RateFast Podcast Shorts: Future Care

RateFast Founder and CEO Dr. John Alchemy gives a lesson on handling future care for workers’ compensation patients once a workers’ compensation claim has reached MMI (Maximum Medical Improvement).
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Dr. John Alchemy: Hello, my name is Dr. John Alchemy, founder of RateFast and I am here today to talk about a mini podcast on Future Care. Future care is something that gets brought up by many of our clients and today I’m just going to talk a little bit about it to give you some information, maybe a little bit better understanding on what it is and how it’s used. 

So in California in the PR4 Report, Future Care is a section of the form that needs to be filled out. Typically after the injured worker has recovered, their condition has stabilized, they get their PR4 Report, and their PR4 report has several elements within it, you can refer to some of our other podcasts for exactly what those other elements are. But among them is Future Care. Future Care is something that the evaluator and provider lays out, and the goal of the future care is to treat and elevate the symptoms of the industrial injury. 

So if they’re still having pain upon discharge, maybe they have a durable medical equipment need, or they’re going to need to see a specialist, all those things go into the Future Care Outline. So the most common things we see in the outline are going to be medications, office visits, need for physical therapy, if it’s an orthopedic injury, perhaps they’re going to need an injection or maybe they’re going to need a surgery, or a follow-up with a specialist. 

Now one of the common questions I get from the providers is, “Well, I don’t know what to put in Future Care because I really don’t know how they’re going to do.” And that’s just fine. You’re not really asked to create a crystal ball and say exactly what this person is going to need for the rest of their life, but in general you want to put in broad strokes in the statement. You want to have them medically reasonable with medical probability. 

So for instance if you know they’re taking iBuprofen now, you’re going to go ahead and put some medications in there. Or if you know they have a condition that can flare like a bad knee, and if they’re up on it too much it’s going to need some physical therapy, go ahead and put it in. If they’re using an electrical stim unit, you’re going to want to make a comment on durable medical equipment and supplies. Or let’s say they’re not interested in surgery, or were offered surgery but just don’t want to do it right now, that means you’re going to put in that they should have access to the surgeon. 

Another question that comes up is, “Well, what if they need other specialists that I’m not aware of?” Maybe something comes up and they need to see a neurosurgeon, or they need to see a neurologist, and the answer to that is just to put down that comment as “specialist care.” Put in your report that if the patient has continuing flares, or symptoms not responding to the conservative treatment, they should have access to a specialist. That’s really all you need to do, because remember once cases are into Future Care, when they come back to exercise Future Care, they still have to have request for authorization created. It’s still going to have to be approved by utilization review. So this aspect of the claim doesn’t really change, and it’s all going to be on a base by base, case by case situation. So do not stress over thinking that the Future Care has to be overly detailed, that it has to cover every aspect of your imagination – not the case. 

When you do write the Future Care, make it simple, concise, and make it appropriately broad. That has been my comments on Future Care, I hope this has been helpful. 

Again you can come over to our website, rate-fast.com, check on the blog, learn all about California PR4 reports, the elements of them, and you can always reach us with any questions at rate-fast.com. I hope this has been helpful. Thank you.

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