Nursing home medical directors should be publicly named, bill urges

It’s just a two-page paper, barely made up of 200 words. But if it passes as the authors intend, it would require all 15,000 Medicare-approved nursing homes in the country to publicly report the name of their medical director.

Physicians involved in skilled elderly care say this is a very important step toward dramatically improving transparency and accountability for older people, their families, and the health systems that serve them.

This basic information has often been covert and elusive, particularly during the pandemic, said Susan Gillespie, MD, president of AMDA, Association for Post-Acute and Long-Term Care Medicine, MedPage today.

For example, she recalled the experience of a family member who had repeatedly tried to express his concerns about the quality of care the loved one was receiving, but was unable to find the staff responsible for it.

“She was trying to get to the medical director, and there were unnecessary delays. She wasn’t able to call until her loved ones got sick,” she said. The patient died.

If the bill is introduced on August 23 by Rep. Mike Levine (D-Calif.) and Rep. Brian Fitzpatrick (R-Pen), Gillespie believes — based on documents from the authors — that CMS will at least publish the name to each nursing home’s medical director. Nursing Home CompareIt can be viewed with just a few clicks.

Currently, the bill vaguely calls for disclosure of “information” about the medical director. Gillespie said the exact scope of information to be released will be determined through the regulatory process. It can be more than just the name of the doctor and nursing home; Board certification can be published, for example.

AMDA urges the public the support.

Manage many facilities?

There are many reasons why the public needs to know the name of the medical point officer at these facilities since this person’s job, as required by the CMS, is essential to ensuring that staff have credentials, know proper transportation protocols, prepare for disasters, and understand special needs For elderly patients at high risk of infection.

The public needs to know the responsible clinician who is doing peer review competently, such as making sure that the patients’ doctors themselves are providing appropriate care, and that staff have the appropriate competencies, such as knowing what to do if there is a deficiency of Valium.

Patients and their families will also be able to see how little the manager’s duties have been distributed. Gillespie said she’s heard of a medical director who oversaw 16 separate nursing home buildings in different locations, all at the same time.

“It depends a little on the facility, its complexity, and the type of care it provides,” said Gillespie, MD, medical director of two nursing homes at VA Finger Lakes Healthcare System in Rochester, New York. She said it’s not unusual to have a doctor in charge of some buildings, but maybe not 10.

“There is a threshold turning into where it becomes difficult, I dare say impossible, to engage in the ways you want a medical director to handle,” she said.

Who are the qualified doctors?

Among other reasons for publishing the names of medical directors is the ability to see a provider’s qualifications, said Karl Steinberg, AMDA’s direct former president, San Diego medical director of two nursing homes and chief medical officer of two nursing home service organizations that house their respective facilities. They have their own medical directors.

He’s heard of nursing homes that employ an interventional radiologist, a retired surgeon, and a pediatrician as medical directors, even though these individuals have no training in geriatrics, long-term care medicine, end-of-life care, or the complex regulatory framework in which nursing homes must operate. .

“What do you do for diabetes, COPD? What do you do with a change in status? What do you do to prevent bed sores, prevent falls?” Steinberg said. “The medical director is supposed to review all policies and procedures and make sure they are up to date.”

He added that these were probably not skills they learned in medical school.

He said many of the SNF’s medical directors are independent contractors who budget between 5 and 20 hours per month. While many if not most of them serve as attendants for some patients, providing direct patient care, they are not specifically responsible for providing direct patient care.

However, they need to ensure that the physicians of these patients attend to their needs, visit their patients at least once per month, and make necessary visits when a patient’s condition changes.

He gave several examples where appropriate nursing home care procedures deviated from what non-elderly professionals were taught in medical school.

For example, when an elderly patient with diabetes is admitted to the hospital, doctors check fingerprints four times a day, using sliding insulin, he said. When they are discharged to the SNF, an uninformed medical director may allow this to continue for several months, “even though it is unnecessary and detracts from the patient’s quality of life.”

