Life Care Planning FAQ
What is life care planning?
According to the American Academy of Physician Life Care Planners, Life care planning is a process of applying methodological analysis to formulate diagnostic conclusions, and opinions regarding physical and/or mental impairment and disability for the purpose of determining care requirements for individuals with permanent or chronic medical conditions, and quantifying these requirements in monetary terms.
What is a life care planner?
A life care planner is an individual who assesses an ill/injured individual’s residual medical conditions, and then formulates a plan of care that is ultimately expressed in monetary terms. Historically, life care planners have consisted of nurses and other rehabilitation professionals. Today, life care plans are routinely authored by physicians, who, unlike non-physicians, possess the independent capacity to diagnose, and independently formulate and defend recommendations for future medical treatment.
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What is a life care plan?
According to the American Academy of Physician Life Care Planners, a life care plan is a comprehensive document that objectively identifies the residual medical conditions and ongoing care requirements of ill/injured individuals, and it quantifies the costs of supplying these individuals with requisite, medically-related goods and services throughout probable durations of care.
Life care plans are expertly formulated medical valuations that objectively identify a subject’s residual medical conditions and future care requirements, and they quantify the costs of those requirements in monetary terms.
The content and structure of a life care plan, and the methods used to produce it, are based upon comprehensive assessments, interviews and/or examinations, research and analysis, and published methodologies and standards of practice.
Life care plans are objective works that provide material evidence regarding the existence, significance and validity of an individual’s medical conditions. They provide litigators, insurance companies, trusts and courts with a qualified, quantitative, and referenceable basis upon which to assess and substantiate the monetary value of an individual’s future medical needs.
What is contained within a life care plan?
At its most basic level, a life care plan is a document that contains a set of facts, a set of opinions, and a set of conclusions.
The facts, or “objective findings” in a life care plan, may consist of medical and/or other relevant records, and/or information obtained during an interview or examination of the subject.
The “opinions” in a life care plan address a subject’s impairments, disabilities, probable duration of care, and future medical requirements.
The conclusions (the “quantitative conclusions”), in a life care plan express the plan’s future medical requirements in monetary terms.
The American Academy of Physician Life Care Planners advocates the following sequence:
- Overview
- Summary of Records
- Interview / Examination
- Impairments
- Disabilities
- Probable Duration of Care
- Future Medical Requirements
- Cost Analysis
- Cost / Vendor Survey
- Citations & References
- Exhibits
All life care plans at Physician Life Care Planning are authored by Board Certified Physician whose work conforms to the tenets, methods and best practices advocated by the American Academy of Physician Life Care Planners.
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What are common mechanisms of injury (causes) requiring life care plans?
- Motor vehicle accidents
- Trucking accidents
- Maritime and shipping accidents
- Work-related / Workplace accidents
- Birth injuries
- Medical malpractice
- Premises Liability
- Product liability
- Drug-related injury
- Plant explosions
- Slip and fall accidents
- Assaults
- Animal attack / dog bites
- Wound by projectile injuries
To what type of injuries are life care plans relevant?
- Acquired Brain Injuries
- Spinal Cord Injuries
- Orthopedic Injuries
- Amputations
- Burns
- Psychological
- Visual Impairment
- Hearing Impairment
- Gastrointestinal
- Etc.
For the purpose of life care planning, what is a catastrophic injury?
A catastrophic injury is one which materially affects, or is anticipated to materially affect, a subject’s ability to independently perform basic activities of daily living (ADLs), e.g. mobility abilities, meal preparation and eating, grooming and personal hygiene, bowel and bladder management, medication management, communication abilities, etc.
What are common types of catastrophic injuries in life care planning?
- Acquired Brain Injuries
- Birth Injuries
- Major Burns
- Multiple Trauma
- Spinal cord Injuries
- Traumatic Brain Injuries
For the purpose of life care planning, what is a non-catastrophic injury?
