THE NURSING-HOME MEDICAL DIRECTOR ROLE IN TRANSITION

Objective: To compare the self-reported role of nursing home medical directors in 1989 (prior to the implementation of the nursing home reform amendments of OBRA 87 in 1990) with the role outlined in the Joint Commission on Accreditation of Healthcare Organizations Long Term Care Standards Manual. Design: Survey. Measurements: Using a telephone interview survey, physicians were questioned about their role as nursing home medical director. Responses were compared with the definition of the medical director's role in the Long Term Care Standards Manual. Information about time spent per month and reimbursement received for medical direction was also obtained. Participants: Physicians serving as nursing home medical directors in 1989 in Houston/Harris Count , Texas. Results: Of 50 nursing home medical director positions in Houston/Harris County in 1989, interviews were completed for 36 (72%). The majority of the medical directors met the criteria for having a signed agreement with the facility, assuring continuous medical coverage, developing emergency procedures, and participating in quality assurance activities. Twenty-eight percent of the medical directors received no monetary compensation for their work. Of those who were paid, the mean monthly earnings for nursing home medical direction were $345. Conclusion: Although all nursing facilities are now required by regulation to have medical directors, a wide variation in medical directors' level of involvement and commitment was documented.