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).
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---
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.
