The Cost Of Care

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The Cost Of Care.

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First set background

patient / plaintiff

gender
birth date age _____
injury date age _____

costs start / end

costs start age _____ –
costs end
↳ years from now
↳ years from costs-start

legal setting

state
case type
environment

financial methodology

express $ as
compounding
discount at
discount rate below.
↳ the current __ year rate is %

Then enter care plan

item
specify (optional)
base cost $ ⟶ per year
needed
frequency times, every
⟶
to ⟶
growth % ⟶

4. add names and case ID (optional)

adding names enables searching and
sorting cases in the My Files tab

Case Lead Contact

doctor

date of doctor's report

plaintiff

defendant

type of accident

case name

firm address

$ expressed as ... values

totals

future value:
present value:
cplr 50-B value:

reportString

totals by broad category

Name (Growth Rate n/a) Cost

medsAggregatedByCategory

totals by sub-category

Name Growth Rate Cost

medsAggregatedByItem

individual item costs

Name Growth Rate Cost

medsIndivSummary

year-by-year medical costs

aggregateYearByYearCosts

year-by-year CPLR §50-B Cost

cplrYearByYear

Quick Start Guide

First Steps

Welcome! The best way to get to know The Cost of Care is by entering a medical care plan. 1. Create (or load) a case in My Files 2. Input a care plan in Input Data 3. View and analyze results in View Costs

Entering Care-Plan Items (Examples)

In this guide, we'll be working off of a mock care plan (below). All items of care begin now and last through life expectancy, unless noted. Open the "input data" tab and click "enter care plan" section to follow along. You'll see a default item there already, so you'll just need to change the bold settings.

Scenario: entering a basic item Example: Steroid Injections, $200 each, 2x/month

Solution: inputs to note in this scenario are in bold item: Procedures and Treaments > Injection specify: "Steroid" base cost $: 200 needed: on a recurring basis from: your costs-start date to: life expectancy frequency: 2 times, every 1 month grows at: statistical growth rate new item | clone item | delete item

Scenario: quickly enter two similar items Example: X-Ray of Right Knee and Right Wrist, yearly, at a cost of $300 ea.

Solution: clone into two items, changing "specify" item: Diagnostics > X-Ray specify: "Right Knee" base cost $: 300 needed: on a recurring basis from: your costs-start date to: life expectancy frequency: 1 times, every 1 year grows at: statistical growth rate new item | clone item | delete item item: Diagnostics > X-Ray specify: "Right Wrist" base cost $: 300 needed: on a recurring basis from: your costs-start date to: life expectancy frequency: 1 times, every 1 year grows at: statistical growth rate new item | clone item | delete item

Scenario: split a cost between physician's and hospital fees Example: MRI Right Shoulder, 1x/18 months, Physicians Fee: $500 Hospital Fee: $1,000

Solution: clone into two items, changing "grows at" and "costs" item: Diagnostics > MRI specify: "Right Shoulder" base cost $: 500 needed: on a recurring basis from: your costs-start date to: life expectancy frequency: 1 times, every 1 year grows at: physician's-fee rate new item | clone item | delete item item: Diagnostics > specify: "Right Shoulder" base cost $: 1000 needed: on a recurring basis from: your costs-start date to: life expectancy frequency: 1 times, every 1 year grows at: hospital/facility-fee rate new item | clone item | delete item

Scenario: item cost changes over time Example: Psychotherapy, $100/session 2x/week for 6 months, then 1x/week for 18 months.

Solution: clone into two items, changing "from/to" and "frequency" item: Other Medical Professionals (Non-M.D.) > Psychologist specify: "initial" base cost $: 100 needed: on a recurring basis from: your costs-start date to: custom years from now ⟶ 0.5 frequency: 2x times, every 1 week grows at: statistical growth rate new item | clone item | delete item item: Other Medical Professionals (Non-M.D.) > Psychologist specify: "subsequent" base cost $: 100 needed: on a recurring basis from: custom years from now ⟶ 0.5 to: custom years from now ⟶ 2.0 (note, i.e. 18 more months after the initial 6 month period) frequency: 1x times, every 1 week grows at: statistical growth rate new item | clone item | delete item

Scenario: item that occurs one-time-only Example: Spine surgery, 1x, now, $20,000

Solution: change "needed" to "one time only" item: Procedures and Treaments > Surgery specify: "Spine" base cost $: 20000 needed: one time only at: your costs-start date "to" hidden: cost is "one time only" "frequency" hidden: cost is "one time only" grows at: statistical growth rate new item | clone item | delete item

