Failure to Provide Required Face-to-Face Physician Visits
Penalty
Summary
The facility failed to ensure that residents received required face-to-face physician visits at least once every 60 days, as mandated by federal regulations. For three sampled residents, documentation and interviews confirmed that either the required in-person visits did not occur within the specified timeframes or that only telehealth/virtual visits were conducted instead of face-to-face encounters. Specifically, one resident did not have a face-to-face physician visit for an eight-month period, and for two other residents, all physician visits during the review period were conducted virtually. The residents affected had significant and complex medical histories, including acute respiratory failure, post-traumatic stress disorder, anxiety disorder, chronic pain syndrome, gastro-esophageal reflux disease, post laminectomy syndrome, toxic encephalopathy, quadriplegia, spastic cerebral palsy, depression, developmental disorder of scholastic skills, acute kidney failure, hemiplegia, hemiparesis, muscle weakness, and a history of falls. Their cognitive status ranged from moderately impaired to moderate cognitive impairment, as indicated by their BIMS scores. Interviews with facility staff, including a Registered Nurse Consultant and the MDS Nurse, confirmed that the required face-to-face physician visits were not provided, and that telehealth visits were used instead. The facility administrator acknowledged that the prior contracted physician services were terminated due to failure to provide agreed face-to-face services. Review of federal regulations and facility policy confirmed that in-person physician visits are required and that telehealth visits do not meet this requirement.