“You don’t really care about strict diabetes control,” Steinberg said of an elderly patient nearing the end of his life. “You let them eat whatever they want because you don’t want them to lose weight and fail to thrive. The time horizon for damage from high blood sugar is longer than they’ll live with anyway.”

Steinberg reviews the chart and frequently sees patients still get their toes four times a day after three months, “and they’re all between 120 and 160 mg/dL. They’re still getting two units of insulin if the number is over 150,” like he said. . “It is strictly ignorance and inertia.”

California leads the way

AMDA would like to see federal policy evolve along the lines of the policy formulated by California.

Steinberg was a member of the California Society of Long-Term Care Medicine’s leadership team who received the Law It was passed last October which goes much further than the House bill.

It requires all medical directors of nursing homes in the state to take a 40-hour online course in Home Care for Hospice Care — one that costs about $4,000 — and earn a “CMD,” a medical director certificate, Within five years, or by January 1, 2027.

They are also required to submit a resume and demonstrate that they are board certified “in a medical specialty consistent with the type of care provided” in long-term care facilities. They must also demonstrate that they have at least two years of experience as a medical director in a nursing home.

Steinberg said it’s the only such legislation in the country, although Maryland may have a similar law not enforced. Steinberg said California lawmakers readily passed it without opposition in any committee or legislature after they were “shocked that a nursing home might hire an interventional radiologist to be its medical director, a retired surgeon, or a pediatrician.”

It has also become clear during the pandemic that “some nursing homes and chains will employ medical directors to do what I call the three: Sit. Shut up and sign. Don’t make waves,” Steinberg said. “We know there are definitely some among us, and that’s what we wanted to address with this law.”

Steinberg continued that having a registry of nursing home medical directors would have been very helpful during the pandemic, saying, “It’s tragic that we haven’t.”

“There were a lot of different sources of information, and they weren’t always reliable with conflicting guidance from local, versus state, versus federal agencies. It was a good idea to send all of that to the medical director” to clarify the correct policy, he said.

The silver lining of COVID

Gillespie and Steinberg note that organizations of medical directors and patient advocates have been calling for medical director legislation for more than a decade, but the resistance always wins. However, the Corona virus revealed the seriousness of the problem and caught people’s attention.

For example, the National Academy of Sciences, Engineering and Medicine in April ReportThe National Imperative for Nursing Home Quality Improvement: Honoring Our Commitment to Residents, Families, and Employees, made several recommendations now codified in California law.

Nursing homes must report to a CMS demographic baseline Information For medical directors, medical directors must complete The report recommended “a senior care education and certification program, and certification in infection control and prevention.”

“These old people are very weak patients,” Steinberg said. “And if you don’t have someone watching over the chicken coop, things are going to slip through the cracks.”

Levine and Fitzpatrick made many of these points in A message To then-CMS Director Sima Verma in May of 2020, just as the public was aware of the horrific impact of the pandemic on nursing home residents.

Gillespie added, COVID “has been the silver lining in the cloud, highlighting long-standing concerns about home care for the elderly, and drawing attention from many others.”

bounce starts

Already, however, the proposed bill receives opposition. Asked about the reaction, the American Healthcare Association/National Center for Assisted Living (AHCA/NCAL) said it was reviewing the bill to see if it would bring greater transparency, but suggested MedPage today In a statement he cautioned.

“While we support transparency efforts that help consumers make decisions about where they or their loved ones should receive care, we cannot support additional reporting requirements that take time away from resident care.”

The statement noted that the nursing home industry suffers from the “worst labor shortage” it has ever faced, and that the organization needs to ensure it “does not discourage qualified and interested physicians from serving as medical directors in our communities.”

LeadingAge, an association of nonprofit providers including nursing homes, had a different view: “Information transparency is an important component of building trust between caregivers, residents and their families, and we support nursing homes in disclosing this information about medical directors,” she said. A spokeswoman in an email.

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    Sheryl Clark He has been a journalist in medicine and science for more than three decades.

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