Scenario: item that occurs infrequently Example: knee replacement, $20,000

Solution 1: clone a "one time only" item, incrementing "at" 20 years item: Procedures and Treaments > Surgery specify: "Knee Replacement" base cost $: 20000 needed: one time only at: your costs-start date "to" hidden: cost is "one time only" "frequency" hidden: cost is "one time only" grows at: statistical growth rate new item | *clone item | delete item item: Procedures and Treaments > Surgery specify: "Knee Replacement" base cost $: 20000 needed: one time only at: custom years from now ⟶ 20 "to" hidden: cost is "one time only" "frequency" hidden: cost is "one time only" grows at: statistical growth rate new item | *clone item | delete item (repeat as necessary for 40, 60 years, depending on remaining life expectancy) Solution 2: create a 20-year recurring period item: Procedures and Treaments > Surgery specify: "Knee Replacement" base cost $: 20000 *needed: on a recurring basis from: your costs-start date to: life expectancy frequency: 1 times, every 20 years grows at: statistical growth rate What's the difference betweensolutions? In the 2nd case, the cost is annualized, i.e. spread out so that instead of a spike every 20 years, a portion is paid each year. The law may dictate which is appropriate for your case. In general, there won't be a huge difference in cost between them.

Scenario: many costs under one umbrella Example: Medications as follows: Coumadin, 2x/day $1/ea, Advil, 3x/day at $0.50/ea Zoloft, 1x/day at $3/ea

Solution: create an item for each individual drug item: Medications: Prescription specify: "Coumadin" base cost $: 200 needed: on a recurring basis from: your costs-start date to: life expectancy frequency: 2 times, every 1 month grows at: statistical growth rate new item | clone item | delete item The Cost Of Care will aggreate these in the "view results" section, both as a whole (all drugs), and divided into prescription vs OTC. In case you're not sure whether a drug is prescription or OTC, The Cost Of Care can check for you. (Note: this check is equivalent to a Google search, and should not be considered medical advice.)

Tab-By-Tab

My Files Tab

1. New Case 2. Duplicate Case 3. Load Case 4. File Explorer: Sort 5. File Explorer: Search New Case Click the "new case" button, and then give your case a name, by typing in the "Current File" input at the top of the screen. As soon as you type a name, let's say "Case1", the case will appear in the File Explorer table. If you forget to name a case, the "current file" input at the top of the page will remain red to remind you. Quick Tip: The Cost Of Care auto-saves cases to the cloud and to your computer. Even un-named cases are saved, but harder to find later. Duplicate Case To duplicate a case, it must first be selected, so click the name of a case in the File Explorer. Now click "duplicate." Another case will appears in your case list. Give it a new name. "Duplicate" creates a new case, but pre-fills all the "input data" tab based on the source. This allows you to use cases like templates, saving time on similar plans: you can duplicate a case, and then change only what's different. Duplicating also allows easy A/B comparison: i.e., how would costs differ if you changed ...underlying assumptions? ...items of care? ...the state of trial? Quick Tip: You can even open two web-browser windows side-by-side to compare visually. Load Case In the File Explorer table, click the name of your original case. It will be highlighted, indicating it is selected for action. Click "Load Case" and notice that the file name at the top of the screen changes. File Explorer: Sorting Cases To sort cases by personnel name, date, or filename, simply click the header at the top of a column (e.g., "plaintiff"). Clicking again will sort in reverse order. If you haven't entered in any names in the "input data" tab, those fields will be blank. To try this out, go to the "input data" tab, expand the "names (optional)" section, and enter in some last names for the personnel in your case. Then come back to My Files. The File Explorer table is now populated with the names you entered. File Explorer: Searching Cases Open your web browser's "find" widget by pressing the key combination Windows: ctrl f Mac: cmd f Type the name or keyword you are looking for. This will work best if you have entered names in the "input data" tab, allowing you to search by doctor, attorney, plaintiff, etc.

Input Data Tab

This tab contains all the inputs related to your case. 1. Inputs related to life expectancy, such as birthdate. * 2. The items in your long-term care plan. 3. Legal and financial assumptions that affect costs 4. Names of personnel, for the "report" and "file" tabs. *Addressed in a separate help article, "Example Medical Items / Workflows," above All inputs are required, but can be entered in any order. If you accidentally leave an input blank, it will be colored bright red to warn you that it needs data. For help on what a specific input means, hover your cursor over the the "i" information icon next to the input.

