Failure to Ensure Timely Physician Visits for Residents
Penalty
Summary
The facility failed to ensure that residents were seen by a physician at the required intervals as mandated by regulation. Specifically, four residents were not seen by a physician at least once every 30 days for the first 90 days after admission, and ten additional residents were not seen at least once every 60 days thereafter. Documentation reviewed for these residents showed significant lapses in the required physician visits, with some residents only being seen once or not at all within the required timeframes. The medical records for these residents included diagnoses such as pneumonia, diabetes, acute metabolic acidosis, dependence on renal dialysis, heart disease, fractures, osteoporosis, depression, and other chronic conditions. Many of these residents were also noted to have severe or moderate cognitive impairment and were receiving complex medication regimens, including antipsychotics, antidepressants, anticonvulsants, and hypoglycemics. Interviews with facility staff revealed a lack of awareness and understanding of the regulatory requirements for physician visit frequency. The DON confirmed that nurse practitioners were not utilized and that physician assistants assisted only once a week. The Administrator stated that the facility followed a schedule of physician visits every 30 days for new admissions and every 90 days thereafter, which does not align with the regulatory requirement of every 60 days after the first 90 days. The Medical Director also stated he was not aware of the 60-day requirement and believed visits every three months were sufficient. He relied on nursing staff to communicate any patient problems and had not discussed visit frequency with the DON or Administrator. Record review and staff interviews confirmed that the facility did not have a clear policy or consistent practice to ensure compliance with the required physician visit schedule. The documentation provided by the facility often included hospital records or telehealth/telephone visits instead of in-person physician visits, and in some cases, no recent physician visit could be found in the medical record. The lack of timely physician visits was identified for residents with significant medical and cognitive needs, and the surveyors noted that these failures could place residents at risk for medical conditions not being identified and care needs not being met.