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LTC care quality: The medical directors' view

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While medical directors have overall responsibility for resident care in nursing facilities, their roles are inevitably intertwined with survey findings and any ensuing legal actions, whether from CMS or collateral legal quarters. Additionally, both medical directors and attending physicians play key roles in the survey process. Even though their primary role is a medical one, medical directors often help surveyors understand a resident’s complex pathology or how a certain resident outcome may have been unavoidable in spite of medical and nursing interventions.

During the 2017 AMDA—The Society for Post-Acute and Long-Term Care Medicine annual conference in Phoenix, I spoke with dozens of medical directors, many of whom I’m proud to say are personal friends. What struck me over and over again was the incredible level of dedication and compassion combined with current clinical understandings as they and their colleagues care for the most vulnerable and often medically challenging segment of our population.

What follows are excerpts from some of the leading certified medical directors (CMDs) in the country. I asked them about the strengths and the shortcomings of the current post-acute/long-term care (PA/LTC) industry and how the role of the medical director is changing.

What are some of the most rewarding aspects of being a medical director?

Dr. Charles Crecelius, MD: Seeing a quality improvement process improve the care of the residents while being well received by the staff. I know the process will be far more likely to be lasting when the staff take ownership.

Dr. Daniel Haimowitz, MD: In my facilities, I am treated as part of the administrative team with respect, and I feel like I’m a valued resource. At one facility, I was specifically brought in to be an “agent of change” (as it were), and we are making great strides. I enjoy the QAPI process—since it seems to me that QAPI is increasingly important in the PA/LTC world, I feel that I help to educate the staff and help the facility succeed. What’s more rewarding than that?

Dr. Karl Steinberg, MD: I love being a medical director because it allows me to be an educator, an advocate, a quality improver and a problem-solver. In my experience, people who choose to work in a nursing home are just great people, whatever their discipline... they feel it's a calling to help care for the most vulnerable, needy patients in our society. So, getting to be a leader among like-minded professionals often does not even feel like work.

What are some of the most challenging aspects of being a medical director in a nursing facility?

Dr. Crecelius: Dealing with the problems that never seem to go away—keeping pressure ulcer rates and injurious falls under control in a population that always seems to get more frail and medically complex.

Dr. Haimowitz: With the new models of medical care and changes in reimbursement, it is more important than ever to not only provide excellent care but to prove it with data. There’s an unwritten mandate to “do more with less,” and that is certainly one of the challenges for medical direction. I reach out to the attending physicians more than I have in the past.

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Alan C. Horowitz

Partner at Arnall Golden Gregory

Alan C. Horowitz

www.agg.com

Alan C. Horowitz, Esq., is a partner at...

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