ROLE OVERVIEW & PURPOSE:
The Program for All Inclusive Care of the Elderly (PACE) Medical Director is responsible for the delivery of participant care, clinical outcomes, and the implementation, as well as oversight, of the quality assessment and performance improvement (QAPI) program. The Medical Director serves as the lead in the design of the medical and clinical components for Neighborhood Healthcare PACE and as a liaison to the medical community on behalf of Neighborhood Healthcare PACE. As a physician member of Neighborhood Healthcare PACE team, the Medical Director must meet all federal and state licensing laws, certification and regulations necessary. The Medical Director serves as the consultant and resource to the Primary Care Physician(s), on-call physicians and Nurse Practitioners. The PACE Medical Director also interfaces and collaborates with specialist physicians in the PACE Provider Network.
PERFORMANCE MEASURES & STANDARDS
1. Supervises all medical/paramedical services, ensuring Neighborhood Healthcare PACE clinical staff achieve the best clinical outcomes possible for all participants. (20%)
2. Achieves Patient-Centered Medical Home (PCMH) objectives and goals. (10%)
3. Attains Medication Management goals and objectives. (10%)
4. Responsible for oversight of the quality assessment and performance improvement program (QAPI), including, along with the QAPI Coordinator and Manager, development of the yearly QAPI Plan, quarterly QAPI reports and year-end evaluation. Attends meetings with Neighborhood Healthcare PACE QAPI Committee and Neighborhood Healthcare PACE Board, as scheduled. Actively participates in Neighborhood Healthcare PACE QAPI meetings. Uses data to compare Neighborhood Healthcare PACE to other PACE sites, and internal data to demonstrate improvement. (20%)
5. Maintains and improves medical policies/standards and protocols based on latest evidence-based medicine protocols for PACE seniors and best clinical practices for PACE older adults. (10%)
6. Develops/implements system of peer review. Develops, in conjunction with the manager, maintains and implements clinic staff job descriptions. Provides staff in-service training as needed. Makes recommendations for hiring/disciplining of PACE clinical staff.
7. Enhances PACE Continuum by defining, developing, and implementing the system of 24- hour medical coverage for Neighborhood Healthcare PACE. Works with administrative leaders in the PACE Organization to ensure that the contracts with network providers are fair, clinically appropriate, and financially prudent. Assembles a panel of network specialist consultants while meeting key regulatory, clinical, and administrative PACE protocols. (15%)
8. Provides information about Neighborhood Healthcare PACE to interested individuals and groups, avoiding prohibited marketing practices as described in the PACE regulations. (5%)
QUALITY ASSESSMENT AND PERFORMANCE IMPROVEMENT
1. Provides leadership in quality improvement program through participation on the Quality of Care Committee;
2. Understand the regulations related to QAPI and PACE and the medical director’s role.
3. Proactively develops a collaborative working relationship with the PACE Quality Coordinator and contributes to the development of the PACE QAPI plan.
4. Oversees the delivery of participant care (resources), clinical outcomes, performance improvement and Utilization Management (UM) within PACE.
5. Designs and conducts quality projects and keeping abreast of federal Outcomes- Based Quality Improvement initiatives.
6. Conducts clinical research and quality studies related to Neighborhood Healthcare PACE participants and services.
7. Participates in Quality Improvement Committee meetings.
8. Responsible for the implementation, as well as oversight, of the quality assessment and performance improvement (QAPI) program.
PACE CONTINUUM OF CARE
1. Defines, develops, and implements the system of 24-hour medical coverage for Neighborhood Healthcare PACE.
2. Works with administrative leaders in the PACE Organization to ensure that the contracts with network providers are fair, clinically appropriate, and financially prudent.
3. Assembles a panel of network specialist consultants while meeting key regulatory, clinical, and administrative PACE protocols.
4. Liaisons with physician groups, specialists and hospitals to represent Neighborhood Healthcare PACE, thereby strengthening positive provider relationships and enhancing referrals.
5. Plays a critical role in educating the medical and aging communities about the role of PACE in the long-term care continuum.
6. Interfaces with contracted medical providers when quality concerns arise. 15. Participates in contract negotiations with medical providers.
