Practice Development for Expert Witnesses
Beryl Vaughan, Consultant
Nationwide

Email go@forensicexpertpro.com or Call (415) 302-9589

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

Doctors who do things doctorly and lawyers who do things lawyerly might not be able to hear what one another is saying with accuracy or ease.

Avoidable Hassle. Whenever effort is needed to interpret what someone else is doing–at the level of common everyday practices–there is room for hassle that is avoidable.

Conducting business like a lawyer is so unusual among forensic experts that lawyers remember, and return to Experts that “get it.”

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.

You can adapt

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 examples about first calls, time management, 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.

Things you can do right off the bat

Managing Calls

Returning calls at the end of the day? That’s the habit of a provider who sees patients in a clinical practice. 

Attorneys, on the other hand might expect you to act like other business people and take the call, or call back promptly.

Solution: Train a staff member with a script that explains A. when you see patients, and B. precisely the absolute earliest you can return the call. Promise. Keep the promise!

Invoicing

Lawyers don’t care how you bill insurance providers. Get your billing department on track for this very different type of work: as a forensic consultant/Expert.

Get and print a Tax ID # on an invoice. You may be asked for an IRS Form W9 by the attorney because the attorney will need to report to the IRS payments to you. The form asks for either a TAX ID or a SSN. Don’t ever provide your SSN. Get a Tax ID, available on the IRS.gov website easily.

Ensure no ICD or diagnostic code is included (what health insurers need.) In fact, there might even be HIPAA issues there. 

 

MANAGING DOCUMENTS: THE LAWYER WAY

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.

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.]
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