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Do it like a lawyer.

By Beryl Vaughan

Complementary: “serving to fill out or complete” as in “their economies are more complementary than competitive.” Merriam-Webster

Med-legal practice isn’t psychotherapy and shouldn’t act like it.

Would you rather do business with someone who makes your life harder, or easier?  In fact, it’s harder for a lawyer to do business with you when your top-to-bottom enterprise runs like a clinical practice, right down to parsing time in 45-minute blocks of time.  Lawyers print their Tax ID # on an invoice, not the ICD code health insurers need.  Returning calls at the end of the day? That’s the habit of a doctor who sees patients in a managed group practice.  Attorneys expect you to call back promptly or, better yet, take the call even if it’s inconvenient.  There are a million little things that set you apart from that expert. The one who breathes air so rarified that mere mortals are a blur beneath.

So, again, would you rather do business with someone who makes your life harder, or easier?  Conducting business like a lawyer is so unusual among forensic experts that it gives you a competitive edge.

How attorneys work and how you can adapt.

Attorneys balance legal services and profit just like any business. In my experience, attorneys run a firm with greater efficiency and profitability than doctors.  Taking a page from the attorney’s book might teach you a more cost-effective approach to your own work.  So, how do lawyers do it? I’m going to show you with these examples: time management and case-flow, document management and billing.

Keeping clinical notes taught you to be thorough.  Your med-legal documentation should reflect the attorney’s own standards.

My guide to best practices. What’s in your file? What’s in your attorney-client’s file?

  • Signed retention contract.

  • Detailed invoices.

  • Everything dated, including the year: yellow pad tear sheets, phone messages (use carbonless duplicates), date-received stamps!

  • Every communication self-explanatory or explanation attached.

  • Pleadings and records indexed. (See below)

  • Emails confirm conversations: “as we discussed by phone earlier today….” “To be sure we’re on the same page, it’s my understanding…,” etc.); signature blocks or handwritten notes identify the author (you or otherwise.)

  • Events and conversations are recorded in a memo with orienting language. This includes staff exchanges if they’ve had a conversation or email you didn’t. Especially relevant to psychiatry and psychology: staff might experience a call from an examinee that is unexpected, odd or disturbed/disturbing.  They should take note–literally.

  • Attorney communication advising you to stop work, and case resolution, dated and time-stamped, because it will impact case-management and billing.

Being complementary has practice-wide impact.

A tale of an obvious fail, and a simple solution.

Law and medicine, a billing disconnect. A micro-view to demonstrate that even the tiniest irritant impacts the success of your practice.

Attorneys gauge their charges in 1/10ths of an hour (6-minute increments.)*  Clinical psychiatrists and psychologists record time based on complicated and inconsistent requirements by Medicare, private insurance, Worker’s Comp. and private full pay, including some mandated by law or contract. I’ve found increments of 15-minutes, 8-minutes, 39-minutes, 5 minutes, and rates CPT linked. If you use any of these in billing your forensic work it will be a hassle for your attorney-client.

Here’s why: logically, attorneys routinely tabulate case costs. For a fraction of a second, he or she has to factor in your charges that aren’t tenths of an hour, resulting in a mental pause.  A few minutes difference isn’t the relevant problem. It’s the mental pause that creates a negative “opportunity” to (1) give the vague impression you are charging more than you should (even if it was less,) and (2) generate a small hassle.

Note the ever-so-whispered sigh of discontent coming from your attorney-client’s direction.

A better scenario

The attorney asks you to bill your time in 6-minute increments, which you are happy to do.  Now you’re no longer a hassle. You’re an accommodator.  Better still, shift your billing methods now to 10ths of an hour, (if you haven’t already.)  Your practice is moving from the hassle column to the helpful column.

Helpfulness is an asset with financial impact

Don’t underestimate the value of helpfulness as a business asset. I’ve put it to the test and it impacts return business, collections, goodwill and the, more ephemeral, business personality you present your client. Being complementary, a customer service model, accommodating your clients, are all helpfulness.

I can’t say strongly enough: your expert opinions cannot be “helpful.”  They are objective, perhaps not helpful at all. Business methods are a different element of your practice.

Takeaway

Solutions result from a close look at your practice’s efficiency, a cost-benefit analysis, including support staff and outsourced services. The goal is to automate a customer service ethos into those business practices. Added up, those elements of your practice that can support your client, should.  Sometimes the attorney’s methods are more cumbersome or expensive for you, or simply inapplicable. Take a closer look for alternatives. This is systems-analysis at its best. The best analyst knows your forensic practice, and that of your attorney-clients, inside and out. I enjoy putting the two together and coming up with something better than I found it–which is why it’s so important to maximize what’s already part of your overhead for a better cost-benefit.

 

*Bell v. Prefix, 784 F.Supp.2d 778 (2011) Court Order “… the likelihood of over-billing (for purposes of determining a reasonable attorney fee in FMLA cases) is quite high when an attorney such as Attorney Supanich bills in .25 hour segments.”  [BV: I don’t claim to know if this was overruled or inconsistent with other case law. What’s important is the Court found .25 hour segments leave room for concern.]

Document management is an acquired skill in law.  Done right, it can save hours, even decades (cumulatively).

Eliminating the hassle factor alone is good for your mental health.

You can learn how to manage the piles of documents attorneys send for your review with the same efficiency as the law firm.  Case paperwork is so cumbersome for attorneys that organization methods are embedded into the brain of every administrative assistant, paralegal, junior associate and partner.

Keep an index much like the Court Clerk’s docket (not a Court docket, which is a calendar.)

Documents and the index are a chronological list of the documents you are given, usually by numbered tab or Bates Stamp (in use since 1891.) Adobe Acrobat and Word can both help. Note: chronological refers to the document’s date. It is a history of the evolution of information. E.g. an older hospital record precedes the discharge order.

The index includes, at a minimum

  • the corresponding tab number,
  • description of the document, and
  • effective date of the document.

The whole shebang is assembled sequentially.

Popular choices are redwells (expanding file bucket,) two hole punched on prongs (trickier to pull out a page later), and binders.

However you do it, the goal is to quickly and accurately put your finger on what you need. As a result, it will be to easier to produce a report and prepare for testimony.

Attorneys need this level of organization in their own practice. The attorney has to manage documents for a team of attorneys, a variety of expert witnesses, discovery requests and, ultimately, trial.  There are legal consequences as well.

Keeping clinical notes taught you to be thorough.  Your med-legal documentation should reflect the attorney’s own standards.

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