The second-largest problem is the lack of physician involvement. Physicians are not required to visit their patients in nursing homes, or know that staff is capable of carrying out their orders. The primary reason why physicians do not go to nursing homes is that the government payment system penalizes them if they do. They are paid more to see a resident in their office than in the facility. Physicians seeing more than one resident in the same home at the same time find their reimbursement is further reduced for the second resident visited.
Physicians can lose significant reimbursement in making rounds in a facility.
If physicians make regular visits, staff would learn much from the physician and physicians would have first-hand knowledge of the quality of care being delivered. They could assist the state in holding the facility accountable for the care. The result could be a higher level of care being delivered. Perhaps the most significant obstacle to nursing home reform is reimbursement by the government. Costs have risen, while reimbursement has continued to lag behind.