This article was written by RateFast founder and CEO Dr. John Alchemy, MD, QME
In the world of occupational medicine, there is a concept known as Maximal Medical Improvement (MMI). This refers to the point at which a patient’s condition recovery has reached its peak and is unlikely to improve any further. It is an important milestone in the treatment process, as it signifies that all available medical interventions have been exhausted and the patient’s condition has stabilized. Upon reaching MMI, the primary treating doctor will need to order the RateFast PR-4 report to summarize the injury for settlement purposes.
Arriving at MMI
Reaching MMI can be a challenging and sometimes frustrating process for both doctors and patients. Doctors naturally want their patients to get better and may struggle with the idea of telling them that there is nothing else they can do. Patients, on the other hand, may become frustrated that they have not fully recovered and may direct their frustration towards insurance denials, perceived lack of effort from their doctor, or indifference from their employer.
To help navigate the complexities of MMI determination, RateFast Express has developed the “RateFast Rule of Six.” This rule states that MMI can be determined based on several factors (all including the number “6”), including six months of conservative care without improvement, six months since the date of injury without a recommendation for surgery, or six to twelve months after surgery.
Using this rule, doctors can focus their treatment plans and communicate clear steps to their patients and insurance carriers. By breaking down multi-body part injuries and addressing each part independently using the RateFast Rule of 6, doctors can determine when each body part has reached MMI and can be removed from active treatment. This approach helps to streamline the treatment process and ensure that patients receive the appropriate care for each specific injury. Adoption of this method also means standardization of care across multi-provider practices.
Making stakeholders aware
Preparing patients and carriers for MMI is also an important step in the process. Doctors should take the opportunity at each visit to discuss the progress towards MMI and what steps are needed to reach that point. Patients need to understand that in California temporary disability payments will stop once MMI is reached and that permanent work limitations may or may not be accommodated by their employer. It is important to have a discussion with the patient about alternative work options and to start preparing them for what their work function limitations will be. Encouraging patients to have a discussion with their employer at this point in time is valuable for all stakeholders to begin long term planning.
Additionally, patients should be prepared for what future care will include. This may involve ongoing medication management, therapy for flare-ups, or even the possibility of future additional imaging and/or surgery. By explaining the PR4 Report, which is a summary of the claim and a first step towards settlement, doctors can help patients understand the long-term implications of their condition and what future care may be necessary.
Conclusion
Remember, reaching MMI is an important milestone in the treatment process, but it can also be a challenging and sometimes frustrating journey. By using the RateFast Rule of Six, doctors can streamline the treatment process and communicate clear steps to their patients and insurance carriers. By preparing patients for what to expect at MMI and beyond, doctors can ensure that their patients have a clear understanding of their condition and a positive shared experience in closing the claim.