Note: this White Paper updates Resolutions A91, A03 and A06.
In 1974, in response to identified quality of care problems, Medicare regulations first required a physician to serve as medical director in skilled nursing facilities and to be responsible for the medical care provided in those facilities. Following the passage of the Nursing Home Reform Act in 1987, AMDA—Dedicated to Long Term Care Medicine (AMDA) House of Delegates, in March 1991, approved the Role and Responsibilities of the Medical Director in the Nursing Home, a document setting forth AMDA’s vision for nursing facility medical directors. It outlines the medical director’s roles in nursing facilities and is the foundation for:
- AMDA’s Certified Medical Director credentials;
- AMDA’s Model Medical Director Agreement and Supplemental Materials: Medical Director of a Nursing Facility and;
- Resolutions on medical direction in other long-term care settings.
Since 1991, the long-term care field has been affected by changes in medical knowledge, clinical complexity of patients, societal attitudes, legal influences, demographics and patient mix, reimbursement, and shifts in the scope of care in various settings. Increasingly, medical directors are held accountable by state legislators, regulators, and the judicial system for their clinical and administrative roles in these diverse facilities. At least one state1 has enacted legislation outlining the specific regulatory responsibilities and educational pre-requisites for medical directors, and other states may follow its lead.
The 2001 Institute of Medicine report Improving the Quality of Long Term Care urges facilities to give medical directors greater authority and hold them more accountable for medical services. The report further states, nursing homes should develop structures and processes that enable and require a more focused and dedicated medical staff responsible for patient care. These organizational structures should include credentialing, peer review, and accountability to the medical director (Institute of Medicine 2001, 140). These developments required AMDA to revise and update its 1991 document to develop a clearer vision for enhanced medical director responsibilities.
In April 2002, AMDA convened a panel to review the document in the context of changes within long-term care. Their work product outlined the medical director’s major roles in the facility and was geared toward ensuring that appropriate care is provided to an increasingly complex, frail, and medically challenging population. These concepts were considered when the Centers for Medicare & Medicaid Services revised the Surveyor Guidance related to F-Tag 501 (Medical Director) in 2005. This AMDA policy statement has therefore been updated to be congruent with current regulatory requirements and their related interpretive guidelines, and as such reflect the current roles and responsibilities of the medical director.
AMDA’s Core Curriculum Faculty has further developed and teaches the roles, functions and tasks of the medical director. The functions and tasks were last updated in 2009 to include person-directed care. This current document has been revised in late 2010 for presentation to the AMDA Board of Directors and the AMDA House of Delegates at the March 2011 meeting in Tampa, Florida. It is AMDA’s most recent position statement to harmonize the leadership role and management responsibilities of today’s medical director.
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