CMD Professional Standards & Competencies 2 — Questions and Answers
Question 1: Under AMDA guidelines, how frequently must the Medical Director conduct a formal review of the facility's quality assessment and assurance (QAA) committee activities?
- Monthly
- Quarterly (Correct answer)
- Semi-annually
- Annually
Correct answer: Quarterly
CMS regulations require QAA committees, of which the Medical Director is a required member, to meet at least quarterly to review and address quality deficiencies.
Question 2: A Medical Director discovers that a physician on staff is consistently failing to complete H&P examinations within 72 hours of admission. The MOST appropriate initial step is to:
- Report the physician directly to the state medical board
- Counsel the physician and document the discussion (Correct answer)
- Terminate the physician's medical staff privileges immediately
- File a grievance with the facility administrator only
Correct answer: Counsel the physician and document the discussion
The Medical Director's supervisory role requires addressing performance issues through direct counseling and documentation before escalating to formal disciplinary action.
Question 3: Which federal regulation specifically outlines the Medical Director's role and responsibilities in a Medicare/Medicaid-certified skilled nursing facility?
- 42 CFR Part 483.75 (Correct answer)
- 42 CFR Part 482.12
- 29 CFR Part 1910
- 45 CFR Part 164
Correct answer: 42 CFR Part 483.75
42 CFR Part 483.75 (now reorganized under 483.70) governs administration requirements for SNFs, including the Medical Director's required responsibilities.
Question 4: When developing clinical practice guidelines for a long-term care facility, the Medical Director should PRIMARILY base recommendations on:
- Manufacturer recommendations for medical devices
- Expert consensus and evidence-based literature (Correct answer)
- Payer reimbursement requirements
- Individual physician practice preferences
Correct answer: Expert consensus and evidence-based literature
Clinical practice guidelines must be grounded in peer-reviewed, evidence-based literature and expert consensus to ensure patient safety and quality care.
Question 5: A competency-based framework for Medical Directors in post-acute and long-term care (PALTC) settings should include assessment in all of the following domains EXCEPT:
- Medical care and clinical leadership
- Regulatory and legal requirements
- Personal financial management (Correct answer)
- Quality and performance improvement
Correct answer: Personal financial management
Personal financial management is not a defined competency domain for Medical Directors; the core domains focus on clinical leadership, regulatory compliance, QI, and systems management.
Question 6: Which action best demonstrates a Medical Director fulfilling the 'physician advisor' role within a skilled nursing facility?
- Personally examining every resident on admission
- Educating attending physicians on evidence-based wound care protocols (Correct answer)
- Approving all medication orders before they are implemented
- Conducting all staff disciplinary proceedings
Correct answer: Educating attending physicians on evidence-based wound care protocols
The physician advisor role involves educating and guiding attending physicians on clinical standards, protocols, and best practices rather than directly managing individual patient care.
Question 7: In the context of CMD professional competencies, 'systems-based practice' MOST closely refers to:
- Using electronic health record systems proficiently
- Understanding how care delivery systems affect outcomes and using resources responsibly (Correct answer)
- Implementing a single standardized care pathway for all residents
- Outsourcing non-clinical administrative tasks to vendors
Correct answer: Understanding how care delivery systems affect outcomes and using resources responsibly
Systems-based practice is a core medical competency encompassing understanding care delivery systems, their effect on patient outcomes, and the Medical Director's role in optimizing those systems.
CMD Professional Standards & Competencies 2
Under AMDA guidelines, how frequently must the Medical Director conduct a formal review of the facility's quality assessment and assurance (QAA) committee activities?