7. Participates in contract negotiations with medical providers.
8. Promotes the mission and goals of Neighborhood Healthcare PACE in the neighborhood, in the community, to referral and regulatory agencies, and other stakeholders.
9. Acts as liaison with Stanislaus County physicians.
10. Plays a vital collaborative role in marketing, intake, and enrollment of PACE enrollees.
PACE CARE DELIVERY/INTERDISCIPLINARY TEAM
1. Provides input into cost-effective clinical practices.
2. Integrates Frail & End-of-Life Care Clinical Glidepath Tools (qty. 24) and PACE Best Clinical Practices (CHF, COPD, Diabetes, etc.) into ongoing primary care service and support of PACE enrollees.
3. Provides orientation, education and on-going training of new PCP and Nurse Practitioner (NP) hires.
4. Defines the form of the NP collaborative practice arrangement in the PACE Organization to include NP scope of practice, prescriptive authority, and degree of autonomy.
5. Consults on the development of clinical policies and procedures.
6. Coordinates the performance appraisal of the primary care physicians, nurse practitioners, and consulting pharmacist.
7. Provides medical consultation to staff.
8. Develops policies and procedures for patient care based on evidence-based medicine protocols and best practices in geriatric medicine.
9. Responsible for the delivery of PACE participant care and clinical outcomes.
10. Evaluates and implements clinical geriatric practice guidelines based on current literature and shared state-of-the-art clinical information with the Neighborhood Healthcare PACE Interdisciplinary Team.
11. Participates in Multidisciplinary Team meetings.
12. Serves as a member of the Neighborhood Healthcare PACE Management Team.
13. Provides direct medical care to PACE participants when the Neighborhood Healthcare PACE Team physician is unavailable.
14. Oversees the palliative and end-of-life dimensions of PACE care and support to include achievement of the best possible quality of life through relief of suffering, control of symptoms, and restoration of functional capacity while remaining sensitive to PACE enrollee personal, cultural, and religious values, beliefs, and practices.
15. Supervises physicians and other primary care professionals employed by Neighborhood Healthcare PACE.
16. Provides internal consultation to the Primary Care Physician(s) and Nurse Practitioner(s) through case review and analysis of aggregate data.
PACE CLINICAL COMPLIANCE
1. Serves as a physician liaison to state and federal agencies, as requested.
2. Ensures compliance with PACE provider regulations as they pertain to medical/clinical and geriatric components of care.
3. Oversees the clinical, compliance and documentation dimensions of the PACE comprehensive Medical Record system and process to include evaluating, creating, revising the components of the medical record.
4. Ensures optimal design of the PACE Medical Record system to address Interdisciplinary Team communications and interventions, optimal diagnostic coding and capture for risk- adjusted HCC coding, clear and comprehensive documentation for Medico-Legal risks, and establishment/oversight of documentation standards for QAPI and research initiatives.
5. Participates in the Participants’ complaint and grievance procedures when the complaint or grievance involves medical or clinical care.
6. Works in conjunction with other PACE leaders to both guide and assist the successful collection submission and analysis of diagnostic risk adjustment data (HCC Coding diagnoses), Health Plan Management System (HPMS) data, DATAPACE3 (DP3) data, PACE Data Analysis Center (PDAC) data.
7. Reviews HCC/Demographic File, for nuances in code selection that greatly affect the assignment of HCCs and corresponding risk coefficients to improve the specificity of data and to ensure that the individual capitation payments for participants maximally reflect the true clinical risk and disease burden.
8. Chairs the Medical Advisory Committee and the Ethics Committee, advising to the Neighborhood Healthcare PACE Board of Directors.
9. Administers the Medical Director’s role in a manner consistent with the PACE program’s core values and mission.
10. Monitors Unusual Occurrence reports to ensure the continued health/safety of participants.
11. Involved in investigating all Level Two Events and translating findings into opportunities to improve clinical care.
12. Develops policies and procedures for appointment of medical staff; assignment and review of clinical privileges.
PRESCRIPTION DRUG PLAN (MEDICATION MANAGEMENT)
1. Collaborating with the PACE Pharmacist, oversees the clinical aspects of the PACE Medication Management Process to include prescriptions and dispensing and administration of medications.
