Frequently Asked Questions
Looking for Models of Cumulative Patient Profiles
This can be a problem because the EMR software most used in Ontario (Pointclickcare) does not have a Cumulative Patient Profile, but a “dashboard” which lists medical diagnoses by ICD10 codes.
The CPSO has a suggested template: https://www.cpso.on.ca/uploadedFiles/policies/policies/policyitems/Cumulative-Patient-Profile_samples.pdf which is an appendix to their Medical Records policy found at: http://www.cpso.on.ca/cpso/media/uploadedfiles/policies/policies/policyitems/medical_records.pdf
The template seen most often in family practice is described in a 1977 article found at: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2378816/ with an update by Ellison found at: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2218384/pdf/canfamphys00181-0069.pdf
Looking For a Standard Medical Director Job Description
There isn’t a standard Medical Director Job Description but the responsibilities and duties of the Medical Director are spelled out in the LTC Homes Act & regulations. Here are some excerpts from the legislation:
LTC ACT 2007 Section 72 specifies that the Medical Director:
shall advise the licensee on matters relating to medical care in the long-term care home; and
1. shall perform any other duties provided for in the regulations. 2007, c. 8, s. 72 (3).
2. and
3. (4) In performing his or her duties under clause (3) (a), the Medical Director shall consult with the Director of Nursing and Personal Care and other health professionals working in the long-term care home. 2007, c. 8, s. 72 (4).
4. The Medical Director’s role with medical staff is that the attending physician and nurse practitioner are accountable to the medical director for “meeting the home’s policies, procedures and protocols for medical services”
In the Medical Director Regulations section 214 there are more specifics:
5. “The Medical Director has the following responsibilities and duties:
Development, implementation, monitoring and evaluation of medical services
Advising on clinical policies, procedures, where appropriate
Communication of expectations to attending physicians and registered nurses in the extended class
Addressing issues relating to resident care, after hours coverage and on-call coverage
Participation in interdisciplinary committees and quality improvement activities.”
These requirements form the basis of any job description.
Is There Data to Indicate the Percentage of NH's Which Have Upped The MD Stipend To $0.36 From $0.31 As Facilitated By The Ministry In 2012?
We have not done a formal survey of our members to get more precise data; and I am not aware of any other survey done by the sector associations OAHNSS or OLTCA. Since there is no requirement to report to the Ministry or anyone else on what an individual home did with the increase, the provincial data may not exist.
Does the bonus still apply to how many patients you look after in a nursing home? i.e., $2000/yr. for 12 LTC patients and $5000/yr. for more than 36 patients?
Please contact the OMA which would know or be negotiating what changes have been made/proposed to the funding agreement with the government: negotiations@oma.org
Transitioning Over to A FHO And Have Questions Regarding How to Register and Bill LTC Residents in This Setting.
Rostering in any practice model depends on the local situation. If physicians who are not part of the FHO are providing coverage there may be negation to the physician’s roster fees; there also have been restrictions placed on billing in LTC homes and receiving rostering fees. Your best bet is to clarify this with your OHIP office, alternatively the Economics department of the OMA.
Does the OLTCC Have Tools with Which We Can Undertake Quality Audits of Our Medical Services.
The answer depends on what you mean by “quality audits of medical services”. If this means a review of whether the services required are being provided, usually the medical director plays a role in ensuring that the attending physicians meet legislative requirements and the obligations stipulated in their contracts, such as:
completion of annual physicals
assessment of acute changes of condition a timely manner
availability of the on-call physician to assess the patient in person if appropriate etc.
Since medicine is a self-regulated profession, the actual quality of medical care is assessed through the peer assessment process of the College of Physicians and Surgeons; with the goal of assessing every physician’s practice every ten years. The actual protocol used in this process is found at: < http://www.cpso.on.ca/uploadedFiles/members/peerassessment/Long-Term-Care-Report.pdf>. Some physicians refer to this document in preparing for their peer assessment, the process is not suitable for assessment by a facility operator or a different professional.
