As the Centers for Medicare & Medicaid Services raise the expectations of health directors, there is a great lack of data reflecting responsibility and time to impact care in nursing homes.
A survey published last year found that 36.1% of nursing homes did not report their medical director's time via a pay-based journal system.
But technology argued by Arif Nazir (MD), medical director and chief medical officer at Adobe Care Partners, to better equip medical directors and get the key details about what they are doing to support staff and residents, and how often they do it.
“Unlike physicians and nurse practitioners, medical directors are entrusted with systematic responsibilities such as clinical governance, policy oversight and quality improvement,” Nazil wrote in an editorial published Thursday in the American Association of Seniles' Journal. “Without clearly delineating these obligations, their contributions run the risk of underestimating or misrepresenting them, even within facilities that strive for regulatory compliance.”
Nazir is a certified medical director for Signature Healthcare, American Senior Communities and is Plainview Healthcare Partners since April.
Nasir pointed to previous research into medical directors' time spent on nursing home tasks, saying that technology helps to dispel the notion that work is being reverted.
He asked more medical directors to use digital platforms that rely on self-reporting management tasks by medical directors, following recommendations from the CMS and the Association of Acute and Long-Term Care Medical Practitioners (PALTMED). Such tools provide clarity and insights that skilled nurses and executives can use to better understand whether healthcare directors are coordinating the types of policy reviews and clinical monitoring that are expected.
Training needs to be prioritized
Nazir is a co-founder and some owner of Careascend.com, which helps healthcare directors report their administration times. His editorial pointed to internal data showing that 40% of users at 389 facilities recorded 11-15 hours of nursing home work per month.
These users spent the most time (22%) monitoring clinical quality and metrics followed by leadership meetings (14%). Nazir said on Sunday that McKnight's Long-Term Care News had an additional 5% of directors spent time educating staff, 4% were working on QAPI meetings or pharmacies, and another 3.5% were working on managed infection control tasks.
Most importantly, Nazil added to his editorial that none of the nursing homes surveyed reported zero medical director time that year, and he said “it is in stark contrast to the 36.1% figure reported in PBJ data.”
He said that the contradictions required a more accurate and standardized mechanism to gain contributions, but also noted that presence alone is not sufficient to ensure quality clinical surveillance.
“While broader policy and technology-driven solutions take time to implement, resource-rich SNF chains can take immediate action,” writes Nazir. “Affiliation with experienced physician leaders will help establish a formal system for health managers' actions, including recruiting qualified professionals with well-defined expectations.”
Nazir told McKnight that CMS and experts within the nursing department should prioritize technology and surveillance partnerships with the Technology and Industry Association to assess whether current medical directors will function and facilitate role clarification.
Only after that, Nazir said CMS should consider creating additional rules that focus on increasing scrutiny and citations.
