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All parties desire the speedy full recovery of any person injured as the result of a traumatic incident and return to all vocational and avocational pursuits. Ideally this maximum medical improvement is accomplished by early, accurate medical diagnosis, performance of appropriate care and medical providers providing regular reporting of progress of applied care before obtaining patient authorization of additional medical care.
Medical Care Governance Controls
Currently, medical care is recommended and performed by medical providers without governance controls. Attorneys serve as legal agents of the injured person but are not doctors and cannot practice medicine and are prohibited from managing the independent medical decisions under Texas Corporate Practice of Medicine statutes and the Texas State Bar Ethics requirements. In normal course of business, health insurance payors provide this oversight of recommended medical care although in the personal injury setting, the third party liability carrier is presented with medical bills for treatment by medical providers AFTER the care has been provided.
Common Outcome of Current Method
Although most medical providers recommend only necessary medical treatment only to the extent and for long as the treatment produces progressive in functionality and decreased symptomology and impairment. Ineffective or inappropriate treatment is expensive and may mean that the injured person ends up responsible for extraordinary medical expenses in excess of any legal settlement.
Self-interested overtreatment by some medical providers inflate medical bills, require excessive medical visits that may jeopardize the injured person's employment and frequently leaves the injured person with massive medical bills and employment in jeopardy.
SHARED RISK MODEL:
Medical providers generally provide medical care to their injured patient under a Letter of Protection issued by their patient agent, the plaintiff attorney, in good faith that the medical bills will be paid from any proceeds from any first and third party insurance. In this model all medical providers have a shared risk of not being paid or having to accept reduction their billed fees if the available settlement fees are insufficient to pay the medical bills from available funds after paying attorney contingency fees and legal expenses. Excessive or inappropriate medical care self-recommended and self-performed by any medical provider will increase the risk for their mutual injured patient and all medical providers.
Governance controls serve the best interests of all personal injury stakeholders sharing a common goal: achieving maximal recovery of the injured person by applying appropriate effective care, avoiding ineffective care, and eliminating fraud and abuse that can occur when a provider receives increased compensation for self-recommended medical treatment without accountability to a third party medical patient advocate for the patient.