Maximizing Medical Record Reviews for Long-Term Care Risk/Legal Committee

1. Getting the Most Out of Your Medical Record Reviews Presented to Long-Term Care Risk/Legal Committee Meeting January 30, 2009 Presented by Jean Bourgeois President, Excelas, LLC

2. Overview – Medical Record Reviews • Claim • Lawsuit • Trial Excelas Introduction – Long-Term Care Risk/Legal Committee Meeting

3. Excelas Background • Specialized medical litigation support for insurers, health care organizations, defense firms and medical corporations to organize, interpret and report on complex health information • Devoted to the defense of long term care and medical malpractice claims and litigation • Focused on the development and presentation of technology to increase efficiency and assure access to critical information Excelas Introduction – Long-Term Care Risk/Legal Committee Meeting

4. Excelas Staff • Registered Nurses • Physicians • Physician Assistants • Allied Health Professionals • Registered Health Information Managers • Attorneys* • Paralegals* Excelas Introduction – Long-Term Care Risk/Legal Committee Meeting

5. Products & Services • Record organization and certification • Document indexing, scanning and Bates numbering • Case summary and medical analysis • Detailed medical chronology • Chronology by topic and/or provider • Provider of care report • Zaxas technology Excelas Introduction – Long-Term Care Risk/Legal Committee Meeting

6. Excelas Experience - 2008 • Reviewed 276 cases – 326,000 pages of records • 139 claims • 132 lawsuits Excelas Introduction – Long-Term Care Risk/Legal Committee Meeting

7. Excelas Experience - 2008 • Review findings – lawsuits • Documentation issues – 69% • Patient non-compliance – 60% • Skin integrity – 58% • Nutrition – 45% • Falls – 36% • Behavior / Psych – 31% • Pain Management – 26% • Infections – 17% Excelas Introduction – Long-Term Care Risk/Legal Committee Meeting

8. Claims Managementand Early Risk Assessment Excelas Introduction – Long-Term Care Risk/Legal Committee Meeting

9. Claims Management Early Risk Assessment Goals • Accelerate the claims handling process • Streamline case review process • Establish early collection of information • Reduce processing times • Increase consistency of reviews • Improve quality of information for decision making Excelas Introduction – Long-Term Care Risk/Legal Committee Meeting

10. Record Organization • Organization of records in a standardized format, chronological order • Certification that records are complete • Record certification checklist • Follow-up on missing documents • Preparation of an index for facility, episode of care and document type Excelas Introduction – Long-Term Care Risk/Legal Committee Meeting

11. Case Summary • Early Risk Assessment: Narrative review of medical information: • Claimant personal and demographic information • Facility information • Allegations • Medical record analysis (case overview) • Summary of pertinent issues – focused on allegations • Further investigation • Conclusion * Excelas Introduction – Long-Term Care Risk/Legal Committee Meeting

13. Zaxas by ExcelasTechnology • Scan records so images can be identified and viewed by document type • Present images in a standard format for use in presentations / exhibits • Link documents and images using the Bates reference • Display documents and record images concurrently • Web enabled capabilities Excelas Introduction – Long-Term Care Risk/Legal Committee Meeting

14. E • View • ” Excelas Introduction – Faith-Affiliated Insurance Program

15. Early Risk Assessment / Claims Management • Accelerate the claims handling process • Reduce processing times • Improve quality and consistency of reviews • Result: • Reduced claims handling costs • Reduced settlement values • Increased number of denied claims • Increased efficiency / paperless process • ” Excelas Introduction – Long-Term Care Risk/Legal Committee Meeting

16. A Long Term Care “Mass Tort Equivalent” Excelas Introduction – Long-Term Care Risk/Legal Committee Meeting

17. E If you suspect your loved one may have suffered at the hands of this nursing home . . . CONTACT OUR NURSING HOME ABUSE LAWYERS RIGHT AWAY 1-800-1WE-SUEU • View • ” Excelas Introduction – Long-Term Care Risk/Legal Committee Meeting

