Role of a Treating Physician for Long-Term Care Residents

Residents in long-term care facilities have the right to choose their treating physician. This right is supported in federal and state law. See 42 C.F.R. § 483.10(d); O.C.G.A. § 31-8-108(b)(1). As a practical matter, however, most physicians, don’t make house calls to the facility. This mean, by default, most residents are treated by the facility’s medical director.

The Treating Physician Will:

Evaluate the patient and write a report detailing the physical examination within a certain number of days prior to admission or following admission. 42 C.F.R. § 483.20(a) says the facility must have physician orders for the resident’s immediate care.
Evaluate the patient as needed and at least every 30 days. An alternate schedule is permissible. The physician must document evaluations in the medical record. 42 C.F.R. § 483.30(c)
Supervise the patient’s care. 42 C.F.R. § 483.30(a). Evaluate the patient and review orders and treatment upon any change of physicians.
Determine the patient’s diagnoses.
Provide advice and treatment, and determine the appropriate level of care for each patient.
Write and sign orders for diet, care, diagnostic tests, and treatment of the patient by others.
Obtain the patient’s informed consent for the use of restraints and psychotropic medications.
Obtain informed consent from the patient or the patient’s health care agent in situations where a reasonable patient could not or would not be aware of the consequences of a given treatment decision without obtaining specific information from the physician. Determine what information is needed by the patient in order to make the consent meaningful.
Ensure that all care rendered by non-physician practitioners is legally authorized and that they are appropriately supervised.
Write progress notes and other appropriate entries in the patient’s chart. 42 C.F.R. § 483.30(b)(2).
Provide for alternate physician coverage if the attending physician is not available. 42 C.F.R. § 483.30(a)(2).