F555 Choice of Attending Physician

Appendix PP of the State Operations Manual outlines the resident’s right to choose their attending physician. However, there are certain requirements the attending physician must meet in order to serve residents in your building, including:

• They must be licensed to practice in the State.
• They must meet all requirements outlined in the physician’s services subsection of Appendix PP (including F710 – F715).
  • They must approve in writing that the resident meets criteria to be admitted to the nursing home.
  • They must participate in assessments, care plans, identify changes in condition, prescribe medications, order transfers to a hospital when necessary, and conduct routine visits.
  • Have 24-hour emergency on-call assistance available.

The nursing home is responsible for ensuring that each resident and/or their responsible party as appropriate is informed of their attending physician, including their name, specialty, and a method of contacting them. This requirement is also for other physicians involved in the resident’s care such as a specialist.

If the physician is unwilling or unable to meet the requirements as outlined in the regulations, the nursing home is able to select another physician for the resident. This can only occur after the nursing home:

• Discusses concerns regarding the current attending physician with the nursing home’s medical director. The medical director must have a discussion with the attending physician and only after a failed attempt to work with the attending physician or mediate differences ma the staff request an alternate physician.
• Discuss options with the resident or their responsible party and honor their preferences, if any.
• If the resident subsequently selects another attending physician that meets the requirements, the nursing home must honor that choice.

The interpretative guidance outlined in F555 also includes that a resident has the right to choose an attending physician, but they are not required to do so. The physician that the resident chooses is also not required to provide service to the resident.  

If a condition for admission to a Continuing Care Retirement Community (CCRC) includes selecting particular physicians within the CCRC conditions, free choice is met by the resident being able to select from those who have practice privileges at the CCRC.

This regulation can be monitored for compliance by including questions about resident’s choice of physician in interviews (such as satisfaction surveys). If a resident (or their representative) expresses concerns with their choice of physician, determine if the nursing home allowed them to choose their attending physician, if they did not ensure that documentation supports the reason their choice was not honored, what alternative options were provided, what accommodations the nursing home attempted to make, and ensure that information was communicated to the resident and/or their responsible party on the resident’s attending physician.

While this regulation is not frequently cited, examples of non-compliance include contacting a different physician outside of the resident’s attending physician (or someone on-call or responsible in their absence) to obtain orders and assigning certain physicians to residents upon admission.