As you proceed with any treatment plan, it essential to continue to evaluate its effectiveness.
About 2 months ago I was evaluating a new patient named Molly, a chocolate Lab, in the client’s home. While taking a history the client mentioned that Molly had prior cold laser treatments in the veterinarian’s office. “We bought a package of twelve treatments”, she explained. “Did they help her?” I asked. “Actually, no” replied the client.
Is a package deal a good deal?
What thoughts go through your head as you read this? How about “wouldn’t there be a smaller package with, say, 3-6 treatments”? Wouldn’t you know after a few, if they were helping or not?
I asked how the veterinarian assessed the effectiveness of laser treatments during the process. And I was told ‘it wasn’t. I asked for more detail.
The client explained that a vet tech administered the treatments. The veterinarian examined Molly after the completion of all twelve sessions. He concluded that there wasn’t any improvement and did not recommend further laser treatment packages. Duh (forgive me).
Concept of medical necessity
In human medicine, the concept of ‘medical necessity’ and proper utilization in care is critical to reimbursement by third-party payers. Pet health insurance continues to play a greater role in influencing providing care. However, the majority of costs comes out of pocket.
Some providers rely on your willingness to spend without thinking and do “whatever my dog needs’. An ethical provider will always make decisions based on the medical need of your dog and not on monetary gain.
Medical evaluation is necessary any time a dog has
- declined in function
- a significant change in their status
- experiences quality of life issues such as with malignancy or major illness
- needs preventive care such as with overuse syndrome after amputation (involving the intact remaining limbs)
- has new rehabilitative potential, such as with post-op CCL tear
The provider then can recommend treatment based on the results of these evaluations. They should re-evaluate effectiveness at regular intervals.
Determining whether the treatment is necessary
First, it should be non-routine a need for a skilled trained provider to reach the maximum level of care. This service should be beyond your ability as a dog owner to do on your own and require specialized skills. In general, the treatment should be at a mid to high level of medical complexity.
A therapist has an obligation to show you as much as you are willing and able to do safely and practically with your dog.
For example, most owners can learn simple range of motion exercises and coach their dog to perform functional exercises. However, spinal manual traction, deep tissue massage, or manual joint mobilization require a professional-level skill.
Is your dog responding to treatment?
Secondly, the dog should be responding well to treatment and improving.
The therapist should set short and long-term goals with the patient achieving them in a timely manner. Back to my client: 12 sessions of the laser without any improvement is an excessive, unreasonable time frame. If there is no improvement within 3-6 visits max, it’s a reason to discontinue the treatment.
There can be a justifiable medical necessity if a patient is not improving, but they would decline without treatment intervention. These treatment types may consist of maintenance or support but are justifiable in terms of medical necessity.
What is maintenance care?
Maintenance care is a treatment that does not yield improvement but prevents future decline.
An example of this could be with severe hip dysplasia or spondylosis of the spine. When a medical condition is progressive and results in a steady decline, treatment interventions are termed as supportive.
Treatment can play a role by
- providing temporary relief or pain
- reducing complications and side effects
- giving comfort and maximizing the dog’s quality of life
Examples of this can be therapy for degenerative myelopathy, metabolic disorders, or metastatic cancers in the late stages.
Finally, medical necessity may be justified for simpler, lower-level care if co-morbidities exist such as
- a dog with Cushing’s Disease has a secondary open wound
- or arthritis affecting multiple body areas
Such treatment may be impractical for the dog owner to provide yet it will improve recovery rates with fewer visits.
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