A non-catastrophic injury is one which does not materially affect, or is not anticipated to materially affect, a subject’s ability to independently perform basic activities of daily living (ADLs); however, “non-catastrophic injuries” can be characterized by serious impairment, disability, and symptoms, which may be chronic and require lifelong medical care.
What are common types of non-catastrophic injuries in life care planning?
- Spinal injuries (intervertebral disc injuries)
- Major joint injuries (hip, knee, shoulder)
- Other orthopedic trauma (pelvic, long bone)
- Burns (mild – moderate)
- Single amputations
- Mild traumatic brain injury
- Chronic pain (spinal, CRPS, etc.)
- Others
For what purposes are life care plans used?
- Case Management
- Elder Care
- Discharge Planning
- Damages valuation: to formulate and quantify an individual’s future medical requirements.
What types of disabilities are addressed in a properly formulated life care plan?
According to the American Medical Association, a disability is an alteration of an individual’s capacity to meet personal, social, or occupational demands because of impairment.
Therefore, a properly formulated life care plan specifies:
- alterations in an individual’s capacity to meet personal demands
- alterations in an individual’s capacity to meet social demands
- alterations in an individual’s to meet occupational demands
What types of medical care are addressed in a properly formulated life care plan?
The American Academy of Physician Life Care Planners categorizes Future Medical Recommendations according to the following structure:
- Physician Services
- Routine Diagnostics
- Medications
- Laboratory Studies
- Rehabilitation Services
- Equipment & Supplies
- Nursing & Attendant Care
- Environmental Modifications & Essential Services
- Acute Care Services
Are there regularly and reliably employed methods used to formulate the costs in a life care plan?
Yes. Life care plans are routinely formulated using both accrual and cash accounting methods. Unit costs in a life care plan are obtained from sources proximate to the subject’s probable location of care. Multiple costs for a specific good or service is accounted for (when possible and/or appropriate). The unit costs employed in a life care plan are representative of submitted charges which are usual, customary and reasonable.
Does a life care planner’s choice of accounting method matter (does it have any real-world implications)?
Yes. As trivial as the selection of an accounting method may sound, it is not inconsequential. Rather, it can significantly affect the value of a life care plan, which means it can have significant, real-world implications on an injured individual’s ability to afford future medical care.
Why are life care plans properly formulated using “submitted charges”, rather than “reimbursement rates” ?
According to Lawrence Lievense, FHFMA, FACMPE, FHIAS, a foremost expert in the field of health care finance in the United States, “The financial value of medical services is equal to the amounts charged by medical providers, and is not determined by the amount paid in cash by third party payors.”
Life care plans which are formulated using “reimbursement rates”, not only fail to measure the full amount paid by payers to providers for medically related goods and services, there is no published, relevant, reliable or regularly employed peer- reviewed methodology for life care planning that supports the quantification of life care plans using “reimbursement rates”. Additionally, Because it is rarely, if ever possible to reliably attribute non-cash remuneration provided by a third party payer to any individual patient, or any individual patient’s medical service; and because it is not generally possible for any person to reliably foresee how many of an individual’s medical bills will be paid through a combination of both cash payments, and in-kind non-cash payments, the quantification of a life care plan using “reimbursement rates” is speculative, and therefore, does not meet standards of admissibility.
Are Life Care Plans required to be formulated in Present Value?
Most life care planners, because they are not trained in the field of finance, do not formulate the present value of the life care plans they author. Rather they formulated them in nominal value, and present value formulation is then performed by a financial analyst or an economist. Many states require damages to be formulated (“reduced”) to present value. Therefore, in instances in which a life care plan is being used in the context of torts to define the value of future medically related care, the nominal values expressed in the life care plan must be converted to present value.
States in Which Damages are Required to be Formulated in Present Value
Present value assessments of life care plans
What is a Certified Life Care Planner (CPLCP™)?
