What can we do to continue caring for our patients after they've entered a nursing facility, and the nursing facility is denying us access?
Q: Our practice's problem arose 18 months ago when our lead doctor became severely ill and was forced to retire. At that time, we had more than 100 longtime patients in four local nursing homes. After our doctor was unable to continue, we filled in with locum tenens and part-time physicians, but the nursing homes demanded that we exhibit more continuity in providing patient care and denied us access to our patients.
Recently, our practice has stabilized, and we have two full-time physicians. I have written letters to the nursing facilities requesting application materials for our physicians to begin following our patients again, but there has been no response. Do federal regulations contain an "any willing provider" clause, or is there any other way to get our doctors seeing their patients again?
A: Nursing homes generally credential physicians of their own choosing to follow patients in their homes. There is no federal requirement that a nursing home credential "any willing provider," as there is no similar requirement for hospitals. While rules vary by state, and your state may require that a nursing facility maintain open medical staffs, generally the public policy considerations in favor of an open staff at a private nursing home are less compelling than similar requirements for hospitals, which many states consider to be quasi-public facilities. Your own recognition that the nursing homes require continuity in providing patient care is one reason why nursing homes are generally permitted to maintain closed staffs.
Send your practice management questions to firstname.lastname@example.org (please include your regular postal address). Answers to our readers' questions were provided by Steven I. Kern, JD, of Kern Augustine Conroy and Schoppmann in Bridgewater, New Jersey; Judy Bee of Practice Performance Group in La Jolla, California; and Keith Borglum, CHBC, of Professional Management and Marketing in Santa Rosa, California.