In the age of hospitalists and electronic health records (EHRs), I’ve observed a decline in comprehensive physician assessments. I commonly see the first 3-4 sentences of the ER history of present illness (HPI) reappear verbatim in multiple provider notes. I seldom see a social or functional history, and rarely see accurate personal contact information. I observe a long list of past medical diagnoses and habits that are always documented (quality indicators linked to payment).  When a palliative care consultation is conducted, the documented focus often appears to be limited to the immediate problem. I wonder if the new generation of physicians and advanced practice practitioners providing post-acute rehab services has a similar “moment in time” focus, and wonder if there are measurable differences in patient and family satisfaction metrics or in facility outcomes. 

California is a vast, progressive state that implements innovative and often more rigorous regulations regarding the role of Medical Directors and nursing home care compared to federal standards. For Medical Directors to thrive, it is essential to grasp what sets California apart, navigate existing regulations, and comprehend the implications of forthcoming regulations—many of which could profoundly affect their daily responsibilities.