18. Allegations • Injuries and harm, including but not limited to: • Pain and suffering • Mental anguish • Humiliation • Pressure • Falls • Ulcers • Dehydration • Malnutrition • Infections • Poor hygiene • Sepsis • Death Excelas Introduction – Long-Term Care Risk/Legal Committee Meeting

19. Allegations (cont.) • Failure to assess, evaluate and supervise nursing personnel • Failure to inform family of: • Staffing problems • Survey deficiencies • History of poor inadequate care • Inability to meet basic life care needs • Falsely represented benefits of services • Knowingly took advantage of a person unable to protect themselves Excelas Introduction – Long-Term Care Risk/Legal Committee Meeting

20. Allegations (cont.) • Failure to maintain medical records • Failure to adopt adequate guidelines, policies, and procedures for responding to complaints • Failure to increase the number of nursing personnel • Failure to transfer in a timely manner • Etc. Excelas Introduction – Long-Term Care Risk/Legal Committee Meeting

21. Medical Information Management Strategy • 30 cases – 100+ years of records • Organized, certified, indexed, scanned and Bates numbered records • Provided organized records to defense counsel • Case summaries to assess case severity • Detailed chronologies of higher risk cases Excelas Introduction – Long-Term Care Risk/Legal Committee Meeting

22. Medical Chronology • Detailed review of all pertinent information found in records • Presented in chronological order • Date of event • Provider of record • Provider of care • Record type being reviewed • Notes / comments • Bates page reference Excelas Introduction – Long-Term Care Risk/Legal Committee Meeting

24. Provider of Care Report • Provides a link to all entries made by an individual provider of care • Available for all providers - or for an individual provider of care • Sorted by: • Date • Document type • Bates number Excelas Introduction – Long-Term Care Risk/Legal Committee Meeting

26. The Result • Gathered all records and verified they were complete • Provided organized records to experts • Streamlined summarization of medical history to support or refute each allegation • Triaged cases with greatest risk potential • Prepared detailed chronologies of higher risk cases for defense counsel • Expedited preparation for settlement Excelas Introduction – Long-Term Care Risk/Legal Committee Meeting

27. The Trial Excelas Introduction – Long-Term Care Risk/Legal Committee Meeting

28. The Plaintiff • Osteoarthritis • Insulin-dependent diabetes • Coronary artery disease • Hypertension • Depression • Skin cancer • Seizure disorder • Rheumatoid arthritis • Spinal stenosis • Cervical spondylosis Excelas Introduction – Long-Term Care Risk/Legal Committee Meeting

29. Chronology by Topic • Subset of information captured in the medical chronology • Focusing on particular areas of interest • Presented in chronological order • Date • Record type • Notes • Provider of record / provider of care • Bates page reference Excelas Introduction – Long-Term Care Risk/Legal Committee Meeting

30. Chronology by Topic (cont.) • Sample Topics: • Behavior / Psych • Compliance – Patient / Resident • Falls • Family involvement • Inconsistencies • Medications / Pain management • Nutrition • Skin integrity / wound care and prevention Excelas Introduction – Long-Term Care Risk/Legal Committee Meeting

32. Events during Trial • Fall Prevention • Falls & Safety • Ambulation and Walker Use • Activities of Daily Living • Weight Loss • Nutrition – Meal intake • Love of Life • Behavior Information - Expressed wish to die • Pain Control • Pain Management • ” Excelas Introduction – Long-Term Care Risk/Legal Committee Meeting

33. Client Benefits • Support defense counsel with specialized, timely and efficient preparation • Organized / accessible medical records • Early risk assessment • Neutral, objective and high quality reports • Standardized approach to medical analysis • Leading edge technology (at no cost) • Services when / only when needed • Reduced claim and litigation costs Excelas Introduction – Long-Term Care Risk/Legal Committee Meeting

34. Getting the Most Out of Your Medical Record Reviews Presented to Long-Term Care Risk/Legal Committee Meeting January 30, 2009 Presented by Jean Bourgeois President, Excelas, LLC