State President's Roundtable Discussions Provide Valuable Input to AMDA Leadership
The roundtable discussions are an important part of the State
Presidents' activities, which are held in conjunction with the business
meeting on Wednesday during AMDA's Annual Symposium. The discussions
provide AMDA leaders and staff with valuable grassroots input on
emergent long term care issues. Meeting participants are comprised of
AMDA state chapter presidents and the Board of Directors.
Prior to the meeting, state chapter presidents are asked to submit
topics for discussion. Once topics are determined, the Government
Affairs team selects leaders based on their experience with and
knowledge of the topic. The leaders then develop the content and
provide handouts for the meeting.
Once the issues have been discussed at Wednesday's meeting,
summaries of the roundtables and suggested follow-up actions are
presented during the State Presidents Council Breakfast Meeting (held
on the Saturday during the annual symposium). The overall goal of the
roundtables is to assist AMDA leaders and staff in determining priority
issues and to develop policy. Summaries from this year's roundtables
follow:
Assisted Living
Leader: Dan Haimowitz, MD, CMD
Participants identified barriers to medical directors in assisted
living facilities and suggested ways that AMDA could improve the
quality of care in assisted living facilities. An ad hoc committee will
be formed to study and develop policy on the issue.
Model Legislation in Maryland
Leader: Steve Levenson, MD, CMD
Participants concluded that the legislative arena is seldom useful for
solving complex problems, and that legislative initiatives by state
chapters often focus on trying to head off undesirable legislation.
Involvement with regulatory agencies could be more fruitful, as in
Maryland where key regulations strengthening and clarifying the role of
physicians in long term care become effective June 6, 2001.
Participants asked for a handbook or similar guidance from AMDA to help
them participate effectively in their states. AMDA has distributed such
tools and guidance for working with state legislators and regulatory
agencies through its State Advocacy Initiative.
State Survey Issues
Leader: Chuck Crecelius, MD, CMD
Participants discussed state survey issues, specifically survey
consistency, both within and between states. They recommended methods
for establishing ties with state survey agencies. All felt further
sharing of ideas and "best practice" examples would be beneficial in
furthering mutual goals and collaboration with their state survey
agencies. A series in Caring for the Ages is planned as well.
Nurse Practitioner/Physician Extenders
Leader: Jonathan Musher, MD, CMD
The discussion centered on the role of the attending physician in
nursing homes. With the increasing medical complexity of patients seen
in long term care settings, physician knowledge and leadership is
crucial. After much discussion, the roundtable agreed on the need for
the physician to perform the initial assessment visit (99303) of a
nursing home resident, because the combination of performing a
comprehensive history, physical exam, review of systems, and care
management including the coordination of all aspects of medical care of
that resident, was essential to the attending physician's
responsibility and crucial to patient care management. These
responsibilities are inherent in the definition of the 99303 initial
visit code. AMDA will send a letter to the National Conference of
Gerontological Nurse Practitioners (NCGNP) regarding their request that
AMDA sign onto a letter asking HCFA to allow nurse practitioners to
bill and be reimbursed for the initial assessment visit in nursing
facilities and skilled nursing facilities. The letter would advise
NCGNP of AMDA's position that the initial 99303 visit be performed by a
physician. It should also reaffirm AMDA's value in partnering with
NCGNP, and acknowledge that nurse practitioners may make an initial
acute visit, but not a 99303.
If you were unable to attend the roundtable meeting and would like
to add input on one of the topics, please contact Meg LaPorte at
410/740-9743, ext. 120, or e-mail to meglaporte@amda.com.
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