Failure to Provide In-Person Physician Examinations for New Admissions
Penalty
Summary
The facility failed to provide evidence that the physician conducted required in-person examinations for all new admissions, as mandated. Record reviews for four residents admitted from short-term general hospitals revealed that there were no progress notes written by the physician in the electronic health records for any of these residents. Instead, all documented examinations and follow-up visits were completed by a Certified Nurse Practitioner (CNP), with the physician either participating via telemedicine or not mentioned as participating at all. The CNP's notes consistently indicated that evaluations were completed via telehealth or telemedicine, and there was no documentation of the physician being physically present for any of the required visits. Interviews with facility staff, including the Director of Nursing (DON), an LPN, and the CNP, confirmed that the physician typically attended meetings and resident visits virtually due to personal circumstances, specifically his inability to leave his wife. The DON and LPN both stated that the CNP usually conducted resident visits, with the physician participating remotely via telemedicine. The LPN described a process where nurses would initiate a video call with the physician and move the device from room to room, while most communication with the physician was conducted by phone. The CNP verified that visits were conducted virtually if indicated in the progress notes and acknowledged that the physician's participation was not always documented. The CNP also stated that the progress note would specify if the physician or CNP conducted any portion of the visit in-person, but in these cases, there was no such documentation. The lack of in-person physician examinations and insufficient documentation of physician involvement led to the deficiency cited by surveyors.