Image of female doctor talking with male patient

Nursing homes will have to publicly disclose information about their medical directors, along with other managing employees, under a new transparency rule from the Centers for Medicare & Medicaid Services.

The change is cause for celebration according to AMDA–The Society for Post-Acute and Long-Term Care Medicine. The group said it had been advocating for a public database of nursing home medical directors for more than a decade, according to a Nov. 17 press release.

“AMDA has strongly advocated for the public reporting of nursing home medical directors for many years,” Milta Little, president of AMDA, said in a statement. “We are happy that CMS has addressed this in its new rule.”

AMDA leadership said the rule will enable more informed decision-making by residents, their families and policymakers.

“Providing the public with information about the medical director will ensure that patients and residents, as well as their families, policymakers, and others, will have access to and learn more about the clinical and administrative leader of the facility,” noted Alex Bardakh, senior director of advocacy and strategic partnerships at AMDA.

“The majority of the public has no idea that the medical director even exists in a nursing facility,” Bardakh told McKnight’s Long-Term Care News. “That is wrong on many levels.”

Transparency woes

Bardakh drew special attention to how the new rule could address current blindspots for families and policymakers.

“On the policymaking side, it’s really clear there’s no way to get in touch with all medical directors across all facilities in the county,” Bardakh said.

The COVID-19 pandemic provided a clear example of how this has negatively impacted care in the US.

“The country could not reach the larger swath of medical directors across the country to provide them with vital information about what was going on,” Bardakh said. “That’s unheard of in other areas of healthcare and that needed to be corrected.”

Bardakh also repeatedly returned to the negative effects a lack of transparency has had for residents and their families in the past. 

“If I looked up a physician and I wanted to know whether they are a good clinician for my loved one in a nursing home, I have no way of knowing that because their work in the nursing home is nowhere to be seen,” Bardakh said. “We have no idea currently whether people who take the job of medical director of a nursing home have any background in that care. And I don’t know of any other situation that does that.”

At a national level, candidates for medical director are required only to be a licensed physician, which can leave the door open for physicians without the needed experience to expertly oversee long-term care.

Future impact

The new CMS transparency rules would address these concerns by providing previously-missing information to analyze problems in the care industry.

“In terms of medical direction, our job is to ensure that there are qualified clinicians doing the job,” Bardakh explained. “If we find that currently facilities have had to hire ‘anybody who’s willing,’ so to speak, in order to comply with the law… we need to understand what that problem is. And hopefully the implementation of what CMS just put into the rule will give us that sense.” 

CMS’ updated decision comes in the middle of a frontline worker shortage in nursing homes as well as the looming presence of a proposed staffing mandate. 

Bardakh acknowledged the difficulties of the staffing crisis, but asserted that the unusual lack of transparency for medical directors warranted immediate action.

Public comments on the initial proposal compelled CMS to amend the final rule so that medical directors have to be included in the “managing employees” who have to be disclosed.

“We revised our current managing employee definition to explicitly include SNF and hospice medical directors and administrators,” a summary of the rule notes. “We believe this change will make clear that SNF medical directors are managing employees, a stance we have held for many years.”

Bardakh told McKnight’s that a public database and the means to reliably contact medical directors across the US would be a major victory for transparency. 
In a fact sheet about the rule, CMS stated that it would make the new data collected available for the public within one year but didn’t specify its methods for doing so. CMS did note, however, that it would clarify the method and timing for releasing the data soon.