Once a PI patient is released with symptoms, or without symptoms, and a prognosis of likely exacerbations with a future medical estimation of $1500 over then next 2 years, how am I supposed to release them from care when they still have ongoing needs?
We have discussed this with several different experts. The consensus is that the patient should not be released from the PI case until BOTH of the following have occurred:
- the ortho/neuro exam is normal or has stabilized AND
- outcome assessments show no significant measurable and functional change after 3 exams over varying times. This one, known as a trial withdrawal of care, is commonly overlooked by chiropractors
If the patient shows no measurable and functional change and they don't worsen without treatment, they should either be released from care or referred out. During the trial withdrawal of care, the patient should be instructed to gradually and carefully increase their activity level to what is was before the injury. It is essential to know if they will be fine without ongoing care. If their situation worsens after not seeing you for a week (or two or three), then you should continue treating, based on their exam findings and outcome assessments.
At some point, though, if they are still having issues, it becomes necessary to stop and say that we tried a withdrawal of care and explain to the PI payer that the patient is unable to go without treatment for more than x days/weeks/months. That becomes the supporting rationale to explain the need for ongoing care and at what cost. When persistent injury symptoms remain, it is an indication that an impairment rating is appropriate.
Documenting their condition as "static" might be a wise thing to do (if applicable, of course), so as to help validate that the patient has not officially returned to pre-injury status or MMI.