Life Care Planning from a Doctor’s Perspective

Readers of this blog have seen me reference the thought-provoking blog called The New Old Age ( several times.  A post by Judith Graham on June 26 profiled Dr. Leslie Kernisan, a San Francisco gerontologist who has walked away from Medicare to establish a new kind of practice.  Dr. Kernisan was so frustrated by the way in which she felt that Medicare’s compensation model interfered with her ability to truly address her patients’ needs that she  felt she could no longer accept reimbursement from them.  Instead, she charges her patients an hourly rate for anything and everything she does.  As a result, she can follow up with them for all of the concerns they might raise, rather than being limited by the specific exams and services for which Medicare will reimburse.  As quoted in the blogpost, Dr. Kernisan feels that she can focus on issues of pain and general frailty that may not fit into the neat little boxes that the traditional fee-for-service model can address.

On her own webpage, at, Dr. Kernisan says that, in addition to helping her older patients and their families address medical challenges particular to the elderly  and understand their overall health situation, her  practice can also help older patients and their families get the care they need from the health system, complete advance directives and living wills, and plan for present and future housing and care needs.  Dr. Kernisan says that her practice is dedicated to  geriatric consultation, and she will make house calls as needed.

I applaud Dr. Kernisan’s commitment to total care of her elder patients and her willingness to try a new model.  In many ways, it sounds like a physician’s equivalent to the Life Care Planning law practice.  Like Dr. Kernisan,  attorneys in the Life Care Planning Law Firms Association ( were frustrated at the limitations of a transactional based practice. While we knew that our clients probably did need a will, Trust, or Medicaid application, we couldn’t help but wonder if they also needed something more.  Life Care Planning attorneys include social workers, benefits planners and other professionals in our practices so that we can provide a comprehensive approach to helping our patients find, get and pay for good care.  Like Dr. Kernisan,  (albeit from a different perspective), we advocate for our clients to assure that they get the medical care they need and the insurance coverage they are entitled to.  We can prepare all of the necessary legal documents and make sure the foundation is in place for current and future housing and care needs.  We would love to work with physicians like Dr. Karnisan who have the same objectives for our elderly clients.



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