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Medical directors: Key to quality care

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All nursing home caregivers are responsible for ensuring that residents receive quality care, but nobody bears a greater ultimate responsibility than the medical director, whose role is central to quality care.

Because hospitals discharge patients “sicker and quicker,” skilled nursing facilities (SNFs) must provide care to residents with medically complex conditions. Competent, committed healthcare practitioners are required to meet the challenges such residents present, and the role of the medical director in this process cannot be overemphasized.


The Medicare conditions of participation prescribe the role of a nursing home’s medical director. The applicable federal regulation states: “The medical director is responsible for–(i) implementation of resident care policies; and (ii) the coordination of medical care in the facility.”

Although the regulation has existed for more than 30 years, little guidance was available until June 9, 2005, when the Centers for Medicare & Medicaid Services (CMS) published advance guidance (PDF) regarding the medical director “tag” (F-tag 501). The guidance became effective on Nov. 18, 2005, and provides a road map for surveyors considering whether to cite a facility with a deficiency related to its medical director.1

Significantly, the “guidance” issued by CMS did not impose any new obligations on medical directors. Rather, the revised guidance articulates and clarifies the essential responsibilities of a medical director.


Although federal regulations require that a medical director be a licensed physician, no requirement exists that he or she be “certified.” Compelling reasons for medical director certification exist, however.

Nationally accepted standards regarding a medical director’s role and responsibilities have been promulgated by AMDA–The Society for Post-Acute and Long-Term Care Medicine, one time known as the American Medical Directors Association (AMDA). Under the auspices of the American Medical Directors Certification Program (AMDCP), medical directors who meet the educational requirements and successfully demonstrate competence in clinical medicine are eligible to receive the certified medical director in long term care (CMD) designation.

Since the program began in 1991, AMDA has certified more than 3,000 medical directors. The certification is valid for six years, and recertification is required beyond the initial six-year period.

A recent study illustrates the benefits of CMDs. The study examined the relationship of CMDs to quality of care in nursing homes. Based on an analysis of 547 SNFs with CMDs, the researchers concluded that the presence of a CMD improves quality by approximately 15 percent.

“The presence of [CMDs] is an independent predictor of quality in U.S. nursing homes,” the study concluded.2

Medical directors have a direct and substantial effect on quality care in the opinion of at least one owner/operator.


Alan C. Horowitz

Partner at Arnall Golden Gregory

Alan C. Horowitz

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