LIFE CARE PLANNING: ADULT & PEDIATRIC

Life care planning requires a detailed, medically supported approach to accurately project future care needs and costs for both plaintiffs and defendants. Injury Care Solutions Group connects attorneys with expert physicians who develop thorough life care plans based on history, physical examination, and peer-reviewed literature. Our experts provide defensible, evidence-based reports that support case strategy, whether you need plaintiff evaluation, defense analysis, or rebuttal opinions. 

Work product includes: 1) Medical Chronology, 2) History & Physical, 3) Research Pricing Document, and 4) Life Care Plan Tables

Travel Expenses: Paid as invoiced

Payment is due: Prior to testimony or at conclusion of the case (NOT CONTINGENT ON OUTCOME)

Methodology of Greg Vigna, MD, JD, Board Certified Physical Medicine and Rehabilitation, and Life Care Planner:

The central tenet for physicians providing services in connection with Academic Physician Life Care Planning, LLC and Injury Care Solutions Group, is to avoid any direct personal contact or communication with treating physicians. This approach ensures that conversations with treaters do not lead the injured plaintiff to reasonably conclude that I or another physician serving as an expert in a litigation matter personally endorses the treating physician’s skill, knowledge, experience, and training.

Collaboration with treating physicians could raise concerns that such conversations constitute the illegal practice of medicine, implying the unauthorized practice of medicine without a valid license in the state. Furthermore, any communication or collaboration with treating physicians could lead an injured person to reasonably believe that I am providing medical care as a treating doctor, which then opens the door to third-party lawsuits. 

For these reasons, on life care plans and expert reports that I provide, my team avoids ‘Collaboration’ unless approved by me. As for Advocacy, that is outside my scope, as my role is to be objective and form my opinions to a reasonable degree of medical certainty, and defend those opinions based on my skill, knowledge, experience, and training as a physician in the field of Physical Medicine and Rehabilitation. 

Literature basis for the Expert Report and opinions that relate to future care included in the Life Care Plans is provided for Plaintiffs via a Rebuttal Report and with the Defense Expert Report and Life Care Plans. 

Costing Methodology: 

When preparing a life care plan, it is essential to source prices for services and items that are Usual, Customary, and Reasonable (UCR) as outlined in the Majority and Consensus Statements” [1] best practices. The concept of “usual and customary” costs generally aligns with the 75th or 80th percentile of charges for similar services within a given geographic area, as noted by Weed & Berens (2019). These percentages represent the costs that are employed. While these best practices offer a useful framework for developing a cost research methodology, there are no clear guidelines regarding how to conduct cost research, leaving individual life care planners to determine what constitutes usual, customary, and reasonable costs for the services included in their Life Care Plans.[2]

The methodology utilized by Academic Physician Life Care Planning is consistent with the billing practices of life care planners as well as Dr. Vigna’s own prior private practice in order to obtain reliable pricing. The methodology employed first is to obtain provider information and/or billing statements, local providers if possible, followed by reputable databases, including Medical Fees (PIMC), VA Reasonable Data Charges, American Hospital Directory, and Context4 Healthcare[3]. Once that information is obtained, it is analyzed by a standard percentage threshold of 2 times the facility fee and 3 times professional fees to obtain a total threshold number that the costs are compared to and deemed reasonable. This reasonableness threshold was developed to account for variations or “flaws” in the database system. The fundamental flaw of the databases is that they cannot consider the human factor of experience and a physician’s right to bill for said experience.  Databases should be utilized in conjunction with other costing methods because there is no database that currently differentiates billing between doctors with 20-25 years of experience versus providers with less than five years. 

[1] Johnson, C., Pomeranz, J., & Stetten, N. (2018). Consensus and majority statements derived from life care planning summits held in 2000, 2002, 2004, 2006, 2008, 2010, 2012, 2015 and 2017 and updated via delphi study in 2018. Journal of Life Care Planning, 16(4), 15–18.

[2] Alison, A., Corwin, A., et. al. “Analysis of Usual, Customary, and Reasonable Charges in Life Care Planning.” Journal of Life Care Planning, vol. 20, no. 2, pp. 5-19.

[3] Weed, R.O., & Berens, D.E. (Eds.). (2019). Life Care Planning and Case Management Handbook (4th ed.). Routledge.

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