The American Academy of Physician Life Care Planners
The American Academy of Physician Life Care Planners (AAPLCP) is a professional organization of board certified physicians, and other clinical and forensic professionals dedicated to the practice and the advancement of life care planning.
The Academy is committed to the advancement of life care planning methodology, standards of practice, research and publication, and the training and education of qualified physicians.
The mission of the Academy is to champion the practice of life care planning by physicians, to elevate and support the discipline of life care planning through physician participation, and to educate physicians, the life care planning community, and the public about physician’s central role in life care planning.
History & Context: Life Care Planning & AAPLCP
Prior to the mid-1970s, when needs arose to formulate and quantify care requirements for residual medical conditions, physicians or other rehabilitation professionals were often solicited to address three basic questions: 1) what is a subject’s condition; 2) what does a subject’s condition require; and 3) how much will the requirements cost over time? At the time, there was wide variation in the quality and the validity of these assessments. In that era, the nascent discipline of life care planning was in material need of structure and standardization.
Since then, professional organizations including the International Commission on Health Care Certification (ICHCC), and the American Association of Nurse Life Care Planners (AANLCP) have established their own standards of practice, as well as professional credentials for practitioners.
Despite advancements in recent decades, most life care plans [and most life care planners] still fail to credibly substantiate the medical opinions and quantitative conclusions they express, and these common failures regularly jeopardize the same people life care plans are intended to help.
A primary reason for this is, relatively few life care planners possess the education, training, or professional capacity to independently address the first two Basic Questions of life care planning, i.e. what is a subject’s condition, and what does a subject’s condition require? These questions necessitate the formulation of medical opinions regarding diagnostic conditions, disabilities, probable durations of care, and future care requirements.
The formulation of 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 overall medical status and need at the time of a life care plan’s production.
Despite their value as case management tools and their growing use in elder care and discharge planning, the vast majority of life care plans are not commissioned for these purposes; rather, they are commissioned as expert medical valuations which are used as documentary evidence in personal injury torts for the purposes of objectively identifying medical conditions and future care requirements, and quantifying the costs of care requirements in monetary terms.
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 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.
The American Academy of Physician Life Care Planners was established to address the challenges of today’s life care planning environment. The Academy is committed to elevating the discipline of life care planning through research and publication, the advancement of life care planning methodology, standards and practices, and the training and education of qualified physicians. By proliferating the availability of physician life care planners to consumers, as well as their accessibility as physician resources/collaborators for non-physician life care planners, it is the Academy’s intention to materially advance the discipline of life care planning and benefit the life care planning community as a whole.
Physiatry & Life Care Planning
The American Academy of Physician Life Care Planners recognizes and affirms Physiatry’s special relevancy and unique applicability to the discipline of life care planning. Physiatry is the medical specialty of physical medicine and rehabilitation (PM&R), and 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.
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).
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).
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.” For these reasons, the American Academy of Physician Life Care Planners advocates the practice of life care planning by board certified physiatrists.