According to its governing organization, the International Commission on Health Care Certification™ (ICHCC™), “a Certified Life Care Planner™ (CLCP™) must be a health care professional, who meets stringent educational and professional qualifications and completes a 120 hour ICHCC™ approved training program along with a sample life care plan that is peer reviewed. The purpose of the CLCP™ credential is to measure the CLCP™ applicant’s working knowledge of medical systems, associated disabilities, and treatment/maintenance protocols required for a catastrophically disabled individual to sustain life within an acceptable comfort level.”
What is a Certified Physician Life Care Planner?
A Certified Physician Life Care Planner is a life care planning Physician who has earned and maintains the Certified Physician Life Care Planner Certification, as governed by the CPLCP Certification Board™.
Are there any relevant, reliable, and regularly employed peer-reviewed methods by which life care plans are formulated?
There are several published, and peer-reviewed standards of practice and principals within the discipline of life care planning. These include the International Commission on Health Care Certification’s (ICHCC’s) Standards of Practice, the American Academy of Nurse Life Care Planners’ Nurse Life Care Planning Standards of Practice, and the Tenets, Methods and Best Practices of the American Academy of Physician Life Care Planners.
The Tenets, Methods and Pest Practices of the American Academy of Physician Life Care Planners was first published in 2017 in A Physician’s Guide to Life Care Planning: Tenets, Methods and Best Practices for Physician Life Care Planners.
This published, regularly employed peer-reviewed methodology is widely accepted within the discipline of life care planning; and it has been reliably employed in thousands of state and federal court cases throughout the United States.
Learn more about published, peer-reviewed methods and practices for life care planning.
What is the primary objective of a Physician Life Care Planner?
According to the tenets, methods and best practices advocated by the American Academy of Physician Life Care Planners, a life care planner’s primary objective is to achieve the Clinical Objectives of Life Care Planning by answering the Basic Questions of Life Care Planning.
What are the Clinical Objectives of Life Care Planning?
According to the tenets, methods and best practices advocated by the American Academy of Physician Life Care Planners, the Clinical Objectives of Life Care Planning are:
- Diminish or eliminate physical and psychological pain and suffering.
- Reach and maintain the highest level of function given an individual’s unique circumstance.
- Prevent complications to which an individual’s unique physical and mental conditions predispose them.
- Afford the individual the best possible quality of life in light of their condition.
What are the Basic Questions of Life Care Planning?
According to the tenets, methods and best practices advocated by the American Academy of Physician Life Care Planners, the Basic Questions of Life Care Planning of Life Care Planning are:
- What is a subject’s condition?
- What medically-related goods and services does a subject’s condition require?
- How much will the medically-related goods and services cost over time?
What are the advantages of using a Physician Life Care Planner?
Most life care planners are non-physicians (e.g. nurses, vocational specialists, or other non-physician rehabilitation professionals) and many of them are good at what they do. Be that as it may, they do not possess a physician’s education, training, skills, or credentials; nor do they possess the professional or legal capacity to do what a physician can when acting in the capacity of a life care planner; that is, independently formulate and defend medical opinions regarding a subject’s medical condition, and recommendations for future medical care.
What is physiatry?
Physiatry is the medical specialty of physical medicine and rehabilitation (PM&R).
What is a Physiatrist?
Physiatrists are medical doctors who have completed specialty residency training in physical medicine and rehabilitation, and who have received board certification by the American Board of Physical Medicine and Rehabilitation (ABPMR), one of 24 medical specialty boards that make up the American Board of Medical Specialties (ABMS), the premier credentialing body for physicians specializing in PM&R, and one of 24 medical specialty boards that make up the ABMS.
Why is physiatry especially relevant to the discipline of life care planning?
Physiatrists are experts in the medical and physical treatment of disabling illness and injury (Bonfiglio, 2009), and have long been recognized as uniquely qualified among medical specialists to provide the scientific and medical foundations essential to the development of life care plans (Pomeranz, 2010).
Physiatrists, by the nature of their training, are holistic and comprehensive in their approach to the assessment of medical and rehabilitation requirements and are well suited to determine what medical conditions remain relevant to a subject’s future care considerations (Zotovas, 2014).
Why are physiatrists so central to the discipline of life care planning?