2. If specified and clinically necessary, designs a PACE formulary using OmniCare Geriatric Medication and Cost Efficacy Guidelines.
3. Designs PACE prescription criteria which address PACE participant clinical risk and cost factors such as PACE participant comorbidities, poly-pharmacy risks, limited life expectancy, frailty factors, and vulnerability to adverse drug reactions (ADRs).
4. Works closely with Consulting Pharmacist to monitor PACE pharmacy utilization and medication prescribing patterns to avoid ADRs and excessive polypharmacy risks and costs.
5. Works closely with the Consulting Pharmacist to pinpoint potential drug-drug interactions, drug-disease interactions, appropriateness of medications and cost-effective alternatives for PACE enrollees.
PATIENT-CENTERED MEDICAL HOME
1. Endeavors to sponsor and promote the design, organization and operation of the PACE primary care clinic as a Patient Centered Medical Home (PCMH) Model of Care and advanced primary care practice setting.
2. Defines the scope of primary care practice and clinical activities in the PCMH.
3. Champions developments, improvements and operation of the Electronic Medical Record (EMR) system for the PACE Primary Care Clinic (PCMH) and PACE eldercare continuum of care (PACE Site, provider network and senior patient home and long-term care settings).
4. Promotes and implements in-home electronic technology monitoring of PACE beneficiaries (telehealth, vital signs monitoring, remote patient monitoring, personal emergency response, elderly fall detection, video/audio surveillance of in-home caregivers and PACE participants).
ADDITIONAL DUTIES AND RESPONSIBILITIES
1. Provides in-service education to Neighborhood Healthcare PACE staff, as requested.
2. Sustains an organizational commitment to diversity of staff and nurturing the skills needed to serve a diverse population.
3. Promotes and oversees educational rotations for community area medical students, residents and fellows, nursing students and nurse practitioners, social workers, pharmacists, public health students, and various rehabilitative specialists.
4. Performs other duties as assigned.
1. Respond promptly and with caring actions to patients and employees. Acknowledge psychosocial, spiritual and cultural beliefs and honor these beliefs.
2. Maintain professional working relationships with all levels of staff, clients and the public.
3. Be part of a team and cooperate in accomplishing department goals and objectives
1. Maintain current knowledge of policies and procedures as they relate to safe work practices.
2. Follow all safety procedures and report unsafe conditions.
3. Use appropriate body mechanics to ensure an injury free environment.
4. Be familiar with location of nearest fire extinguisher and emergency exits.
5. Follow all infection control procedures including blood-borne pathogen protocols
1. Maintain privacy of all patient, employee and volunteer information and access such information only on a need to know basis for business purposes.
2. Comply with all regulations regarding corporate integrity and security obligations. Report all behaviors and/or activities that are unethical, fraudulent, or unlawful.
1. M.D. degree and licensure to practice medicine and surgery in the State of California. Board certified in internal medicine or family practice.
2. Certificate of added qualification in geriatrics and/or experience in the care of the chronically ill. Fellowship in Geriatrics preferred.
Knowledge, Skills, and Abilities
1. Current knowledge of chronic care/geriatric issues and best practices.
2. Solid “fit” with the PACE culture and mission; while Geriatric training and experience are helpful, the “fit” with the culture and mission of PACE is more important.
3. Skill to build strong working relationships with physicians and other health care providers. Good judgment, problem-solving and cognitive skills.
4. Ability to process information accurately and in a timely manner.
5. Ability to coordinate and facilitate teamwork and interdisciplinary groups.
6. Good public communication skills.
7. Demonstrated leadership abilities.
8. Enthusiasm for geriatric medicine and taking care of the chronically ill.
1. Minimum of three years in medical practice for the chronic care geriatric population.
2. Demonstrates skills in medical administration and/or previous experience as a Medical Director.
3. Experience working with an interdisciplinary team and performing comprehensive geriatric assessments preferred. Knowledge of and experience with chronic care coordination also preferred.
4. A record of forming and implementing a vision for an organization.