RICHMOND, Va. β A Virginia state senator has introduced legislation (SB555) aimed at increasing physician oversight in skilled nursing homes, following CBS 6's previous reporting on medical care in these facilities.
Sen. Glen Sturtevant (R-Colonial Heights), proposed the bill after working as a medical malpractice attorney handling nursing home cases. The legislation would strengthen state requirements for advanced medical provider visits beyond current federal mandates.
"I wanted to introduce this bill that would be specific to Virginia and statewide, where we ensure that we have these healthcare professionals engaging with and seeing their patients more often," Sturtevant said.
The proposed legislation comes after Dr. Jim Wright, Medical Director at the not-for-profit Lakewood Retirement Home in Henrico, told CBS 6 last year that doctors should visit skilled nursing facility patients more frequently than federal law requires. 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.
Wright believes physician involvement is crucial, especially during the first few weeks of a patient's stay.
"Certainly when someone is first coming in physician involvement, certainly for their history and physical, which should occur within the first few days, and then ongoing visits by the physician for at least two to three weeks, and I would say on a weekly basis is super important for the success of a rehab stay," Wright said.
Current vs. proposed requirements
Federal law currently 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.
Current requirements can be found by clicking here.
Sturtevant's bill would require a doctor, physician assistant or nurse practitioner to visit residents in person or through telehealth at least once monthly. Two of those visits must be completed in person by a physician.
If visits don't occur, nursing homes would be required to notify residents or their families and the state health department. Violations could result in sanctions or fines.
"It helps make sure that they know earlier in the process that they need to get in there and advocate for their parent who may not be able to really advocate very well for themselves," Sturtevant said.
Transparency measures
The legislation would also require the health department to maintain a database tracking each nursing home's compliance rate with physician visits and publish that information on its website. The department would develop an annual accountability scorecard for each facility.
"That's valuable information, that is hard data that these families can look at these score cards for these nursing homes and decide if that's the right place for their family member," 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.
Industry response
The Virginia Health Care Association, the prominent trade association for nursing homes, said they were still assessing the bill's impact on members in light of existing robust and specific federal requirements for physician services.
Sturtevant shared a draft with CBS 6 of changes the industry suggested to his bill, which included eliminating required monthly visits, removing sanctions or fines for non-compliance, and eliminating the accountability scorecard.
Sturtevant said he believes the bill will come up for discussion in subcommittee on Friday morning.
CBS 6 is committed to sharing community voices on this important topic. Email your thoughts to the CBS 6 Newsroom.
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