RICHMOND, Va. — Sen. Glen Sturtevant (R-Chesterfield) said legislation attempting to strengthen physician oversight in nursing homes was “watered down” from its original version before it passed through a Senate subcommittee Friday morning.
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"There have been a lot of efforts to reform the nursing home system in the General Assembly. They oftentimes meet a lot of hurdles as a result of the industry and the lobby community who push back very hard and who have a lot of influence down here at the General Assembly,” Sturtevant said.
Sturtevant proposed the bill following a CBS 6 investigation that highlighted two daughters who said their mother was in a skilled rehabilitation facility for 20 days with no evidence in medical records that her attending doctor ever visited her.
Watch: Daughters concerned about amount of time doctors spend in nursing homes
"When you see that name what comes to mind?” investigative reporter Melissa Hipolit asked the daughters.
"I don't know who that is," one daughter said when shown the doctor's name.
Dr. Jim Wright, Medical Director at the not-for-profit Lakewood Retirement Home in Henrico, said doctors should visit skilled nursing facility patients more frequently than federal law requires.
"If you've got post-hospital, very acutely ill patients, you better be rounding on those patients at least three times a week, and we've got many physicians in our group that are rounding on their patients every single day. They only have one skilled rehab facility, and those are the patients that have the best care and get the best outcomes," Wright said.
Wright noted that Medicare revisions over the past 25 years mean sicker patients are being discharged from hospitals to skilled rehabilitation facilities much quicker.
"A lot of us are still practicing 1990s medicine, where physicians could come by the nursing home once a week or once a month and treat their long-term care patients. That is not the case now, and I think some physicians haven't caught up to that," Wright said.
Current federal law mandates that residents must be seen by a doctor within 30 days of admission, then at least once every 30 days by either a doctor, physician assistant, nurse practitioner or clinical nurse specialist for the first 90 days.
After that, visits are required at least once every 60 days.
Sturtevant's original bill would have required a doctor, physician assistant or nurse practitioner to visit residents in person or through telehealth at least once monthly.
If visits didn't occur, nursing homes would notify residents, residents' families, and the state health department.
Violations could result in sanctions or fines.
The legislation also would have required the health department to develop an accountability scorecard for each nursing home's compliance rate with doctor visits, published annually.
"If we can get these folks being seen by clinicians more often than they are now, we are likely going to be able to head off and avoid major hospitalizations, major infections, medicine mismanagement, that's really the underlying intent of this bill," Sturtevant said.
When asked about requiring more frequent doctor visits specifically, Sturtevant acknowledged the challenges of implementing statewide policy.
"The best practice is for physicians to be the ones who are assessing these residents on at least a 30 day basis. The reality is, is that when you're developing a policy for the entire Commonwealth, some areas have more access to doctors and more doctors available than others, and so we want to recognize the reality of that fact and make a system that is workable across the Commonwealth," Sturtevant said.
When bringing up the bill in subcommittee Friday, Chairwoman Sen. Jennifer Boysko (D-Fairfax) said "let’s just go ahead and get this done."
Three lobbyists from the nursing home industry argued against most of the provisions in the bill.
"We don't have the workforce evaluation, and we don't have the money,” said Scott Johnson, General Counsel for the Virginia Health Care Association (VHCA).
Another argued that facilities already have medical professionals visiting daily when clinically necessary.
"In between those every 60 day visits when clinically necessary we have physicians, NPs, PAs in our buildings every single day of the week. We are not missing seeing them for clinically needed reasons, and so by adding these monthly visits the bogging down of their time and taking it away from folks that do need from a clinical standpoint," said April Payne, Chief Quality and Regulatory Affairs Officer with the VHCA.
Their argument appeared to resonate with Boysko, who highlighted provider shortages statewide.
"There are certain areas where we really have a dearth of providers, what would happen to a facility if the bill went through and something happened to a facility because they couldn't get someone in to see? What would happen to the facility?” Boysko asked.
"It would be something that could be audited and sanctioned, you could have monetary penalties,” Johnson replied.
Sturtevant told CBS 6 the nursing home industry suggested changes to the legislation.
Matt Benka with Virginians Advocating for Seniors, which represents about 30% of nursing homes in the state, spoke positively about the amended version.
"A lot of thought has been put into this, and I think potentially it could be a really good compromise," Benka said.
The changes endorsed by the industry eliminate required monthly visits, sanctions or fines for non-compliance, and the accountability scorecard. However, they do call for notifying residents, residents' families and the state health department if a doctor fails to visit a resident according to federal rules.
The subcommittee unanimously passed the amended version.
Sturtevant said that because the amended version is moving forward, it's possible that amendments could still be made to bring the legislation closer to what he originally intended.
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