Physician

POSITION SUMMARY:

The Physician is responsible for the primary and long-term medical needs of the participants of the PACE Southeast Michigan (SEMI). The medical evaluation of participants includes a detailed history, physical exam, record review of past medical history, the ordering of diagnostic studies, and the evaluation, synthesis and documentation of the results. As a member of the Interdisciplinary Team (IDT), the physician provides medical leadership and supervision to the team, oversight of the Nurse Practitioner (NP), and planning for the health care needs of the participants of PACE SEMI

SPECIFIC DUTIES AND FUNCTIONS:

1.     The physician performs a complete medical evaluation upon the Initial Intake Assessment and upon routine Re- Evaluation Assessments, including: a detailed history, physical exam, record review of past medical history, the ordering of diagnostic studies, and the evaluation, synthesis and documentation of the results.

2.     The PACE SEMI physician provides oversight of the NP in the health care setting through the following:

a.      In collaboration and consultation with the PACE SEMI physician, the NP may diagnose and treat common health problems, which may involve:

                                               i.     o initiate appropriate diagnostic studies, such as laboratory, x-ray and other specialty procedures;

                                             ii.     to alter the treatment program in collaboration with the physician;

                                            iii.     to initiate emergency medical measures in life threatening situations;

                                            iv.     to monitor for changes in participants with chronic diseases or disorders;

                                              v.     to transmit to the pharmacist by telephone, in pers-n, or in writing, valid prescriptions, including controlled substances, Schedule 3- Schedule 5 medications, that the supervising physician has delegated the practitioner to prescribe;

                                            vi.     to follow up with participants in the home to evaluate their status; conferring with a PACE SEMI physician in regard to an actual or suspected status change;

b.     In collaboration with the Nurse Practitioner (NP), the physician develops protocols as required under the delegation and supervision statutes, including delegating the prescribing of controlled substances. When delegating Schedule 3 to 5 controlled substances, the rules require the supervising physician to:

                                               i.     establishes a written authorization containing the signatures of both parties to the appropriate pharmacy;

                                             ii.     record limitations or exceptions to the delegation;

                                            iii.     document the effective date of the documentation;

                                            iv.     record any amendments, if any;

                                              v.     review and update the authorization annually.

c.      With regard to the diagnosis and treatment of common health problems, the physician provides for the overall clinical supervision of care given by the NP through:

                                               i.     periodic conferences/meetings with the NP to discuss cases or problems;

                                             ii.     periodic chart review of routine evaluations and progress notes;

                                            iii.     review of NP orders;

                                            iv.     telephone consultation with the NP when not on PACE SEMI premises;

                                              v.     review of coding and encounter data.

3.     The physician works and collaborates with the participant and the family, as well as all members of the MDT in developing the participants’ plan of care.

4.     The physician assumes all the responsibilities of a staff physician, including:

a.      to obtain health and medical histories;

b.     to perform physical examinations for the PACE SEMI evaluation and re-evaluation process;

c.      to assess for pathological developments and evaluates episodic illnesses;

d.     to consultation with and referral to other physicians including specialists; fosters a positive relationship with peers within the medical community;

e.      to provide and coordinate primary care services needed by the participants, including health promotion and health screening;

f.      the primary, secondary and tertiary education of participants and families;

g.     to coordinate care with other services;

h.     to admit participants to in-patient facilities, including hospitals, nursing homes, and extended care facilities;

i.      to maintain attending/primary responsibility for the management of participants admitted to the nursing home; to confer with the attending physician for in-patient management and discharge planning.

j.      to update the team regularly regarding participant progress while in the hospital; initiates discharge planning with the hospital staff and Interdisciplinary Team, and documents pertinent information in the medical record;

k.     to initiate appropriate diagnostic studies, such as laboratory, x-ray and other specialty procedures for participants;

l.      to respond to participant outcomes and alter the treatment program appropriately;

m.    to institute emergency medical measures in life threatening situations;

n.     to monitor for changes in participants with chronic diseases or disorders;

o.     to transmit orders, verbally, or in writing, which would include, but is not limited to: medications, diagnostic studies, consultation, dietary changes, rehabilitative needs, end of life wishes or Advanced Directives; orders which are a significant change in the plan of care are discussed with the MDT, prior to implementation if this is appropriate;

p.     to discuss the Do Not Resuscitate (DNR) option with the participant and/or family members and completes the appropriate paperwork; DNR orders are written in the medical record and re-written in the orders portion of the electronic medical record at routine re-assessments.

q.     to follow up with participants in the home or in nursing facilities to evaluate their status;

r.      to develop and maintain the treatment program in the nursing home facilities;

s.      to maintain prompt availability for on- site consultation;

t.      to plan to do initial and periodic assessments on all participants;

u.     to communicate changes in participants to team members in a timely manner;

v.     to develop and complete plan of care as needed in a timely manner;

w.    to coordinate 24 hour care as indicated by inter-disciplinary team

x.     to submit timely and accurate documentation in medical record of each of the above as well as other changes in care.

y.     To ensure that assessments will be completed prior to care conference of scheduled participant.

5.     The physician participates in medical oversight committees, including but not limited to:

a.      Quality Assessment Performance Improvement;

b.     Utilization Management;

                                               i.     assists in adopting practice parameters;

                                             ii.     reviews charts as indicated.

c.      Ethics Committee;

6.     The physician participates in clinic meetings and promotes and maintains open communication among staff.