Requested A Performance Review of The Docs, Including Whether They Have Fulfilled Their Contractual Obligations.
If you have not been doing annual performance reviews, this is your opportunity to put that practice in place. It is your opportunity to:
discuss with your DOC/administrator whether there were concerns that they wish addressed.
implement an annual review
perform an audit of whether annual assessments and other requirements are being done
find out if there are issues that you can help the attending physicians with, to enable better care
The LTC Homes Act and Regulations 79/10 can be found on the e-laws website of the government of Ontario (enter “long term care” into the search box). The legislation is fairly clear:
The facility has an obligation to ensure that, under the LTC homes act s.12, there is “an organized program of medical services in the Home”. Further, the Regulations section 83 stipulate that “An attending physician must enter into a written agreement with the Home that includes the term of the agreement, the Home’s responsibilities and the physician’s responsibilities or duties, including the physician’s accountability to the Medical Director for meeting the Home’s policies, procedures and protocols for medical services, provision of medical services, and provision of after-hours and on-call coverage”
Under the Regulations s. 214 for the LTC Homes Act the Medical Director has the following responsibilities and duties:
Development, implementation, monitoring and evaluation of medical services
Advising on clinical policies, procedures, where appropriate
Communication of expectations to attending physicians and registered nurses in the extended class
Addressing issues relating to resident care, after hours coverage and on-call coverage
Participation in interdisciplinary committees and quality improvement activities
The attending physician responsibility for provision of medical care include:
Comprehensive admission and annual assessment, including history and physical examination, and review of available medical records
Development of a treatment plan in concert with other team members, the resident, and the family that is consistent with the resident’s needs and goals of care
Periodic monitoring of chronic health problems at appropriate intervals, using diagnostic testing, consultation, and interventions as warranted
With regard to on-call responsibilities:
The Physician on Call Program states, under section 4.2 Physician Eligibility, that the physician “(b) provides on-call coverage to the LTCH after-hours by:
(i)being available by phone during the on-call period.
(ii) being available to attend, in person, to the Home in a timely manner when, in the reasonable professional opinion of the physician, medically necessary; and
(iii) responding, in a timely manner, to the Home when providing coverage to more than one home. “
We have suggested (in the LTC Medical director course) that the annual performance review include whether the attending MD is meeting their obligations under their contract and:
Attending at agreed frequency – minimum of once a week, approximately a half day per 25 residents
Meeting clinical care requirements
Documenting completely and legibly
Engaging in CME relevant to long term care
Providing feedback – what the attending MD needs from you or the facility to provide better care effectively and efficiently
Accepting feedback from facility & health care team
Your facility may be cited in a compliance inspection if there is not a physical exam by the attending MD on admission and annually, or participation in after hours on call.
Questioning The Required Frequency of Meds Reviews in LTC (I.E. Quarterly/Every 3 Months).
The Meds Reviews take a lot of time and energy to be done and also takes nursing time and pharmacy time.
Compensation
The current rate of compensation from the ministry is $0.30/resident/day. Several years ago, they provided an option of an additional discretionary amount of $0.06/resident/day, that could be directed one of two ways. Many homes opted to use this additional funding for their medical directors so the standard rate is $0.36/resident/day, with some homes paying less and some paying more. Anybody who receives less than $0.36 negotiates with their homes to receive this amount. Anything above this needs to come out of the home’s operating budget and may not be feasible.
There is no on-call stipend for the medical director. The on-call stipend is for clinical services only, which is paid to all attending physicians in the home at a rate set by the Ministry. This rate is not generally negotiable with the homes.
It Was Recommended the Home Provide Proof of Insurance for The Medical Director's Responsibilities. Is There a Sample or Type of Wording to Be Used in The Contract.
Medical Directors are not covered under CMPA for their administrative (non-clinical) duties. The following language may be added to medical director agreements:
" The (home) agrees to purchase and maintain in force and for the term of the agreement, Commercial General Liability insurance, which policy shall apply to the performance of the Services, but only while the Medical Director is performing Services for (the home) as set out in this agreement".