CMD Advanced Professional Practice 3 — Questions and Answers
Question 1: A surveyor cites a facility for a deficiency related to unnecessary medication use. Under which F-tag category does this most likely fall?
- F600 – Abuse Prohibition
- F757 – Unnecessary Medications (Correct answer)
- F684 – Quality of Care
- F741 – Sufficient and Competent Nursing Staff
Correct answer: F757 – Unnecessary Medications
F757 specifically addresses the requirement that residents receive only necessary medications at the appropriate dose, duration, and for valid clinical indications.
Question 2: In the context of CMD responsibilities, what does the term 'clinical oversight' PRIMARILY encompass?
- Reviewing every individual physician order before implementation
- Setting and monitoring adherence to facility-wide clinical policies and standards of practice (Correct answer)
- Personally evaluating every new admission within 24 hours
- Managing the pharmacy formulary and medication procurement
Correct answer: Setting and monitoring adherence to facility-wide clinical policies and standards of practice
Clinical oversight means the medical director establishes standards, monitors adherence through data, and ensures the facility's clinical care systems function appropriately.
Question 3: A facility is experiencing repeated C. difficile outbreaks. Which action by the CMD would MOST directly address the root cause?
- Increase environmental cleaning frequency in resident rooms
- Lead a root cause analysis examining antibiotic prescribing patterns and contact precaution adherence (Correct answer)
- Mandate ribotyping of all C. difficile isolates
- Transfer all positive residents to acute care facilities
Correct answer: Lead a root cause analysis examining antibiotic prescribing patterns and contact precaution adherence
Root cause analysis targeting antibiotic stewardship and infection control precautions addresses the primary modifiable drivers of C. difficile transmission in LTC.
Question 4: Under CMS regulations, how frequently must the medical director or designee review the care of each resident?
- Daily during rounds
- As defined by facility policy based on the resident's clinical condition and needs (Correct answer)
- Monthly at minimum for all residents
- Only at quarterly care plan meetings
Correct answer: As defined by facility policy based on the resident's clinical condition and needs
CMS does not mandate a specific visit frequency; instead, the standard is that physician visits occur based on the resident's medical needs as defined in the care plan.
Question 5: A CMD is asked to chair the Quality Assurance and Performance Improvement (QAPI) committee. What is the PRIMARY goal of this committee?
- Investigating and reporting all adverse events to state authorities
- Systematically identifying, analyzing, and improving care processes and outcomes (Correct answer)
- Credentialing all clinical staff who work in the facility
- Managing litigation risk by reviewing incident reports confidentially
Correct answer: Systematically identifying, analyzing, and improving care processes and outcomes
QAPI's primary mission is proactive, data-driven identification of quality gaps and implementation of sustainable improvements in care delivery.
Question 6: Which of the following BEST describes the medical director's role when a resident's family demands aggressive life-sustaining treatment that the care team believes is non-beneficial?
- Defer entirely to the family's wishes to avoid legal liability
- Facilitate a structured goals-of-care meeting involving palliative care, ethics, and the care team (Correct answer)
- Unilaterally write a do-not-resuscitate order based on clinical judgment
- Transfer the resident to acute care to avoid the conflict
Correct answer: Facilitate a structured goals-of-care meeting involving palliative care, ethics, and the care team
A structured goals-of-care meeting with multidisciplinary support is the ethical and professional standard for resolving conflicts about futile or potentially non-beneficial treatment.
Question 7: A new antipsychotic order is written for a resident with dementia for 'agitation.' What is the CMD's FIRST responsibility upon reviewing this order?
- Approve it as the attending physician is responsible for individual prescribing decisions
- Ensure non-pharmacological interventions were trialed first and that a specific, documented behavioral target exists (Correct answer)
- Require a psychiatry consultation before any antipsychotic can be prescribed
- Discontinue the order as antipsychotics are never appropriate in dementia
Correct answer: Ensure non-pharmacological interventions were trialed first and that a specific, documented behavioral target exists
CMS and evidence-based guidelines require documentation that non-pharmacological approaches were attempted and that behavioral targets are specific before antipsychotic initiation.
CMD Advanced Professional Practice 3
A surveyor cites a facility for a deficiency related to unnecessary medication use.
Under which F-tag category does this most likely fall?