1. Future Medical Cost Projections
Module 11
Client Assessment, with handout
Hi. Welcome to Module 11 of the InSitu Academy training program for Future Medical Cost Projection. My name is Kathryn and I will be guiding you through the training program.

2. Client Assessment Confirm and verify information Fill in gaps
Overview of current treatment plan
Determine functional ability and limitations
Obtain current prescriptions
List of equipment needs
Module 11 covers the client interview process. In Module 10, we covered the referral intake process, and mentioned having the attorney or their paralegal contact the client to inform them to expect a phone call from you. The purpose of this client interview is multi-fold. Confirming, verifying and updating any current treatment plans, medications and equipment needs you have obtained from the medical records is the primary purpose. In addition you will be determining functional abilities and limitations during your conversation. With Module 11 is a hand-out designed to assist in the client interview assessment. The template has a list of the most encountered items for validation or clarification pertaining to personal injury or worker’s compensation cases. Following the list of items ensures nothing will be forgotten or left out. You can develop your own form or obtain the template from the subscription service with InSitu Academy.
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3. Caution Many clients are medically undertreated No money No insurance
Treatment not authorized by WC carrier
The client interview template is designed to capture most treatments, functional abilities and equipment. As you interview the client it may become apparent that the client may not have continued with recommended treatment or medications due to a lack of money or insurance coverage. Sometimes a worker’s compensation carrier will not authorize a recommended treatment. All reasons may leave the client medically undertreated.
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Who you are
What you do
Why you are asking questions
What you will do with the report
Will you send them a copy
Should they call you back
Making the call
Upon calling the client, introduce yourself and ask if their attorney’s office had contacted them about receiving your call. Explain your role and why you are asking questions. Explain that you will not be sending them a copy of the report directly, but will be sending the report to their attorney’s office and they should contact the attorney with any questions about the report. Inform the client to call you back if they think of anything else that may be beneficial to the report after your call.
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Template
Correlates with worksheet categories
Current status
Functional status
List of current treating physicians
Last diagnostics
Surgery
Therapy
Equipment
Medications
Injections
Spinal cord stimulator
Other
Now let’s take a look at the client interview template. Either print off the hand out or pull it up on your computer for reference. The first section of the template should be completed with the client’s case information. The second section correlates to all the categories that are on the cost projection report worksheet. We will review each of the categories and discuss why each is important and how to ask for the information.
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Current Status
Current pain level 01
Location of pain 02
Other symptomatology 03
General overview of medical condition and treatment plan 04
When asking about the current status of the client we are requesting information about their current medical condition. An assessment of their pain level and location should be done. Ask the client to grade their pain level on a scale of 1-10, with 10 being the most intense. Ask specifics about the location of the pain, such as hip, leg, knee, front, back, etc. Request information regarding any other symptomatology like hearing or sight deficits. Summarize your perception of the medical condition and their treatment plan, then ask for confirmation if correct or not.
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7. Functional Status Physical limitations and restrictions
Ability to perform activities of daily living (ADL)
Able to drive
Work status
Help with house or yard
To understand the functional status of the client, ask if they have physical limitations such as standing, lifting or moving the involved body part. Are they able to perform their daily living activities such as showering, maneuvering to the bathroom or dressing independently. Request information of their work status, are they able work part time or perform a lesser job? Do they drive themselves to Dr’s appointments and the grocery store or are they dependent on family members for assistance. How much are they able to contribute to the up keep of their home with house or yard work?
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Treating Physicians
Names and specialty of all treating physicians
Last appointment
Next appointment
Recommendations
Any physician recommended but not seeing
Note: many clients have been released from active medical care from specialty physicians
From the time of the medical records review until your interview with the client, the number of treating physicians may have changed. It is not uncommon to have been released from active medical care by specialty physicians. Request the names and specialty of all current treating physicians, when their last appointment was and when the next one is scheduled. Ask if any new recommendations for treatment or physicians has been discussed.
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Diagnostics
Last procedures performed
Date
Body part
Any scheduled
Request the dates of all the last diagnostic procedures and examinations performed. This would include any MRI’s, CT’s, x-rays and lab work. Procedures would include biopsies. Have the client explain the body part tested and if there are any diagnostic procedures or examinations scheduled in the future.
