(July 16, 2014): In 2005, the Centers for Medicare and Medicaid Services (CMS) revised and implemented surveyor guidance pertaining to the role of medical directors in long-term facilities. This guidance gives surveyors and providers more information about the role of a medical director, which is outlined in regulation 42 C.F.R. §483.75 (i). It also helps give providers an idea of how to avoid an Office of the Inspector General (OIG) enforcement action against them for alleged questionable medical directorship arrangements with physicians.
I. CMS Guidelines on the Role of a Medical Director:
CMS’s original guidance states that facilities must designate a physician to serve as medical director. It also specifies that the medical director is responsible for implementation of resident care policies, as well as the coordination of medical care in the facility. The CMS guidance requires that the medical director has input and guides the development and implementation of resident care policies, but it does not require a medical directors to single-handedly put the policies into practice or monitor implementation. According to CMS, the facility has to prove with sound evidence that the medical director had input in the review of policies and procedures, and that these policies and procedures reflect the current standard of practice.
The other critical role of a medical director is the coordination of medical care. Coordinating medical care includes organizing, directing, and managing care from appropriate health care providers to meet the health care and psychosocial needs of residents. The medical director is an important link between the facility, attending physicians, and other providers. He is tasked with promoting a common understanding of the “big picture” for individual residents.
II. Reducing Your Level of Risk:
To reduce the risk of non-compliance with CMS guidelines, facility boards should implement certain policies and procedures specifically dealing with medical directors that reflect the CMS guideline policies. For one thing, medical directorships should be reflected in written agreements and satisfy the requirements of all other relevant laws, including the Stark law and Anti-Kickback law. A database of all these agreements should be maintained and should include a reliable tracking system to ensure that each agreement is reviewed periodically. Such monitoring on an annual basis of all medical director agreements can ensure that in each case the medical director is actually providing the services required and is being paid the compensation set forth in his agreement.
To prove that the medical director is implementing resident care policies, hospital boards should check to make sure medical directorship services are legitimate and important in order for the facility to carry out its clinical functions.
To prove their role in coordinating medical care in the facility, medical directors should complete a daily written log specifying each task performed and the amount of time spent performing the task.
III. Final Remarks:
CMS’s guidance pertaining to the regulation is useful to all providers and medical directors because it shows what will be looked at to determine whether a legitimate, bona fide medical directorships exists. If a medical director has real duties and responsibilities that are actually performed and documented, this will differentiate him from a sham medical directorship arrangement designed to reward referrals and pay kickbacks. This is especially important as the government continues to aggressively enforce efforts against providers who engage in illegal kickback practices and violations of the Stark law.
Robert W. Liles, Esq., is a Managing Partner at Liles Parker, Attorneys & Counselors at Law. He focuses his practice on internal audits/investigations, fraud defense, and compliance and regulatory matters. The attorneys at Liles Parker represent a wide variety of health care providers and suppliers in administrative and civil proceedings. For a free consultation, call Mr. Liles at: 1 (800) 475-1906.