Failure to Alternate Physician and APRN Visits as Required
Penalty
Summary
The facility failed to ensure that residents were seen by a physician at the required intervals, specifically not alternating physician visits with those of Advanced Practice Registered Nurses (APRNs) every sixty days as mandated. Clinical record reviews for three residents with complex medical histories, including diabetes, chronic kidney disease, dementia, and chronic obstructive pulmonary disease, revealed that after the initial admission visit by the physician, subsequent required visits were conducted only by APRNs. There was no documentation of physician visits or assessments in the residents' charts for extended periods, in some cases spanning over two years. Interviews with facility staff, including the Director of Nursing Services (DNS), APRNs, and the Medical Director, confirmed that the physician was not conducting or documenting the required alternating visits. The Medical Director stated that she only completed the initial admission visits and considered further documentation redundant due to the APRNs' involvement. She also indicated that she was aware of the regulatory requirement for 60-day physician visits but cited resource constraints and the independent practice status of the APRNs as reasons for not adhering to the requirement. The APRNs confirmed that they were responsible for the majority of routine and follow-up visits, including annual comprehensive assessments and 60-day interval visits. The facility was unable to provide a policy outlining the requirements for physician visits and annual physicals when requested. The lack of physician documentation and failure to alternate visits between the physician and APRNs as required led to the deficiency. The findings were based on clinical record reviews, staff interviews, and the absence of relevant facility policies.