View Costs Tab

This tab gives you multiple ways of viewing costs: 1. The total cost of all care items at the top 2. Year-by-year totals of all items at the bottom 3. Various aggregations by item type in the middle Understanding the aggregations The table "each individual item" corresponds 1-to-1 with the items entered in the "input data" tab. The other aggregations lump together related items. For instance, if you entered in 12 different medications, "each individual item" would show all of them -- but that may not be a useful overview. So, "subtotals by item" type will show the combined cost of all prescription medications on one line, and all non-prescription medications on another, while "Subtotals by category" will combine both kinds of medications together to give you an overview of the broad categories in your plan. Viewing the effect of changes After you've entered in a care plan, it can be useful to leave the "view costs" tab open next to the "input data" tab to see how costs are affected if you change elements of the plan.

Knowledge Base

FAQ

I'm logged in -- why can't I save/load/calculate?

You can browse The Cost Of Care with a free account, but to use calculations or save/load cases, you must be subscribed. You can subscribe individually, or be given access as a member of a subscribed team or organization. To manage your subscription, see the My Account tab at the top right. If you believe your team or organization is subscribed, but you do not have access, please contact your account administrator (see the My Account tab) to request that your email be added to the subscription.

What are some common workflows?

Medical professional creates a care plan using The Cost Of Care ⟶ shares case with legal team ⟶ legal team loads and views costs and analysis Care plan is pre-existing (hard copy) ⟶ assistant enters care plan into The Cost Of Care ⟶ legal team views costs analysis For medical professionals: Create ⟶ Input ⟶ Share For legal or financial professionals: Working from a plan created in The Cost Of Care: Load ⟶ View and Analyze Results Working from a hard-copy care plan: Input plan ⟶ View and Analyze Results

Why am I getting unexpected results?

The most common reason for unexpected results is the humble typo. As with a spreadsheet, the results of The Cost Of Care are only as good as the input it gets. If you enter in a growth rate of 33% instead of 3%, or a "cost begins" date before the date of trial, The Cost Of Care will still give you an answer -- it just won't be a useful answer from a negotiating or forecasting perspective. Whenever possible, The Cost Of Care will attempt to warn about possible input errors by highlighting the input in red. Nevertheless, if you're getting a result you don't expect, please check your inputs one-by-one to make sure that the amounts and time-periods all make sense. Another useful troubleshooting procedure is to duplicate your case (My Files tab > Duplicate Case button) and, in the duplicate, delete your items of care one-by-one, while viewing the View Costs tab. If, after deleting a certain item, the costs normalize, then the error was in that item. If you get down to the last item, and the costs still seem unusual, then the input error must be in the Adjust Assumptions or Life Expectancy sections. Once you've found the input error in the dupliate case, you can go back and change it in the original case, and delete the duplicate case. If you're sure that there are no input errors, please take a screenshot and send it to our tech support. (For more instructions, see User Manual tab > Tech Support > Filing a Bug Report.)

Tech Support

1. Report Bugs 2. Request Features 3. Contact Support

Statistical Sources

Life Expectancy Tables: Discount Rates:

Mathematical Methodology

How Partial-Year Costs are Calculated

1. Every year is first calculated and discounted as though it is a full year. 2. The full-year amount is then multiplied by the fraction of the year where costs are needed. 3. The same procedure applies whether or not there is a discount rate, and no matter when in the year discounting takes place. In a formula [discounted partial year amount] = [discounted full-year amount] x [fraction of year containing costs] In an Example "Today": February 1 2020 Date of Trial: Dec 1 2020 (0.83 years from today) Life Expectancy: Nov 1 2024 (4.75 years from today) Date Years from now Cost Feb 1 2020 0 to 0.83 (pre-trial, no costs) Dec 1 (trial) 0.83 to 1.0 0.17 of year 0 amount Feb 1 2021 1.0 to 2.0 full year 1 amount Feb 1 2022 2.0 to 3.0 full year 2 amount Feb 1 2023 3.0 to 4.0 full year 3 amount Feb 1 2024 4.0 to 4.75 0.75 of year 4 amount Nov 1 (death) 4.75 onward (no costs after death) So, starting now, there will be five years that incur some costs, with the first and last being partial years.

Discounting

Discounting happens mid-year, unless you choose otherwise in the "Adjust Assumptions > Discount At." "Discount At" determines the amount that the discount rate exponent is greater than the growth rate exponent. The range is from 0 (discount at beginning of year) to 1 (discount at end of year), with 0.5 being mid-year (discount at precisely mid-year, not by calendar date). So, with mid-year discounting, the growth rate / discount part of the calculation would look as follows: Year 0 (now): GrowthRate^0 / DiscountRate^0.5 Year 1 (now): GrowthRate^1 / DiscountRate^1.5 Year 2 (now): GrowthRate^2 / DiscountRate^2.5 etc. Choosing "mid-year" offsets the discounting exponent by +0.5.

