Nursing home leadership should intensify efforts to include their medical directors in regular team meetings, analyses of care issues and agenda-setting, according to a physician expert, who added that a “minimalist” role for facility physician leaders will no longer suffice.
Greater collaboration is even more vital in a US long-term care setting increasingly dependent on value-based reimbursements, said Arif Nazir, MD, chief medical officer for Adobe Care Partners, at an American Association of Post-Acute Nursing event on Wednesday.
“The value-based evolution of our health systems has been painful but was much needed to set structures of accountability and quality,” he told McKnight’s Long-Term Care News in a followup interview Thursday. “Success within these structures will require an unprecedented focus on physician and other practitioners’ collaboration with the nursing staff in all settings, particularly in post-acute and long-term care.”
Nazir noted that medical directors have the expertise to help nursing home leadership pinpoint concerning trends in care outcomes, make evidence-based recommendations and even help create better relationships with third parties such as long-term care pharmacies.
A key place where this collaboration can take place is at regular Quality Assurance and Performance Improvement (QAPI) meetings, Nazir said.
“I really think the MD’s involvement in QAPI is so important,” agreed Amy Stewart, vice president of curriculum development at AAPACN and the event’s host. “[The medical director is] another important member of the team and a required member of the team. They really want to move the quality meter.”
However, Nazir heavily stressed the importance of setting up weekly check-ins when possible, regardless of when they are.
“I think those key players need to be meeting at least weekly,” Nazir told attendees — referring to medical directors and nursing home leaders such as directors of nursing. “Sitting down and going over how the week went, what is the strategic agenda … what are the quality metrics showing — really getting a quick pulse check.”
Nazir also noted that this form of collaboration can help medical directors be more aware of the challenges faced by long-term care providers, and be more accessible to the team of care workers in the nursing home.
He recommended that nursing home leaders walk around the facility with the medical director, being seen by staff and breaking the ice where necessary.
Medical directors also can be useful educational sources facilities, he said. They could, for example, provide supplemental education materials for staff — perhaps to focus on any trending problem areas of care in the facility. Medical directors could spearhead efforts to drive up staff vaccination rates, he offered as an example.
Nazir noted that most problems nursing homes have with their medical directors are communication issues — issues that can be resolved productively, and increasingly need to be proactively resolved to achieve the best possible care outcomes and efficiencies.
“The minimalist role that medical directors used to play in the past will not suffice and they will be required to fully engage and partner with their teams in all aspects of quality,” Nazir told McKnight’s.
