A study published on September 2, 2024 in the Journal of the American Geriatrics Society reported: “More than a third of U.S. nursing homes (36.1%) reported zero medical director presence in Quarter 1, 2023. Medical director presence fluctuated between 2017 and 2023 with a decline over the past 4 years. Among nursing homes reporting a medical director, the medical director was on payroll for an average 36 min per day or 4.2 h per week per facility, and less than 1 min per resident day. Medical director presence and time varied significantly by ownership type and state. For-profit nursing homes reported a lower rate of medical director presence (61.4%) compared to non-profit (71.3%) and government (66.5%) nursing homes and reported that medical directors spent less time in the facilities. Facilities seldom (0.2%) receive regulatory deficiencies for medical director requirements.”
The study concluded: “Though medical directors have a critical role in overseeing clinical care, some nursing homes report no medical director time and those that do report about 4 h per week. Together, these findings may indicate the need for improvement.”
Specifically, 42 C.F.R. § 483.70(g) states:
Medical director.
(1) The facility must designate a physician to serve as medical director.
(2) The medical director is responsible for—
(i) Implementation of resident care policies; and
(ii) The coordination of medical care in the facility.
Flag F841 provides:
Medical Director Responsibilities
The Medical Director’s responsibilities require that the Medical Director:
- Knows current standards of practice related to the care of LTC residents and how to oversee other practitioners. He/she should also assist with developing staff education.
- Participates in administrative decisions related to resident care policies, including developing, recommending and approving these policies.
- Participates on the QAA Committee (or assigns a designee) and through other activities addresses issues related to medical care coordination in the facility.
- Participates in organizing and coordinating the services provided by physicians and other professionals. He/she must also identify performance expectations for physicians as well as facilitating feedback based on performance and practices. If a health care practitioner is providing care inconsistent with current standards of care, the Medical Director should discuss and intervene if necessary.
- Is responsible for the quality of medical/medically-related care being provided.
- Is expected to work with the facility’s clinical staff on developing policies to prevent potential infections as well as surveillance activities.
- Promotes person-centered care, including through the formation of advance directives protocols and promoting resident choice in making care decisions.
- Assists with developing performance monitoring systems to resolve issues related to medical care.
Other Important Points
- If the Medical Director is also an attending physician, the facility needs to ensure that there is a mechanism to ensure there are no concerns/issues with his/her performance, so the Medical Director is not reviewing his/her own performance.
- If a facility is part of a multi-facility organization and the Medical Director is involved in developing corporate/regional policies, the policies in place for each facility must be facility-specific based on the facility’s residents’ needs and environment.
- If the Medical Director names a designee to participate on the QAA Committee, his/her responsibility as a member of the Committee is not changed, nor is his/her responsibility for overseeing overall medical care within a facility.
If you or a loved one may have been injured as a result of medical malpractice in a nursing home in the United States due to nursing home pressure ulcer (nursing home bed sore) negligence, a nursing home infection, nursing home fall, nursing home aspiration, nursing home neglect, nursing home negligence, nursing home abuse, nursing home understaffing, or the nursing home otherwise failing to properly care for a vulnerable adult, you should promptly find a medical malpractice lawyer in your state who may investigate your nursing home medical malpractice claim for you and represent you or your loved one in a nursing home medical malpractice case, if appropriate.
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