Our next “Ftag of the Week” on the CMSCG Blog is part of the Resident Rights regulatory group, F555 Right to Choose/Be Informed of Attending Physician. As the name of the regulation implies, the requirements under F555 reflect the idea that nursing home residents have the right to choose their own physician, so long as the physician is appropriately licensed to practice. Whether the resident and/or resident representative decides to choose the attending physician without assistance from the facility, or the facility assists with identifying physician options, this regulation is in place to ensure the resident is involved in the process and that his/her preferences are honored.
Physician Selection Scenarios – and Regulatory Requirements
While residents retain the right to choose their physician, they are not required to do so, nor can a physician be required to provide services to a resident solely because the resident chose that particular physician. The regulation states that facility staff are not permitted to interfere in the physician selection process for the resident but are expected to assist with identifying a replacement physician in several circumstances.
If the physician that a resident has selected is unwilling/unable to provide services, the facility is required to inform the resident of this. The facility is also required to identify alternate physician options, discuss the alternate options with the resident/ representative and honor the resident’s preferences if he/she has any regarding the options presented. The resident may also identify another attending physician who meets regulatory requirements, and the facility is required to honor the resident’s choice in physician in that circumstance.
However, if the facility determines that the attending physician selected by the resident is not fulfilling his/her duties, then the facility’s Medical Director must speak with the attending physician and attempt to work with the physician/ mediate any issues before the facility can request an alternate physician. The facility is responsible for notifying the resident/ representative ahead of consulting a different physician.
The facility is also responsible for ensuring that each resident remains informed on information about his/her physician, including the physician’s name, specialty and contact information. Information about others providing care for the residents should also be provided. Many facilities have a number of PAs and NPs on staff or there as part of a physician practice group providing services so this information should be available to the residents as well. Also, don’t forget information on consultant physicians who visit routinely for psychiatry, psychology, wound care, etc. should also be available to the resident. The resident deserves to know who the physician is who shows up to provide consultation.
There are two other items noted in the IG that are related to where there are circumstances where practice privileges have to be met before the physician can be selected:
- CCRCS – If a nursing home contained within a CCRC has a list of physicians with practice privileges at the CCRC, and the resident chooses on of these, then the “free choice” requirement is met.
- Distinct Part of Acute Care Hospital – If a resident is in a distinct part of a general acute care hospital, he/she can choose his/her own physician, but if the hospital requires physicians in that distinct part to have privileges, then the resident could not choose a resident who lacked those privileges.
Issues related to a resident’s right to choose his/her attending physician and to be kept informed of that information can be identified through resident/representative interviews, as well as staff interviews. This is not frequently cited on survey, but the following are some actual survey citations so you can see how this could be identified on survey:
Recertification Survey Citation – F555 S/S: C
During a Resident Council interview, residents told the surveyor that they were concerned that they had to use the facility’s Medical Director as their Attending Physician or they were not allowed to remain in the facility. The Director of Nursing told the surveyor that she had received complaints about the Medical Director before from residents, and that he did not have a great bedside manner but was the only physician with privileges in the facility at that time. The Admissions staff was interviewed and noted that residents/ representatives were told ahead of time that the Medical Director was the only physician for the facility, although she was aware of the requirement that residents be able to choose their own physician. She further stated that sometimes residents went to another facility or voluntarily discharged to home when they found out that they could not use their own physicians.
Recertification Survey Citation – F555 S/S: D
A resident reviewed for choices was interviewed and stated she did not get to select the doctor that was assigned to her since the facility only had one doctor. She further stated that she did not know the doctor’s name or his contact information. An RN was interviewed and told the surveyor that there were two doctors per floor who were both in the facility daily and residents were divided between them, with residents being able to change doctors if they chose to. The Assistant Director of Nursing stated that if a resident wants to change the assigned doctor, then he/she can let staff know and then the Medical Director will select a different doctor unless the resident has a preference.
As is the case with ensuring residents’ other choices and preferences are honored, it is important to ensure residents are satisfied with their physician, or an alternative is identified if necessary. You have the responsibility for ensuring that residents are advised of their rights upon admission to the facility, including the process for notifying the appropriate staff member if there is a need for a change in physician. It might be in your best interest to interview the resident after they have “settled in” and follow-up on how much he/ she actually knows about their attending physician, including the physician’s name, and what to do if they want to change their physician. No one is going to remember all of the information that they are bombarded with at the time of admission. Hopefully, all of your medical staff keep their bedside manner polished and don’t require reminders!