A principle reason non-physiatric life care planners seek guidance from physiatrists is many treating physicians specialize within narrow scopes of a subject’s care, and therefore, are not accustomed to fully assessing the total impact of a subject’s injury/illness on his/her overall health and function. Further, treating physicians are commonly unfamiliar with proper life care planning methodology, which is important as it affects proper consideration of all relevant information, which affects the formulation of appropriate diagnostic and rehabilitation conclusions, which constitute proper foundations for future medical and rehabilitation needs (Gonzales, 2014).
Physicians who are board certified in physiatry are preeminent in physical medicine and rehabilitation, and are, therefore, preeminent in their capacity to serve as effective life care planners.
It is no coincidence that Section 1, Chapter 2 of the Life Care Planning and Case Management Handbook is entitled “The Role of the Physiatrist in Life Care Planning”, and it states: “For a Life Care Plan to appropriately provide for all the needs of an individual, the plan must have a strong medical foundation.” It continues: “Physicians specializing in physical medicine and rehabilitation (physiatrists) are uniquely qualified to provide a strong medical foundation for life care planning based on their training and experience in providing medical and rehabilitative services to individuals with disabilities. Physiatrists are, by their training, experienced in dealing with individuals who have catastrophic functional problems. Additionally, physiatrists are trained to anticipate the long term needs of their patients.”
What advantages does a Physician Life Care Planner have over a non-physician life care planner?
Unlike non-physicians, physician life care planners have the ability to independently formulate and defend opinions regarding a person’s diagnostic conditions and future medical requirements.
The formulation of a medical opinion is beyond the bounds of most life care planners’ professional licensure; and this lack of professional capacity presents non-physician life care planners with a material challenge which is succinctly described by Richard Bonfiglio in the essential text, the Life Care Planning and Case Management Handbook: “The foundation of many life care plans is limited by the plan developer’s experience and the frequently marginal input from treating physicians. Especially in developing a plan for an individual with complex health care needs due to a catastrophic injury or illness, the life care planner and the treating physicians may have very little experience in dealing with a person with similar medical issues…”.
The challenge for non-physician life care planners is magnified by the practical reality that the treating physicians they rely upon are often unavailable, unwilling or unable to assist life care planners in the development of their plans’ medical foundations. Many treating physicians do not have time to respond to requests for information—and if and when they do respond, they often afford limited time to meaningful consideration (Gonzales, 2014). In addition, and in many cases, treating physicians are unable to properly assess the overall medical status and need at the time of a life care plan’s production.
The use of life care plans as documentary evidence in personal injury torts presents non-physician life care planners with another critical challenge, as described by Tracy R. Gunn in the Life Care Planning and Case Management Handbook: “It is the role of the physician to establish the existence of physical or mental impairment and it is inappropriate for the rehabilitation consultant [or other non-physician] to present opinion testimony as to the existence of a medical condition or its likely progression.”
Non-physician life care planners’ lack of requisite capacity to independently formulate a medical opinion, and their lack of requisite capacity to present opinion testimony regarding the existence of a medical condition or its likely progression, regularly jeopardizes the parties who rely upon life care plans to substantiate medical conditions, formulate care requirements, and quantify medically-related compensatory claims , i.e. the subjects of life care plans, the parties who customarily commission their production, courts, and ultimately, life care planners themselves.
What are the relevant strengths and weaknesses of Life Care Planning Physiatrists vs. Treating Physicians?
According to the essential text the Life Care Planning and Case Management Handbook, “For a life care plan to appropriately provide for all the needs of an individual, the plan must have a strong medical foundation. Physicians specializing in physical medicine and rehabilitation (physiatrists) are uniquely qualified to provide a strong medical foundation for life care planning…”
Nonetheless, both Physiatric life care planners and treating physicians have meaningful roles, each with their own strengths and weaknesses.
Do you need a life care plan, or do you want learn how a physician life care planner can help meet your needs?
Call 830-953-7189 for a Free Consultation, or fill out this form and we will contact you.