|
Submitted for publication to Roundup Magazine, June 1997. Robert H. Taylor, M.A.,C.R.C.,C.D.M.S.,C.P.C.,C.L.C.P. Vocational Diagnostics, Inc. Phoenix, AZ A major question facing physicians in these days of managed care is, "How can I spend the time necessary with my patients to answer questions and advise them about their future care needs?" The follow-up question is, "Am I really knowledgeable about every area of my patient's life that will or may be impacted by their disability?" The involvement of a qualified Life Care Planner by the physician to evaluate his patient enables the physician to do what he is best trained to do, practice medicine. It also provides both he and his patient with a thorough understanding of how a disability is going to affect the patient in years to come. As a Life Care Planner is trained to address the projected costs of future care needs made necessary as a result of the disability, the financial impact of the disability can be recognized and understood by the patient, his family, and the physician. Life care planning includes the methodology utilized to project the future care needs of a disabled person and the costs associated with both the medical and non-medical needs over the projected term that the disability is going to be in evidence. This is usually one's statistical lifetime. The Life Care Plan is the document that is created which sets forth these needs and the costs to provide for them. The Life Care Plan is intended to address 18 areas of a person's life which can be affected by a disability. These areas are:
The physician plays an integral role in the development of a Life Care Plan. After all, it is the physician who must first identify the reason for the disability, i.e., the medical condition which has resulted in permanent impairment and the limitations in function as a result of the impairment. Physicians provide foundation for many of the items contained in the Life Care Plan. Such things as routine medical care, medications, surgical intervention and hospitalizations are areas that must be addressed by the physician. This is sometimes an uncomfortable area for physicians to get into as it calls upon them to some degree to utilize a "crystal ball" to forecast the future medical course. Open-ended forecasting, however, need not occur. A physician need only offer his opinions within a reasonable degree of medical probability as to what will probably be necessary in the future. By virtue of his training, review of the research and experience, most physicians are comfortable in providing the information necessary to develop parts of a life care plan once they understand what is truly expected of them. Once the physician has identified the future course that is anticipated medically, the life care planner can determine the impact of the medical condition on the non-medical areas of the individual's life. I, for one, always do a lengthy clinical interview with the individual I am working with, be it a young child, adolescent, or adult. It is important to understand the problems that the individual is having in all areas of his life as a result of the disability. To gain this understanding, interviews of up to three hours in length are not uncommon. Can the physician be expected to take three hours out of his day to talk to one patient and understand how the person's disability affects all areas of his life? Of course not. Such an approach would create a unreasonable burden on the physician and impede the delivery of quality medical services. Therefore, in order for a physician to fully understand the impact of disability, the use of a life care planner becomes critical. The Life Care Plan is intended to compute the annual costs of care in all of the above areas. It is not uncommon for annual costs of care to be in the tens of thousands of dollars. It is not uncommon to see annual costs of care exceeding $100,000 in the case of an infant who is developmentally delayed and requires gastrostomy feedings and skilled nursing care. Establishing the annual costs of care over the projected term in the future allows a family to gain a better understanding of financial commitments that will need to be made to properly provide for the needs of the disabled individual. The era of managed care has placed greater burdens on both the physician and the family of the disabled person. The physician must justify every recommendation he makes for service or equipment that may be paid for by insurance. Can the physician have knowledge of all that is available at his fingertips? Frequently this is not the case, yet, the physician is asked to justify why a certain prescription for services or equipment is necessary. The Life Care Planner, through his specific training and experience, can provide the physician with the foundation for his opinions. The family is placed at an even greater disadvantage. Suppose an insurance carrier agrees to pay for a wheelchair that a disabled child requires. How does the family know that the wheelchair they are being sold is the best that they can get for that price and will, most importantly, be of maximum benefit to their child in the future? The same argument holds true for any non-medical service or equipment that the disabled person may require that the family must purchase. Maximizing of resources becomes critical. By utilizing a life care planner to help make these decisions for the family, there is enhanced probability that the most appropriate services or equipment will be purchased. The physician can then be assured that his patient is being properly cared for. Liability concerns of the physician may also be shifted as he can rely on another professional to assist in delivery of necessary services and equipment. Potential future medical complications can, thus, be avoided or minimized. Quality of life for the disabled individual is enhanced and overall costs, both medical and non-medical, are decreased. The life care planner, therefore, contributes to the effectiveness of health care service delivery. Who pays for the services of the life care planner? This is, unfortunately, one of the greatest dilemmas in our industry. While group medical insurers have long embraced the concept of case management as a means of controlling costs, insurers control health care service delivery through case managers of their choosing who are on their payrolls. Can the decisions of a case manager in this capacity always be objective? In my opinion, the most objective case manager is a life care planner who is not connected with the payor. This is not to say that all health insurance companies adopt this approach; there certainly are those that welcome the involvement of life care planners and, in fact, even when retained by the family, may assume the cost of the service if they are convinced that such involvement in the case will be of benefit to all parties in the long run. The ultimate decision to involve the life care planner, however, falls to the family. Much the same as the family should anticipate some out-of-pocket expenses in order to receive quality health care, out-of-pocket expenses should be anticipated when involving a life care planner. I always urge the family to discuss the involvement of a life care planner with their group health carrier, but there are no guarantees that such a cost will be assumed. Given the potential inappropriate use of funds on improper services and equipment, however, in my opinion, a family cannot afford to not have a life care planner involved in some ways. Wherever possible, the life care planner will utilize collateral sources to pay for items in the Life Care Plan, however, the life care planner should also educate the family as to what out-of-pocket expenses should be anticipated in the future. An even greater burden will fall onto families in years to come to provide for health care services with dollars out of their own pocket. It is necessary, therefore, to project future financial needs for the disabled person just as people determine what their current financial requirements are to fund their retirement. Once the annual costs of care for the disabled person are identified, the family can then embark on the necessary financial management course to fund these future needs. The life care planner can assist in this regard by working with other, qualified financial service professionals such as accountants and financial planners who will determine the best investment options to meet these future care needs and structure the necessary portfolio. In summary, when a physician recommends a life care planner become involved with his patient who has a disability, he is making it possible to not only practice medicine more effectively but for his patient to attain the best quality of life possible with the disability. As more demands are placed on the physician to provide timely and more cost-effective medical care, he must look beyond the walls of his own office in order to address these demands. The life care planner provides him with an effective way to do so.
|