Calculating Future Values

All growth rates start with an initial value at today's date, and increase every full year thereafter. Example "Now" = Feb 23 2020; growth rates change on this date Feb 23 2020 [annualized base cost] x 1.03^0 * Feb 23 2021 [annualized base cost] x 1.03^1 Feb 23 2022 [annualized base cost] x 1.03^2 Feb 23 2023 [annualized base cost] x 1.03^3 etc. * Anything raised to the 0th power equals 1. That makes sense in this case, since there is no growth yet, thus leaving us with the unaltered, annualized base cost in Year 0. Even if you're using a costs-start date later than "now," growth rates still increase yearly at today's date. Let's look at an example to understand how that works. Our hypothetical item will be needed for two years, but we'll comapre a two-year period that starts now to a two-year period that starts part-way through the year. Item base annualized cost: $1000 Growth rate: 3% Cost across... ...two years, 0.0 to 2.0 ...two years, 0.1 to 2.1 0.0 to 1.0 = $1,000 0.1 to 1.0 = $900 1.0 to 2.0 = $1,030 1.0 to 2.0 = $1,030 2.0+ = n/a 2.0 to 2.1 = $106 Total = $2,030 Total = $2,036 ...two years, 0.2 to 2.2 ...two years, 0.3 to 2.3 0.0 to 1.0 = $800 0.1 to 1.0 = $700 1.0 to 2.0 = $1,030 1.0 to 2.0 = $1,030 2.0 to 2.2 = $212 2.0 to 2.3 = $318 Total = $2,030 Total = $2,048 . . (etc.) . ...two years, 0.9 to 2.9 ...two years, 1.0 to 3.0 0.9 to 1.0 = $100 0.0 to 1.0 = n/a 1.0 to 2.0 = $1,030 1.0 to 2.0 = $1,030 2.0 to 2.9 = $955 2.0 to 3.0 = $1061 Total = $2,085 Total = $2,091 In each case, the cost is needed for a total of 2 years, but as the starting year moves farther into the future, less of the cost is incurred across the first year (at the base cost) and more of the cost in incurred across the beginning of a third year (at a higher cost due to the growth rate having incremented twice). In the example above, the start- and end-dates were set manually for the sake of demonstration. However, you could also see the phenomenon above by changing the costs-start date, which would similarly shift the onset of costs in relation to "now," which is when growth rates increment each year. Tip: You can test the example for yourself by entering in the following care item [Input Data tab > enter care-plan items] while simultaneously viewing year-by-year costs at the bottom of the View Costs tab. If so, you'd enter in the medical item as follows, with the bold fields being those that differ from the defaults: item: Medications: Prescription specify: (not needed in this example) base cost $: 1000 needed: on a recurring basis * from: custom years from now ⟶ 0 * to: ⟶ 2 frequency: 1 times, every 1 month grows at: custom growth rate ⟶ 3.0 * You'll change "from" and "to" by 0.1 increments as the with the example below: e.g. 0 ⟶ 0.1, 2 ⟶ 2.1

When Growth Rates Are Updated

The growth rates for medical services are updated on a yearly schedule. If, in a given case, you do not want growth rates to update yearly, you can set them manually. Any custom growth rate remains fixed at the value you set. Alternatively, The Cost Of Care makes it easy to export a case data as a table, and viewable and saveable in a spreadsheet or a word processor. Exported tables do not update.

Equations and Definitions

Cost = [Fraction of year that costs apply] x [annualized cost of item] x [(growth rate)^(CalcYear) / (discount rate)^(CalcYear + DiscountAt)] Fraction of year that costs apply: term is self-explanatory. Generally applies to initial and final years of care plans. Initial year: costs begin at your chosen costs-start date, which will either be "now" (in which case the first year of costs is a full year) or at a future date, in which case costs will only be incurrred for part of the year. Final year: the end of life expectancy usually does not fall exactly X.0 years after the date of trial, so the final year will usually be a partial year as well. Annualized Cost = [base cost of item] x [frequency item is needed] Future Value = [annualized cost] x (GrowthRate^CalcYear) Present Value = [annualized cost] x (GrowthRate^CalcYear / discountRate^CalcYear) CalcYear: the exponent used for the growth and discount rates. (e.g. the last number in in in $100 x 1.03^0) "Now" is 0, because a cost calculated right now would not have grown yet. A cost occuring 6 months from now would be multiplied by the growth rate raised to 0.5 (i.e., halfway through the year); a cost at nine months from now would be multiplied by the growth rate times 0.75 (i.e. three-quarters of the way through the year); a cost one year from now would be multiplied by the growth rate 1 year from now is 1.0, etc. For growth rates, only non-fractional exponents are are used. I.e., the costs of medical services is at one level now, this year (exponent a.k.a CalcYear 0.0), and will increase by a certain percent next year (xponent a.k.a CalcYear 1.0). Partial years are handled by the modifier "fraction of year that costs apply," also described in this section. The CalcYear (again, the exponent) used in discount rates behave are the same as those used for growth rates except that a constant offset is applied, usually 0.5, to indiciate that the discount happens halfway through the year. See "discount at" in this section. Discount At: determines the amount that the discount rate exponent is greater than the growth rate exponent. The range is from 0 (discount at beginning of year) to 1 (discount at end of year), with 0.5 being mid-year (discount precisely mid-year, not by calendar date).

