AB 749

CALTCM’s Public Policy Committee has been quite busy over the past several months, advocating for our members and the residents we provide care for. We are the proud sponsors of AB 749, a bill that requires nursing home medical directors in California to be certified by the American Board of Post-Acute and Long Term Care Medicine. In the early days of the pandemic, some of us were faced with pressure to admit COVID patients to our facilities. CALTCM members warned that “if you send us five, we’ll send you back 20 within a week.” Sadly, we were prophetically right. Many of us also advocated testing of all staff in order to identify outbreaks early. Because of our training, we knew what to do, and we had varying levels of success in limiting outbreaks at our facilities. Our actions saved lives.

While cardiologists and orthopedic surgeons aren’t asked to prove their value, those of us in geriatrics and long term care medicine are often asked for evidence of our value. A seminal study by Rowland in 2009 demonstrated that nursing homes with certified medical directors had, on average, 15% better quality metrics. As some of the nursing homes in the control group may have also had certified medical directors, the improvement in quality might actually have been even greater. There are numerous examples during the pandemic of medical directors taking charge in assuring that a facility had abundant PPE, stellar infection prevention and aggressive testing protocols. There is no doubt that more qualified and engaged medical directors could have saved lives during the pandemic. Our advocacy for stellar infection prevention was heard by CDPH who heard and implemented our recommendation for each facility to have a full time infection preventionist. It's now time for our legislature to take this next step for improving the care of our medically complex residents.

AB 749 will help ensure that every medical director in California is prepared to provide effective oversight of quality and safety in their nursing homes. For decades, Senate Committees, OIG reports, peer-reviewed papers and industry experts have acknowledged the value of competent and engaged medical directors. We can no longer hope that the right thing happens on its own accord. It’s time to require that all nursing home medical directors be certified.

Nursing homes care for the complex and vulnerable. The pandemic has reminded us just how vulnerable our residents are with nearly 10,000 deaths. Nursing homes are mini-hospitals, demanding the active engagement of medical directors with clinical, regulatory, bioethics, and management expertise. The importance of this role has been known for decades. By federal regulation the medical director is explicitly responsible for coordinating medical care in the nursing home. Yet, many nursing home medical directors are woefully unprepared to do this. Requiring medical director certification provides clear recognition of their value and importance.

Certification is self-paced, web-based, and does not require an examination. It respects the professionalism of the physician while recognizing that most residency and fellowship training programs do not provide the knowledge and skills necessary for a doctor to be prepared for the responsibility of coordinating medical care in a facility. Allowing the status quo to continue, sends a clear message that we do not value our vulnerable nursing home residents or the quality of care they receive. In the wake of the tragic outcomes of the COVID-19 pandemic, it’s time to take this simple step of requiring certification. That is why CALTCM is proud to have sponsored AB 749.

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