Physicians play a crucial role in supervising the care of residents in nursing facilities. Physician visits should be thorough and comprehensive, encompassing an evaluation of the resident’s condition, review of medications and treatments, and a review of the plan of care– directing any necessary adjustments to ensure optimal management of residents’ health care.
Review of the Total Program of Care
During each visit, the physician or non-physician practitioner (NPP), must review the resident’s total program of care, write, sign and date progress notes, and sign and date all orders, with the exception of influenza and pneumococcal vaccines, which may be administered per a physician-approved facility policy after assessing for contraindications.
Total program of care refers to all of the care provided by the facility to maintain or improve the residents’ highest practicable physical, mental, and psychosocial well-being, as defined by the comprehensive assessment and plan of care. While it is not necessary for the physician to review the total plan of care during each visit, they must review the total plan of care during visits required by §480.30(c), F712, which governs the frequency of physician visits.
Frequency of Physician Visits
The regulations require that a resident be seen by a physician at least once every 30 days for the first 90 days after admission, and at least once every 60 days thereafter. A physician visit is considered timely if it occurs no later than 10 days after the date the visit was required.
In a skilled nursing facility (SNF), the initial comprehensive physician visit must take place within the first 30 days of the resident’s stay. This initial visit must be conducted personally by the physician. After the initial visit, the non-physician practitioner (NPP), if permitted by state law, can alternate visits with the physician.
In a nursing facility (NF), a non-physician practitioner working collaboratively with the physician and not employed by the facility may perform the initial comprehensive visit, as allowed by state law.
In a facility where the beds are dually certified for Medicare and Medicaid, the resident’s payer should set the standard for physician visits and allowable delegation of tasks to an NPP.
The table below, Authority for Non-Physician Practitioners to Perform Visits, Sign Orders, and Sign Medicare Part A Certifications/Re-certification when Permitted by the State, is adapted from the State Operations Manual.
Facility QAPI efforts should include designating a member of the facility team to oversee physician visit compliance to ensure that residents are seen at the required intervals and by the appropriate provider and that documentation standards are upheld, including signature requirements.
To learn more about regulatory requirements related to Physician Services, plan to join our July 11, 2023 Deep Dive Into Federal Regulations in a Year webinar. This session will include a review of strategies to avoid citations related to Physician and Nursing Services, strategies for successfully managing the survey process and understanding the critical element pathways used to guide surveyor investigations.
Written By: Brandy Hayes, RN, RAC-CT, RAC-CTA
Clinical Consultant
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