by Michael Wasserman, MD, CMD

One of the ongoing challenges in the delivery of care to residents of nursing facilities is to sort out where the care needs of a resident mesh with their medical needs.  One thing is certain, and that is for a nursing home to provide the best care for its residents, it requires a team approach.  Clearly, the front-line staff are responsible for most of the direct care that residents receive.  Nurses and therapists are on-site to provide necessary and prescribed medically oriented care.  The residents have an attending physician who is responsible for their medical needs. The facility has a medical director.  

At the present time, the role of the medical director varies from facility to facility.  In trying to ascertain the specifics of this role, it is instructive to look at F Tag 501.  This states that 1) The facility must designate a physician to serve as medical director, and 2) The medical director is responsible for i) Implementation of resident care policies, and, ii) Coordination of medical care in the facility.  One should not be surprised that the interpretation of this guidance is variable.  Under such circumstances we should try to find data to support the most effective role of medical directors.  Fortunately, such information exists.

In 2009, Rowland published an article in JAMDA (the Journal of the American Medical Directors Association) entitled “Impact of Medical Director Certification on Nursing Home Quality of Care.”  The study looked at a standardized quality score of facilities with fully certified medical directors (CMDs) and found a 15% improvement in quality.  The conclusion was that “the presence of CMDs is an independent predictor of quality in U.S. nursing homes.”  Of note, the study was not perfect.  The control group may have included facilities with certified medical directors that hadn’t been reported as such, which would actually have diluted the impact of the study.  It is therefore quite possible that certified medical directors actually have a greater impact on quality in nursing facilities.

What can a facility do to assist their medical director in obtaining their CMD?  First, they should support membership in AMDA (The Society for Post-Acute and Long-Term Care Medicine) and CALTCM.  They should also support the completion of the Core Curriculum on Medical Direction (http://www.abplm.org).  As a facility medical director, it’s important to encourage your facility to support you in all of these endeavors.