Getting the Most Out of Your Medical Record

Getting the Most Out of Your Medical Record Reviews Presented to Long-Term Care Risk/Legal Committee Meeting January 30, 2009 Presented by Jean Bourgeois President, Excelas, LLC

Overview – Medical Record Reviews • Claim • Lawsuit • Trial Excelas Introduction – Long-Term Care Risk/Legal Committee Meeting

Excelas Background • Specialized medical litigation support for insurers, health care organizations, defense firms and medical corporations to organize, interpret and report on complex health information • Devoted to the defense of long term care and medical malpractice claims and litigation • Focused on the development and presentation of technology to increase efficiency and assure access to critical information Excelas Introduction – Long-Term Care Risk/Legal Committee Meeting

Excelas Staff • • Registered Nurses Physician Assistants Allied Health Professionals Registered Health Information Managers Attorneys* Paralegals* Excelas Introduction – Long-Term Care Risk/Legal Committee Meeting

Products & Services • Record organization and certification • Document indexing, scanning and Bates numbering • Case summary and medical analysis • Detailed medical chronology • Chronology by topic and/or provider • Provider of care report • Zaxas technology Excelas Introduction – Long-Term Care Risk/Legal Committee Meeting

Excelas Experience - 2008 • Reviewed 276 cases – 326, 000 pages of records • 139 claims • 132 lawsuits Excelas Introduction – Long-Term Care Risk/Legal Committee Meeting

Excelas Experience - 2008 • Review findings – lawsuits • • Documentation issues – 69% Patient non-compliance – 60% Skin integrity – 58% Nutrition – 45% Falls – 36% Behavior / Psych – 31% Pain Management – 26% Infections – 17% Excelas Introduction – Long-Term Care Risk/Legal Committee Meeting

Claims Management and Early Risk Assessment Excelas Introduction – Long-Term Care Risk/Legal Committee Meeting

Claims Management Early Risk Assessment Goals • Accelerate the claims handling process • • • Streamline case review process Establish early collection of information Reduce processing times Increase consistency of reviews Improve quality of information for decision making Excelas Introduction – Long-Term Care Risk/Legal Committee Meeting

Record Organization • Organization of records in a standardized format, chronological order • Certification that records are complete • Record certification checklist • Follow-up on missing documents • Preparation of an index for facility, episode of care and document type Excelas Introduction – Long-Term Care Risk/Legal Committee Meeting

Case Summary • Early Risk Assessment: Narrative review of medical information: • Claimant personal and demographic information • Facility information • Allegations • Medical record analysis (case overview) • Summary of pertinent issues – focused on allegations • Further investigation • Conclusion * Excelas Introduction – Long-Term Care Risk/Legal Committee Meeting

Zaxas by Excelas. Technology • Scan records so images can be identified and viewed by document type • Present images in a standard format for use in presentations / exhibits • Link documents and images using the Bates reference • Display documents and record images concurrently • Web enabled capabilities Excelas Introduction – Long-Term Care Risk/Legal Committee Meeting

E • View • ” Excelas Introduction – Faith-Affiliated Insurance Program

Early Risk Assessment / Claims Management • Accelerate the claims handling process • Reduce processing times • Improve quality and consistency of reviews • Result: • • Reduced claims handling costs Reduced settlement values Increased number of denied claims Increased efficiency / paperless process Excelas Introduction – Long-Term Care Risk/Legal Committee Meeting

A Long Term Care “Mass Tort Equivalent” Excelas Introduction – Long-Term Care Risk/Legal Committee Meeting

E • View • ” If you suspect your loved one may have suffered at the hands of this nursing home. . . CONTACT OUR NURSING HOME ABUSE LAWYERS RIGHT AWAY 1 -800 -1 WE-SUEU Excelas Introduction – Long-Term Care Risk/Legal Committee Meeting

Allegations • Injuries and harm, including but not limited to: – – – Pain and suffering Mental anguish Humiliation Pressure Falls Ulcers Dehydration Malnutrition Infections Poor hygiene Sepsis Death Excelas Introduction – Long-Term Care Risk/Legal Committee Meeting

Allegations (cont. ) • Failure to assess, evaluate and supervise nursing personnel • Failure to inform family of: – Staffing problems – Survey deficiencies – History of poor inadequate care – Inability to meet basic life care needs • Falsely represented benefits of services • Knowingly took advantage of a person unable to protect themselves Excelas Introduction – Long-Term Care Risk/Legal Committee Meeting

Allegations (cont. ) • Failure to maintain medical records • Failure to adopt adequate guidelines, policies, and procedures for responding to complaints • Failure to increase the number of nursing personnel • Failure to transfer in a timely manner • Etc. Excelas Introduction – Long-Term Care Risk/Legal Committee Meeting

Medical Information Management Strategy • 30 cases – 100+ years of records • Organized, certified, indexed, scanned and Bates numbered records • Provided organized records to defense counsel • Case summaries to assess case severity • Detailed chronologies of higher risk cases Excelas Introduction – Long-Term Care Risk/Legal Committee Meeting

Medical Chronology • Detailed review of all pertinent information found in records • Presented in chronological order • • • Date of event Provider of record Provider of care Record type being reviewed Notes / comments Bates page reference Excelas Introduction – Long-Term Care Risk/Legal Committee Meeting

Provider of Care Report • Provides a link to all entries made by an individual provider of care • Available for all providers - or for an individual provider of care • Sorted by: • Date • Document type • Bates number Excelas Introduction – Long-Term Care Risk/Legal Committee Meeting

The Result • Gathered all records and verified they were complete • Provided organized records to experts • Streamlined summarization of medical history to support or refute each allegation • Triaged cases with greatest risk potential • Prepared detailed chronologies of higher risk cases for defense counsel • Expedited preparation for settlement Excelas Introduction – Long-Term Care Risk/Legal Committee Meeting

The Trial Excelas Introduction – Long-Term Care Risk/Legal Committee Meeting

The Plaintiff • Osteoarthritis • Insulin-dependent diabetes • Coronary artery disease • Hypertension • Depression • Skin cancer • Seizure disorder • Rheumatoid arthritis • Spinal stenosis • Cervical spondylosis Excelas Introduction – Long-Term Care Risk/Legal Committee Meeting

Chronology by Topic • Subset of information captured in the medical chronology • Focusing on particular areas of interest • Presented in chronological order • • • Date Record type Notes Provider of record / provider of care Bates page reference Excelas Introduction – Long-Term Care Risk/Legal Committee Meeting

Chronology by Topic (cont. ) • Sample Topics: • • Behavior / Psych Compliance – Patient / Resident Falls Family involvement Inconsistencies Medications / Pain management Nutrition Skin integrity / wound care and prevention Excelas Introduction – Long-Term Care Risk/Legal Committee Meeting

Events during Trial • Fall Prevention • Falls & Safety • Ambulation and Walker Use • Activities of Daily Living • Weight Loss • Nutrition – Meal intake • Love of Life • Behavior Information - Expressed wish to die • Pain Control • Pain Management Excelas Introduction – Long-Term Care Risk/Legal Committee Meeting

Client Benefits • Support defense counsel with specialized, timely and efficient preparation • Organized / accessible medical records • Early risk assessment • Neutral, objective and high quality reports • Standardized approach to medical analysis • Leading edge technology (at no cost) • Services when / only when needed • Reduced claim and litigation costs Excelas Introduction – Long-Term Care Risk/Legal Committee Meeting

Getting the Most Out of Your Medical Record Reviews Presented to Long-Term Care Risk/Legal Committee Meeting January 30, 2009 Presented by Jean Bourgeois President, Excelas, LLC