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Surgery
Review surgical history
Any planned surgery
Any discussed, or recommended, surgery
Any implanted hardware
The client may have experienced multiple surgical procedures with their injury. Review their surgical history, including the date and type of procedure. Remember to ask if hardware implantation occurred with any of the surgeries. Ask if there are currently any surgeries planned or if there has been discussions or recommendations for future surgeries.
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Therapy
Status of formal therapy program
Type of therapy
Physical
Occupational
cognitive-behavioral
Speech
Massage
Acupuncture
Home exercise
Fitness
aquatherapy
Therapy is a big part of the client’s treatment plan and recovery. Physical and occupational therapy are the most common therapies with an injury, but could include multiple therapies. Discuss the current status of the formal therapy program and include all therapies in the information for the worksheet.
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Equipment and DME
Discuss any and all equipment and supplies
Cane
Braces/splints
Walkers
TNS unit and supplies
Special shoes/orthotics
Hearing aids/glasses
Bedside commode
Raised toilet seat
Hospital bed and mattress
nebulizer
Examples
Equipment and replacement of parts are expensive. The medical records review may have indicated equipment needs on discharge. Verify with the client all equipment and any newly added equipment since discharge. See the examples of the most frequently seen equipment needs on Slide 12. Remember to include replacement part costs for equipment on the worksheet.
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Medications
Spell the names of all drugs
Dosage and frequency
Who prescribed
Pharmacy
OTC meds
Compounded drugs
Other topical medications
Patches
Nebulizer treatments
Inhalers
Any medications prescribed but not filled
Medications may have changed since the medical record review so do not depend on the record as your current source. Ask the client to bring all their medication bottles they are currently taking and place them in front of themselves so they are easily available during the phone interview. Have the client read and spell the name of each medication, their dosage, who prescribed the medication and the pharmacy. Be sure and ask about any over the counter medicines the client may be taking and include on the list of medications. Other types of medications that may be prescribed are compounded drugs, topical medications, patches, nebulizers and inhalers. Remember to ask the client about these medications as well any prescriptions they have not filled.
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Injections
Last injection
Scheduled injections
Type, body part
Review with the client the date of the last injection, where it was injected and the type of injection. Ask if any future injections have been scheduled and the type of injection as it could have changed from the original injection. Remember that there are usually limitations on the amount of injections that can occur.
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15. Spinal Cord Stimulator
Recommended? Or discussed?
Indicated in medical records?
Psychological evaluation, done?
Trial placement, done?
Initial placement, done? When?
Remote?
Programming schedule?
Spinal Cord Stimulators are expensive and require a thorough collection of information if being considered. Review with the client the discussions and recommendations for a SCS. Ask yourself if it was indicated in the medical records. Ask the client if a trial placement has been discussed or completed. If the placement of the device has already occurred, ask when and where and if a programming schedule has been set.
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16. Other Home attendant care Vehicle modifications Home modifications
Other items of care to consider are home attendant care for activities of daily living and modification of the home or vehicle to accommodate the injury. Ask the client if any of these items pertain to them.
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Summary
Goes into narrative report
Language skills important
Use bullet points
Put in as “client states, reports, discusses, etc.”
Factual, non-interpretive statements
Points to remember are that the information from the client interview will go into the narrative report and worksheet. Use bullet points in the narrative report for a cleaner look and language that accurately expresses the information. To maintain the integrity, use words and phrases that include, “client states, reports, discusses”. Remember that statements should be factual without interpretation or opinion.
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Retention
Keep notes and intake form in file
May need to produce for subpoena for production of records
Develop a system for keeping notes and the client interview record in a file. It may be electronic or hard copy but available in case it is needed to produce a subpoena for record production.
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Home Work
Arrange to call a family member or friend to go through an intake interview
Contact local attorney and volunteer to do 1-2 actual client intake interviews
Upon completion of homework assignment, please write a summary or overview and submit to InSitu support team for review. A Certificate of Attendance for CEU credit will be issued after the summary/overview is submitted.
Listed on Slide 19 are activities for follow up and learning. Completing these activities will assist in preparing and developing a comfort level for interviewing clients. First practice with a family member, then contact a local attorney and volunteer to do 1-2 actual client interviews.
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Contact Information
Thank you for joining us to learn how to prepare and conduct a client interview. We hope you have found the information beneficial. Please contact for any questions or assistance.
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