PHYSICIAN ESSENTIAL JOB FUNCTIONS AND TASKS
Initial Patient Care/Care Transitions
The attending physician should assess a new admission in a timely fashion, based on a joint physician-facility-developed protocol and, depending on the individual's medical stability, recent and previous medical history, presence of significant or previously unidentified medical conditions, or problems that cannot be handled readily by phone.
The attending physician will:
- Seek, provide, and analyze needed information regarding a patient's current status, recent history, and medications and treatments, to enable safe, effective continuing care and appropriate regulatory compliance;
- Provide appropriate information and documentation to support the facility in determining the level of care for a new admission;
- Authorize admission orders in a timely manner, based on a joint physician-facility-developed protocol, to enable the nursing facility to provide safe, appropriate, and timely care; and
- for a patient who is to be transferred to the care of another health care practitioner, continue to provide all necessary medical care and services pending transfer until another physician has accepted responsibility for the patient.
Physician Regulatory Visits
Comprehensive regulatory patient visits, in coordination with the facility’s overall plan of care for a
resident, establish and guide the total program of care for each resident. The intent of these visits
is to have the physician take an active role in supervising the care of residents. This should not
be a superficial visit but should include an evaluation of the resident’s condition and a review of
and decision about the continued appropriateness of the resident’s current medical regimen.
The attending physician should:
- Maintain a schedule of visits appropriate to the resident's medical condition depending on the patient's medical stability, recent and previous medical history. The frequency of visits shall be no less often than once every 30 days for the first 90 days after admission, and at least once every 60 days thereafter.
- Review the resident's total program of care, including medications and treatments, at each regularly scheduled visit, including reasons for changing or maintaining current treatments or medications, and a plan to address relevant medical issues. The total program of care includes all care the facility provides residents to maintain or improve their highest practicable mental and physical functional status, as defined by the comprehensive assessment and plan of care. Care includes medical services and medication management, physical, occupational, and speech/language therapy, nursing care, nutritional interventions, social work and activity services that maintain or improve psychosocial functioning.
- Periodically review all medications and monitor both for continued need based on validated diagnosis or problems and for possible adverse drug reactions. The medication review should consider observations and concerns offered by nurses, consultant pharmacists and others regarding beneficial and possible adverse impacts of medications on the patient.
- Properly define and describe patient symptoms and problems, clarify and verify diagnoses, relate diagnoses to patient problems, and help establish a realistic prognosis and care goals.
- Participate as a member of the interdisciplinary care team in the development and review of the resident's comprehensive care plan with the understanding that the minimum level of physician participation in interdisciplinary development and review of the care plan shall be a person-to-person conference with the registered professional nurse who has principal responsibility for development and implementation of the resident's care plan.
- Determine the progress of each patient's condition at the time of the regulatory visit by evaluating the patient, talking with staff as needed, talking with responsible parties and/or family as indicated, and reviewing the relevant information, as needed.
- In consultation with the facility's staff, determine appropriate services and programs for a patient, consistent with diagnoses, conditions, prognosis, and patient and family goals and wishes, focusing on helping patients attain their highest practicable level of functioning in the least restrictive environment. Conduct or arrange for palliative care counseling and pain management interventions when the resident is determined to be terminally ill or has a life-limiting condition that may benefit from these services.
- Prepare, authenticate and date progress notes at each visit.
- Maintain progress notes that cover pertinent aspects of the resident’s condition and current status and goals.
- Provide documentation needed to explain medical conclusions and decisions; permit effective, timely resident care.
- Over time, documentation related to physician visits should address relevant information about significant ongoing, active, or potential problems and cover at least the following:
- Status of chronic medical conditions;
- Status of any recent or current symptoms or changes in condition;
- Pertinent physical findings;
- How the individual’s acute and chronic conditions affect functioning, quality of life, nutrition, hydration, cognition, mobility, prospects for improvement, and ability to socialize and participate in activities (for example, how a recent episode of pneumonia or exacerbation of COPD affected anticipated functional improvement);
- Clinically important abnormal lab results
- The rationale for substantial changes in medication and treatment orders, including identification and management of complications of existing medications and treatments, and ensure that each medication has an indication for continued usage;
- Identified special needs such as dental services or restorative care
- Review of the pertinence of the overall plan of care
- Evaluation of any discharge potential.
Physician Acute Illness Visits
Acute illness visits should be performed to meet the medical needs of the complex residents in the nursing home.
APPROPRIATE CARE FOR RESIDENTS
The attending physician should:
- In consultation with facility staff, ensure that treatments, including rehabilitative efforts, are medically necessary and appropriate in accordance with relevant medical principles and regulatory requirements;
- In consultation with the facility staff, manage and document ethics issues consistent with relevant laws and regulations and with patients' wishes, including advising patients and families about formulating advance directives or other care instructions and helping identify individuals for whom aggressive medical interventions may not be indicated; and
- Provide orders that ensure individuals have appropriate comfort and supportive care measures as needed, for example, when experiencing significant pain or in palliative or end-of-life situations.