Table 4.

Competencies for the Attending Physician in the Nursing Homes

1. Foundational (ethics, professionalism, and communications)   1.1 Addresses conflicts that may arise in the provision of clinical care by applying principles of ethical decision making 1.2 Provides and supports care that is consistent with (but not based exclusively on) legal and regulatory requirements 1.3 Interacts with staff, patients, and families effectively by using appropriate strategies to address sensory, language, health literacy, cognitive, and other limitations 1.4 Demonstrates communication skills that foster positive interpersonal relationships with residents, their families, and members of the interdisciplinary team (IDT) 1.5 Exhibits professional, respectful, and culturally sensitive behavior toward residents, their families, and members of the IDT 1.6 Addresses patient/resident care needs, visits, phone calls, and documentation in an appropriate and timely fashion

2. Medical Care Delivery Process   2.1 Manages the care of all post-acute patients/LTC residents by consistently and effectively applying the medical care delivery process—including recognition, problem definition, diagnosis, goal identification, intervention, and monitoring of progress 2.2 Develops, in collaboration with the IDT, a person-centered, evidence-based medical care plan that strives to optimize quality of life and function within the limits of an individual’s medical condition 2.3 Estimates prognosis based on a comprehensive patient/resident evaluation and available prognostic tools and discusses the conclusions with the patient/resident, their families (when appropriate), and staff 2.4 Identifies circumstances in which palliative and/or end-of-life care (e.g., hospice) may benefit the patient/resident and family 2.5 Develops and oversees, in collaboration with the IDT, an effective palliative care plan for patients/residents with pain, other significant acute or chronic symptoms, or who are at the end of life

3. Systems   3.1 Provides care that uses resources prudently and minimizes unnecessary discomfort and disruption for patients/residents (e.g., limited nonessential vital signs and blood glucose checks) 3.2 Can identify rationale for and uses of key patient/resident databases (e.g., minimum Data Set [MDS]) in care planning, facility reimbursement, and monitoring of quality 3.3 Guides determination of appropriate levels of care for patients/residents, including identification of those who could benefit from a different level of care 3.4 Performs functions and tasks that support safe transitions of care 3.5 Works effectively with other members of the IDT, including the medical director, in providing care based on understanding the general roles, responsibilities, and levels of knowledge and training for those of various disciplines 3.6 Informs patients/residents and their families of their health care options and potential impact on personal finances by incorporating knowledge of payment models relevant to the post-acute and LTC setting

4. Nursing Home Medical Knowledge   4.1 Identifies, evaluates, and addresses significant symptoms associated with change of conditions, based on knowledge of diagnosis in individuals with multiple comorbidities and risk factors 4.2 Formulates a pertinent and adequate differential diagnosis for all medical signs and symptoms, recognizing atypical presentation of disease, for post-acute and LTC residents 4.3 Identifies and develops a person-centered medical treatment plan for diseases and geriatric syndromes commonly found in post-acute patients and LTC residents 4.4 Identifies interventions to minimize risk factors and optimize patient/resident safety (e.g., prescribes antibiotics and antipsychotics prudently, assesses the risks and benefits of initiation or continuation of physical restraints, urinary catheters, and venous access catheters) 4.5 Manages pain effectively and without causing undue treatment complications 4.6 Prescribes and adjusts medications prudently, consistent with identified indications and known risks and warnings

5. Personal QAPI (Quality Assurance and Professional Improvement)   5.1 Develops a continuous professional development plan focused on post-acute and LTC medicine, utilizing relevant opportunities from professional organizations (AMDA, AGS, AAFP, ACP, SHM, American Academy of Hospice and Palliative Medicine), licensing requirements (state, national, province), and maintenance of certification programs 5.2 Utilizes data (e.g., Physician Quality Reporting System indicators, MDS data, patient satisfaction) to improve care of their patients/residents 5.3 Strives to improve personal practice and patient/resident results by evaluating patient/resident results by evaluating patient/resident adverse events and outcomes (e.g., falls medication errors, healthcare-acquired infections, dehydration, rehospitalizations)

Notes: AAFP = American Academy of Family Physicians; ACP = American College of Physicians; AGS = American Geriatrics Society; LTC = long-term care. From Katz et al., 2014. Copyright 2014 by HMP Communications LLC.