The 5 Things You Need to Know About the Future of Personal Injury 1 Trevor Robertson Trevor Robertson DC is President and CEO of the Personal Injury Provider Network Dr Robertson is a graduate of National College of Chiropractic and has maintained a private practice in La Jolla California ID: 1043109
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1. TUESDAY WEBINAR SERIESBrought to you by:The 5 Things You Need to Know About the Future of Personal Injury1
2. Trevor Robertson Trevor Robertson, DC is President and CEO of the Personal Injury Provider Network. Dr. Robertson is a graduate of National College of Chiropractic and has maintained a private practice in La Jolla, California for over 22 years. Dr. Robertson was voted Best Chiropractor in San Diego in 2010/2011 and 2012. PIPN is dedicated to offering a united sustainable solution for managing provider risk and keeping chiropractic on the forefront of personal injury. 2
3. As the largest provider of healthcare to accident victims, we as Chiropractors have a unique opportunity to significantly increase market share while elevating the profile of our profession.3
4. The Personal Injury LandscapeCurrent management of PI cases is inefficient and contributes to over-billing and over utilization of health care resourcesThe landscape is slowly changing, however with legislation in place that effectively limits DC accessA new and different solution is needed; one that willEliminate fee reductions and denialsMaximize provider reimbursementIncrease the volume of PI referralsThe Personal Injury Provider Network (PIPN)4
5. Chiropractic and PI Outcomes5
6. Chiropractic as the Foundation of Effective Treatment“Fraud and Buildup in Auto Injury Insurance Claims,” 2008 Edition Insurance Research Council6
7. Fraud and Build-up: Perception or Reality?7
8. Auto Injury TrendsDespite a continual increase in number of vehicle miles driven nationwide, there has been a steady decrease in the number of accidents and consequently a drop in auto injury insurance claimsHowever, savings have been off set by a steady increase in the average cost per claim“Trends in Auto Injury Claims” Insurance Research Council November 2011What is driving the increase in costs per claim?8
9. Fraud and Buildup in PI2008 report published in Insurance Research Council November 2011, “Trends in Auto Injury Claims”Why the growth in fraud and buildup?9
10. R I S K“the potential that a chosen action or activity (including the choice of inaction) will lead to a loss”10
11. Inefficient system that encourages buildup in an attempt to manage RISK How PI patients are managed today….11
12. In an attempt to manage fraud, legislation has been enacted in several states (FL, NY, NJ)In Florida, insured residents are limited to up to $2,500 in PIP (personal injury protection) benefits in the event of an automobile accident, if they seek care within 14 days.Within 14 days, only an MD, DO, dentist or a physician’s assistant, or certain licensed nurse practitioners may determine the need for emergency medical care (EMC). Once EMC need is determined, the patient will have available up to $10,000 in PIP benefits.If the insured is not diagnosed with an EMC or wants to seek treatment initially with a doctor of chiropractic (DC), he or she would be limited to only $2,500 of the $10,000 in PIP coverage. The Legislative Solution?Makes DCs dependent on medical providers for referralsRemoves DC as primary care providerLimits patient accessLimits reimbursement12
13. How Can We More Effectively Manage Risk? 13
14. Unmet Needs in PI2013 primary market research study among Chiropractors in 48 states.Eliminate fee reductions and denialsMaximize provider reimbursementIncrease the volume of PI referralsReduce the rates of fraud and buildupRaise the profile of chiropractic in PIMINIMIZE RISK14
15. What is PIPN?A multi-disciplinary network of preferred providers who are committed to optimizing PI patient care A collective and transparent solution that offers contracting insurance carriers and their injured patients direct access to qualified, preferred providersAn opportunity to maintain control of PI patients while marginalizing fraudulent providers who cost insurance carriers billions each yearThe Personal Injury Provider Network (PIPN)15
16. What is the Role of PIPN?PIPN works on behalf of our providers to:Establish fair and equitable reimbursement/fee schedules with all major automobile insurance carriersFacilitate timely reimbursement for services providedEnsure its providers continued access and full, clinical control of personal injury patientsMinimize fraud and buildup by marginalizing less ethical providers16
17. The Current ModelPI Provider3rd Party1st PartyInsurance AdjustersPI Patient17
18. The PIPN System3rd Party1st PartyPIPNPI PatientPI ProviderEliminates RISK18
19. WIIFM - What’s in it for me?PIPN is free to join and you can choose to remove yourself from the network at any time, at no costTransparent fee schedules that are fair, equitable and sustainableImproved efficiencies resulting in more timely reimbursementGreater access to PI patientsDecreasing future risk of legislative changes19
20. Benefits of PIPNThere is strength in numbers and we need your support 20
21. Questions?21
22. Contact www.pipn.net provider.relations@pipn.net 1-800- 330- 8314 ex. 70122