design-care-plan-and-cadence

name

design-care-plan-and-cadence

description

Build a defensible, phased chiropractic care plan: an acute/corrective/supportive phase structure with a visit cadence, re-exam checkpoints that re-justify continued care, functional goals, and a plan-completion target — with the insurance-vs-cash boundary drawn so covered active care and cash maintenance care don't blur. Reach for it when structuring a new patient's care. Used by `chiropractic-practice-lead` (primary).

Skill: design-care-plan-and-cadence

Invoked by: chiropractic-practice-lead (primary). Coordinate the necessity documentation with chiro-billing-compliance-specialist.

When to invoke: structuring care for a new patient or re-planning after a re-exam.

Output: a phased care plan (cadence + re-exam checkpoints + functional goals + completion target) with the covered/cash boundary drawn.

Procedure

1. Anchor to the exam and the functional deficit. The plan follows what the exam found — the region(s), the functional limitation, and a measurable goal (ROM, pain-interference, a functional task). No exam finding, no plan phase. Never build the plan to hit a visit target.
2. Phase the plan. Typical structure: an acute/relief phase (higher frequency, symptom control), a corrective/rehabilitative phase (re-establish function), and — only if clinically indicated and moved to cash — a supportive/wellness phase. Set a cadence per phase.
3. Place a re-exam checkpoint at each phase boundary. A re-exam re-justifies continued care with fresh PART/functional findings and either advances the phase, changes the plan, or discharges. This is what keeps active care defensible.
4. Draw the covered/cash line explicitly. Active, improving, medically-necessary care may be covered; once function plateaus, continued care is supportive/maintenance → cash or wellness plan. Flag the expected transition point in the plan and coordinate the ABN with the billing specialist.
5. Set a plan-completion target and a re-book rule. Define what "completed" means (goals met / discharge) and re-book the next visit before the patient leaves — an open re-book is a dropped plan.
6. Write it for the patient and the record. The patient gets the cadence + why; the record gets the goals + checkpoints that make the plan auditable.

Worked example

New patient, acute low-back pain, functional deficit lifting/sitting.

• Goal → restore pain-free sitting >30min and lifting ADLs in 8-10 weeks.
• Acute phase → 3x/wk × 2wk (relief) → re-exam. Corrective → 2x/wk × 3wk → 1x/wk × 3wk → re-exam.
• Checkpoint at each boundary; if plateaued at wk 8 → discharge or transition to cash supportive care with ABN.
• Completion target = goals met + discharge; re-book every visit.

Guardrails

• The plan follows the exam, never a revenue target — over-recommending care is the fast path to a board complaint and a payer audit.
• A phase with no re-exam checkpoint is not defensible — continued active care needs fresh documented necessity.
• Name the covered→cash transition up front so maintenance care isn't billed as active.