As the Centers for Medicare & Medicaid Services ratchets up its expectations of medical directors, data reflecting their responsibilities and the time they spend influencing nursing home care is sorely lacking.
A study published last year found that 36.1% of nursing homes did not report any medical director hours via the Payroll Based Journal system.
But technology may both better equip medical directors to guide care and capture important details about exactly what they do to support staff and residents and how often they do it, argued Arif Nazir, MD, a geriatrician, medical director and chief medical officer at Adobe Care Partners.
“Unlike attending physicians or nurse practitioners, medical directors are entrusted with systemic responsibilities, including clinical governance, policy oversight and quality improvement,” Nazir wrote Thursday in an editorial published in the Journal of the American Geriatrics Society. “Without clearly delineating these duties, their contributions risk being undervalued or misrepresented, even within facilities striving for regulatory compliance.”
Nazir is a certified medical director for Signature HealthCARE, American Senior Communities and, starting in April, Plainview Healthcare Partners.
Pointing to the previous study on medical director time spent on nursing home tasks, Nazir said technology would help dispel the notion that work was going undone.
He called for more medical directors to use a digital platform that relies on self-reporting of administrative tasks by medical directors in accordance with CMS and Post-Acute and Long-term Care Medical Association (PALTmed) recommendations. Such tools provide clarity and insights that skilled nursing owners and executives can use to better understand if their medical directors are coordinating the kinds of policy reviews and clinical oversight they expect.
Training should be prioritized
Nazir is co-founder and part owner of CareAscend.com, which helps medical directors report their administrative time. In his editorial, he pointed to internal data that showed 40% of users at 389 facilities recorded 11 to 15 hours of nursing home work per month.
Those users spent the most time (22%) monitoring clinical quality and metrics, followed by leadership meetings (14%). Nazir told McKnight’s Long-Term Care News Sunday that another five percent of directors spent time on staff education, four percent worked on QAPI meetings or pharmacy oversight, and another 3.5% managed infection control tasks.
Most importantly, Nazir added in his editorial, was that none of the surveyed nursing homes reported zero medical director hours for the year, which he noted was “a stark contrast to the 36.1% figure reported in PBJ data.”
He said that discrepancy demanded more accurate and standardized mechanisms for capturing contributions, but also noted that presence alone isn’t enough to ensure quality clinical oversight.
“While broader policy and technology-driven solutions will require time for implementation, resource-rich SNF chains can take immediate steps,” Nazir wrote. “Partnering with experienced physician leaders can help establish formal systems for medical director conduct, including the recruitment of qualified professionals with clearly defined expectations.”
Nazir told McKnight’s that CMS and professionals within the skilled nursing sector should prioritize technology and oversight partnerships with industry associations to assess if current medical director structures work and promote clarification of the role.
Only after that, Nazir said, should CMS consider any additional rule-making that focuses on increased scrutiny and citations — otherwise, they will fall short on quality improvement.