you supposed to tell me that?"

 

[Ferrismonk]

I get what ur trying to do , but How do u explain that to patients when they ask why?

For safety, I feel it is very important that patients have one person in charge of their pain care. I use a multimodal approach to pain management and cannot do so effectively or safely if you are going elsewhere for pain management as well. It seems that I also can provide all the pain treatment the doctor your lawyer is recommending. Of course, you are free to see whomever you wish. If you prefer to transfer your care to the doctor your lawyer recommends, that is fine and we'll just discontinue treatment at this office. Your choice.