ATTENDING PHYSICIAN - San Diego
This position requires expertise or interest in Nursing Facility care, Post-acute care, geriatric medicine, and rehab medicine.
We contract with Medical groups, payor groups and/or individuals to round on their SNF patients, and as a group currently attend patients and long-term residents in 240 skilled nursing facilities in 3 counties in Southern California-Orange, San Diego and Los Angeles counties. Our goal is simply to revolutionize LTC and Post-Acute services in Southern California. We accept admissions 24 hours, 7 days a week, and complete most History and Physicals within 24 hours, and always within the 72 hours required by regulations.
An Attending Physician covers a service area which usually includes 8 to 20 skilled nursing facilities, depending on the distance, volume of patient admissions, etc. New buildings are added or buildings are changed as needed to meet the requirements of new contracts, and flexibility is expected to meet contractual needs.
Attending Physicians conduct rounds Monday through Friday rounding in Nursing facilities to manage patients on skilled days, managing their medical care and insuring timely and safe discharge off skilled days. Each physician will handle all their paged calls from 7A.M. to 6 P.M. Monday through Friday. Calls from 9A.M.through 6 P.M are triaged through our office, and only those that require immediate attention are paged. Other calls and request for orders (ie, skin tears, treatments orders, orders for vitamins) are entered on the computer and left "unpaged". Several times during the day, each physician and NP will call into the office to review these pages and the LABS that are faxed. Our nurses will then do the callbacks to the facilities with new orders. Critical labs, family concerns, and more involved clinical situations are paged directly to the physician to handle.
An Attending Physician determines their rounding schedule each day, and might round in up to 5 or more SNF's per day depending on the new admissions and the volume of skilled patients. In general, our contracted medical groups require each skilled patient to be visited once a week at minimum,and more if medically necessary. We have both capitated and Fee For Service contracts. If a physician is working with a Nurse Practitioner, the physician is responsible to keep the census, direct the Nurse Practitioner's work and do scheduled physician, N.P. performance evaluations.
An Attending Physician is responsible for timely, monthly visits for all the custodial residents in their buildings as well. Nurse Practitioners can do theses visits every other
month if needed. California Title 22 requires custodial visits every 30 days. SOAP notes are required for all residents and patients. Billing forms are faxed to the office on a DAILY basis. Only a hands-on visit with documentation is a billable event.
An Attending Physician is responsible to complete all medical records, sign telephone orders and charts from the facilities in a timely manner. Dictated discharge summaries are required on all skilled patients who leave the Nursing facility and return to the care of their Primary Care Physician.. A sample of medical staff charts are reviewed for quality every 6 months, which reviews discharge summaries, timely visits, SOAP notes, etc.
A full time Attending Physician does 400 or more required visits per month. The Attending Physician may need to round occasionally on Saturday or Sunday, depending on the season and volume of admissions.
All Physicians and N.P.'s participate in the Call Schedule for call pay. Weeknight call begins at 6P.M.through 7 P.M. Weekend call for Saturday and Sunday starts at 8 A.M. and goes for 24 hours. Typically on a weeknight, there might be 15-30 calls. On Saturday or Sunday call, (24 hours) there might be 70-100 calls.
On Call phone logs are faxed to all medical staff by broadcast fax by the person on call, by 7 A.M. each weekday morning. The log contains all activity for the group, new admissions after 6 P.M., changes in condition, late lab results, etc and orders given.
All medical staff are issued alpha numeric pagers, cell phones and fax machines. Medical Staff Meetings are held every 2 months to discuss Clinical issues, Operation, Quality, etc. Attendance is expected at at least 4 of 6 meeting.