Episode 9: In this episode, KPA’s Kurt Reibling is joined by Trace Kelly, one of Kentucky Pain Associate’s advanced practice registered nurses (APRN), who is also a chiropractor. Trace is a valuable member of the KPA team bringing additional perspectives to the care and treatment of patients being treated for motor vehicle accident related injuries.
Why Have a Chiropractor on Staff at KPA?
Kurt explains that Dr. Jason Lewis, the Medical Director at KPA, has always supervised the nurse practitioners on staff. Nurse practitioners (APRNs) can diagnose, prescribe and order specific patient therapy. They approach the patient from a purely medical perspective.
KPA has routinely seen patients referred to them by chiropractors. Trace Kelly was one of those chiropractors. There are certain treatments, including prescriptions, that chiropractors can’t issue. However, Dr. Lewis and our nurse practitioners are able to do that, as needed.
Trace Kelly has been a chiropractor for over 20 years. He has over 10 years of experience treating automobile accident patients. He later earned his nursing license and his additional education to become an Advanced Practice Registered Nurse. This provides a very unique combination of skills and experience when treating injured patients.
Trace explains that he really enjoys working as part of a team. As part of the KPA team, he’s able to leverage his extensive background in the musculoskeletal area, which he honed as during his 20 years as a chiropractor. Because Kentucky Pain Associates primarily treats auto accident injuries, this knowledge and skill set is proving invaluable. He comments that being chiropractor has made him a better nurse, and being a nurse has made him a better chiropractor.
Does this Present a Conflict for Referring Chiropractors?
Interestingly, it’s actually an advantage. Trace explains that actually, he’s very much an ally for outside chiropractors who are referring patients or considering it. He understands their needs and how they treat patients. He literally speaks their language.
Medical Documentation for a Patient’s Treatment and Injury Claim
A strong advantage KPA offers to both injured patients and attorneys who may be involved in handling the accident injury claims is the in-depth medical notes and narratives KPA provides. Trace is peer-review certified in Kentucky. He has an extreme level of detail, making it much easier for an attorney to build an effective case.
Because he has two medical specialties, the types of treatments he recommends, based on identification of root causes, can ensure a more thorough recovery. Again, he’s viewing the patient from the perspective of a chiropractor and a registered nurse.
Trace functions as a very valuable advocate for his patients, particularly those in under-served population. He ensures they’re benefitting from a more holistic approach to treating the overall situation.
Advantages for the Personal Injury Attorney
Injury claims and cases are strongly dependent upon the medical documentation related to the injuries, including not only the diagnosis but the treatment path as well. As previously stated, Trace Kelly is peer-review certified. He believes this makes him a better provider. He wants the documentation and the evidence-based care he provides to be “solid.” Part of the motivation he had for pursuing this certification is to attempt to improve his profession, as a chiropractor.
Trace explains that many primary care providers refuse to see personal injury patients. They literally turn them away. If they do decide to treat the injured patient, how they document the situation in the medical narratives can inadvertently devastate the injury-victim’s accident and injury claim.
Note: Host Jim Ray is not an attorney. When he discusses receiving “a record that’s this built out with that level of care and consistency, I can rest assured that this is solid…” he’s speaking from the perspective of an attorney who may be receiving medical records from KPA.
Trace points out that these cases are medical-legal hybrids. When you document the case, you need to approach it from this hybrid standpoint. The language is different than what may be found in a normal medical record. Specific language, especially when it’s not present in the record, will have an impact on the value of the claim or case the attorney is building on behalf of the injured individual.
Trace Kelly is Independent Medical Examination Certified
Kentucky Pain Associates also treats individuals who are filing workers’ compensation claims. The Independent Medical Exam (IME) is a critical part of the worker’s comp claim. The medial professional performing the IME will document how the injury has impacted the worker in terms of performing the tasks related to have a normal life. The impairment rating is a vital assessment that can have a direct impact on the workers’ comp benefits an injured worker will receive.
There are 3 types of medical professionals who can perform IMEs:
- Medical Doctors
Court and Trial Experience
Trace has done many depositions and made numerous court appearances. This experience helps him to practice differently and to document more thoroughly, because he understands the importance of the medical records for the patient and his/her attorney.
Treating Patients with Traumatic Brain Injuries
Kurt explains that KPA has been involved in objectively testing for the existence of brain injuries. They’ve also added TBI assessments from neuropsychologists. Surprisingly, traumatic brain injuries (TBIs) are often overlooked in the ER. TBIs don’t typically show up in MRIs or CT scans. He comments that Trace has identified additional ways for KPA to preliminarily test for TBIs.
Trace discusses the positive impact simply screening for brain injuries has had on the community. The missed diagnoses in the ER can leave a patient with long-term complications, including behavioral health conditions (some leading to depression and/or suicide).
The ACE Diagnostic Test (Acute Concussion Evaluation) is supported by the CDC for both adults and children. The MACE 2 (Military Acute Concussion Evaluation) was developed to evaluate mild TBIs (i.e. concussions). Both are used by KPA as primers alerting the medical staff that the patient should be recommended for more extensive TBI testing. That testing can also be performed at the Kentucky Pain Associates offices.
Traumatic Brain Injuries are permanent injuries. Rather than focusing on recovering, the patient is works to learn how to cope with and compensate with the loss of brain activity, related to the injury.
Kurt and Trace stress the need for testing and documentation of TBI injuries. Without treatment, a patient is at a high-risk of developing Parkinson’s or Alzheimer’s in the future. It’s the risk of future impairment that should be noted in the medical records. This can help the attorney to include the need for future medical care as part of the demand letter and during the settlement negotiations. It underscores the need for a thorough medical workup, which KPA strives to provide.
Trace explains the MedTrak testing, provided by KPA, captures the TBI diagnosis much more effectively than a standard clinical examination. It makes it much more likely that the injured patient will receive the appropriate treatment for the brain injury. Again, these “invisible injuries” are often overlooked or misdiagnosed, without the proper testing and evaluation.
Kurt comments that in a whiplash scenario, the head does not actually have to strike the dashboard, windshield or steering wheel to sustain a brain injury. A blow to the head is not necessary. If the vehicle was traveling at 17mph at time of impact, it’s likely a brain injury has been incurred.
Kurt wraps up the episode with the fact that KPA has 3 customers: the chiropractors who refer patients to them, the patient him/herself and the attorney who also either refers the client or is handling the injury claim. He comments that Trace Kelly is an expert in keeping KPAs customers satisfied.
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Remember, work injury or MVA? Think KPA!