PHYSICIAN’S  SERVICES

IN  THE NURSING  HOME

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     In theory, it would be best for the physician providing primary care of a resident before admission to continue overseeing care in the nursing facility.  In today’s fragmented medical care processes, a primary physician will pass the patient on to those doctors known as hospitalist who coordinate and manage care in the hospital.  Medical oversight is passed from the hospital into the nursing home to a physician contracted to meet the care needs of facility residents.  The resident’s original physician could continue to provide care in the nursing home if they chose to meet the nursing home’s policy and procedure for physician’s services which is complex and can be discouraging to such a continuing care arrangement.



                                                            PAGE CONTENTS

                            ∆  Regulatory oversight.

                        ∆  Physician visits.

                        ∆  Specialized nursing home physicians.

                        ∆  Family meetings with the physician.

 

  ∆  Regulatory oversight.

    Medicare /Medicaid certified nursing homes must ensure the medical care of each resident is supervised by a physician and that another physician is available to furnish necessary medical care in an emergency or when their attending physician is unavailable.  In addition, the facility must have a physician who serves as medical director and is responsible for implementation of resident care policies and the coordination of medical care in the facility.  One of the facility’s contracted physicians usually serves as the medical director.


  ∆  Physician visits.

    At the time a resident is admitted, the facility must have physicians orders for the new resident’s immediate care.  The resident must be seen by a physician at least once every 30 days for the first 90 days after admission, and at least every 60 days thereafter.  Physician visits up to 10 days past the due date are still consider within the schedule.


   At the option of the physician and nursing home, visits after the initial visit may alternate between personal visits by the physician or a physician assistant, nurse practitioner, or clinical nurse specialist who meet regulatory and professional licensing standards and state laws relating to such practices and work under the supervision of the physician.  The physician may not delegate a task when regulations specify the physician must personally perform the task or when delegation is prohibited under state law or facility policy.


  ∆  Specialized nursing home physicians.

    Nursing homes contract with one or more physicians to provide care for residents.  These contracted physicians may have an office practice or be part of a medical group specializing in nursing home care.


    Medical practices serving only health care facilities do not have traditional offices but see all their patients at nursing homes.  As specialists in nursing home medicine, these physicians are often better qualified to meet the needs of this well defined population, understand the way care is delivered in such a setting, have participated in training centered on the nursing facility resident, and have more time in the facility to interact with residents and their families.  A physician maintaining both an office and nursing home practice is pulled from one to the other, limiting their time and the knowledge that is developed by focusing on this narrow spectrum of clients.


    Specialized nursing home medical practices may only be available in areas of high population with rural facilities having to use physicians who also have an office practice. In the end, the quality of care provided by nursing home physicians depends upon the individual doctor but where they are available, specialized nursing home physicians may have more to offer.


  ∆  Family meetings with the physician.

    Most physicians practicing in a nursing home will meet with family members to discuss the care of the resident.  The ambush method of meeting with the doctor may not be the best approach.  Work with the facility nursing staff to help fit you into the physician’s schedule because no matter what their plans are upon arrival at the facility, many unplanned but important items will appear to eat up more of their time than was scheduled.



To access the regulation §483.40 Physician Services, click on the following link.

http://ecfr.gpoaccess.gov/cgi/t/text/text-idx?c=ecfr&tpl=/ecfrbrowse/Title42/42cfr483_main_02.tpl




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