CPLR 50-B Calculations

How do I migrate from Excel?

The results in Excel and The Cost Of Care are the same, dollar for dollar, provided you supply equivalent inputs. "Equivalent," because: 1. entering the start-date of a cost has changed. 2. The Cost Of Care is date-sensitive by default. We'll deal with each of these differences in turn.

Entering the start-date of a cost

In The Cost Of Care, usually you will not need to enter in the start-date of a cost at all, because, by default, all items of care start at the date of trial you set. But in instances where you need to manually set the start-date of a cost for a future time beyond the date of trial, the following conversion applies: Whatever starting year you would use in Excel, subtract 1 in The Cost Of Care. Why? In Excel, years are counted "1st year of costs, 2nd year, 3rd," so "now" is year 1.0. In The Cost Of Care, time is measured in "years since now," so now is 0.0. Let's look at a couple of examples:

Excel			The Cost of Care
Start	End		Start	End
1	1		0	1
"Cost starts at the beginning of the first year; continues through the end of the 1st year"			"Cost starts 0 years from now; ends 1 year from now"

Another example:

Excel			The Cost of Care
Start	End		Start	End
2.25	4.5		1.25	4.5
"Cost starts 3 months (0.25 years) into the 2nd full year; continues halfway through 4th year"			"Cost starts 1.25 years from now; ends 4.5 years from now."

Date-sensitivity in The Cost Of Care

The Cost Of Care is, by default, sensitive to today's date, today's treasury yields, and other variables. This can lead to results that seem to be slightly different from those obtained in Excel. For instance, imagine you enter in a series of costs, all set to start "today." Additionally, you enter in a plaintiff's Date of Birth, and The Cost Of Care calculates a life expectancy through some future date, which remains fixed. As every day passes, "today" is incrementally closer to the end of life expectancy, so the total duration of costs is shorter. Therefore, you may see a change of a few dollars each day, without having made any actual changes to a care plan. The difference is usually negligible in relation to the total cost of a plan. Similarly, by default the discount rate used for a case is updated daily in response to changing US Treasury yields. If an evolving cost is undersireable, that behavior can easily be overriden. For instance, rather than starting costs "today," you could set a fixed future costs-start date. Or, for a fixed discount rate, you can simply choose "custom rate" rather than "today's rates" in the Adjust Assumptions section.

Other notes on migrating from Excel

The CPLR 50-B "duration" input in the Excel app is equivalent to The Cost Of Care "lives X years from now." In The Cost Of Care, this value can be set automatically, via the default calculation of life expectancy, or overriden manually. The Excel app only accomodates whole-number from/to years; The Cost Of Care allows decimal from/to years.

Example of Equivalence Between Excel and The Cost of Care

An easy way to verify that the results between apps are identical is to enter in the same, single item-of-care in each program. Remember to set custom (fixed) values in The Cost Of Care to mimic Excel, otherwise The Cost Of Care will use today's date, today's treasuries, etc. and the results may be a few dollars off. Here's an example with arbitrary amounts: Excel — base cost: 1000 — from: 1 — to: 26 — growth rate: 0.03 (displays as 3%) — discount rate 0.02 (displays as 2%) — CPLR 50-B duration: 76 The Cost Of Care Life Expectancy section — Custom Lives X Years From Now: 76 Adjust Assumptions section — State: NY* * Or change the state to a non-NY state to view results in terms of present value rather than future value. — Discount Rate: 2.0% Enter Care Plan section — Base Cost: 1000 — From: Custom Years from Now: 0 — To: Custom Years from Now: 26 — Growth Rate: Use Custom: 3.0 Independently from comparing against Excel, entering a single item in The Cost Of Care and changing variables one-by-one while viewing results is a good way to visualize the effect of each variable, and the capabilities of The Cost Of Care.

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