Monthly Archives: April 2015

Practice Scope for Nurse Practitioners

Nurse Practitioner

Nurse Practitioners have had an increasing role in Golden Living Facilities.  Whether employed by a physician practice, the Living Center, or a third-party such as PRIME, NPs have been an asset to care.  Their presence allows for more timely evaluation of patients, increased communications, and more frequent visits to patients with complex medical conditions.  Ultimately, this can result in more efficiency, fewer hospital readmissions, and better overall care.

There are a few  limitations to the scope of practice about which we need to be particularly cognizant.

  • Federal regulations do not allow NPs to independently order labs[1] or radiology tests[2]. This  means that the attending physician will need to order these either in writing or verbally and not just co-sign an order after the fact.
  • Nurse Practitioners are allowed to see patients before the physician, but it is the attending physician who must perform and bill for the initial History & Physical Examination.[3] This physician H&P must be documented by the physician, and may not be just a cosignature of an NP note.

Your state may have further restrictions on the scope of practice of advance practice nurses.  If you are unsure, please check with your Director of Nursing.  We also have Regional company counsel who can help clarify any regulatory questions.


[1] 42 CFR § 483.75 (j)(2)

     The facility must–

  • 483.75(j)(2)(i) Provide or obtain laboratory services only when ordered by the attending physician;

[2] 42 CFR § 483.75 (k)(2)

  • 483.75(k)(2) The Facility must—

     (i) Provide or obtain radiology and other diagnostic services only when ordered by the  attending physician;

[3] Interpretive Guidelines 42 CFR § 483.40 (c)

     Although the physician may not delegate the responsibility for conducting the initial visit in a SNF, NPP’s [non-physician practioners] may perform other medically necessary visits prior to and after the physician’s initial visit, as allowed by State law.

Golden Living Gala at AMDA

An estimated 1,400 Medical Directors came to Louisville for the National American Medical Directors Association Meeting. At the Golden Living Gala on Friday Night, Medical Directors from Golden LivingCenters came together to enjoy  dinner, hear the announcement of the GLC Medical Directors of the Year and engage in an interactive discussion with company leaders.

Chief Executive Officer of Golden Living Dr. Neil Kurtz gave an overview  regarding issues facing the industry. Golden LivingCenters President Julianne Williams reviewed the company’s strategic targets for the upcoming year. Dr. Michael Yao and the Regional Medical Directors led and interactive discussion regarding issues concerning Medical Directors in particular. This discussion included best practices to improve prescribing and local barriers to antipsychotic reduction.

Meet Dr. Alfred Baum from GLC – Plymouth

Dr_Alfred_BaumOne of the 2015 Golden LivingCenter Medical Directors of the Year, Dr. Alfred Baum serves as the Medical Director for Golden LivingCenter – Plymouth in Massachussetts.

The GLC – Plymouth Executive Director Emmanuel Freddura nominated Dr. Baum for the award and shared that he has been the medical director for their LivingCenter since 1985.

“Dr. Baum is very approachable, knowledgeable and a champion of quality patient care with great clinical outcomes,” Freddura said.

Dr. Baum champions the LivingCenter in the community and at the Beth Israel Deaconess Hospital in Plymouth, which is a main referral source. He praises the LivingCenter and the nursing skills of the staff to the hospital case managers.

“Dr. Baum is a selfless, compassionate physician,” Freddura continues. “Often he is at the bedside of a dying resident monitoring their comfort, allaying their fears and giving emotional support to the resident and their family.”

A graduate of New York Medical College, Dr. Baum holds his board certifications in both Geriatric and Internal Medicine and is a Certified Medical Director in Long-Term Care.

Golden Living Announces 2015 GLC Medical Directors of the Year


This is the fifth year for the Golden LivingCenter Medical Director of the Year Award, and it’s a wonderful way to recognize how essential our Medical Directors are to the quality of care provided by Golden Living. They are aligned with our company mission and strive to make decisions based on our Golden Living values of integrity, accountability, excellence, and quality. These outstanding Medical Directors practice with clinical excellence that epitomizes Golden Living’s long-term and post-acute care.

The winners were nominated by our Executive Directors and Directors of Nursing Services. These nominations were reviewed by Golden Living administrative, nursing, and medical leaders. Our winners demonstrate clinical excellence in patient care, facility leadership, make contributions to quality of care in the LivingCenter, and are involved in the community.

We announced these Medical Directors at the Golden Living Gala earlier this month in Louisville, Ky., where the American Medical Directors Association (AMDA) held its Long Term Care Medicine 2015 Conference. Each one of these physicians is unique, but all share one distinguishing professional attribute: an unwavering dedication to our patients and their care.

My congratulations goes to our 2015 GLC Medical Directors of the Year:

MD of the Year Table

The nominees this year were:

Dr. Thomas Bailey GLC – Lincoln Hills, Ind.
Dr. Alfred Baum GLC – Plymouth, Mass.
Dr. William Blume GLC – Brentwood, Ind.
Dr. Joel Bolen GLC – Montgomery, Ala.
Dr. Domenick Brasile GLC – Western Reserve, Pa.
Dr. Jerry Bruggeman GLC – Glasgow, Mo.
Dr. Monica Brunelle GLC – Brookview, Ind.
Dr. Richard Chung GLC – Independence, Kan.
Dr. Brian Clonts GLC – Branson, Mo.
Dr. Darwin Davis, Jr. GLC – Bloomfield, Mo.
Dr. Stuart Edmiston GLC – Richmond, Ind.
Dr. Nathaniel Grow GLC – Petersburg, Ind.
Dr. Aysha Habib GLC – Elizabeth Adam Crump, Va. and GLCommunity – Elizabeth House, Va.
Dr. Peter Halmos GLC – Cumberland, Md.
Dr. Travis Henderson GLC – Mobridge, S.D.
Dr. Randall Horine GLC – North Willow, Ind.
Dr. Linda Mazour GLC – Franklin, Neb.
Dr. Tamara McCue GLC – Wellington, Kan.
Dr. R. Cecil McInnis, Jr. GLC – Riverchase, Ala.
Dr. Parvez Memon GLC – Bakersfield and GLC – Shafter, Calif.
Dr. John Middleton GLC – Westminster, Md.
Dr. Abdul Mohiuddin GLC – Petersburg, Va.
Dr. Dana Nash GLC-Southaven, Miss.
Dr. Ward Paine GLC – Morgantown, W.V.
Dr. Tiffany Reed GLC – Greensboro, N.C.
Dr. Frank Reusché GLC – Walnut Creek, Pa.
Dr. Chester Rogers GLC – Mishawaka, Ind.
Dr. Aaron Shives GLC – Watertown, S.D.
Dr. Deepak Shrivastava GLC – Portside, GLC – Hy-Pana and GLC – Chateau, Calif.
Dr. Daljeet Singh GLC – New Haven, Mo.
Dr. Tarlochan Tagore GLC – Sanger, Calif.
Dr. Luther Thomas, III GLC – Augusta, Ga.
Dr. Teofilo Vinluan GLC – Merrillville, Ind.
Dr. Mark Vogt

Dr. David Weintrab

GLC – Westwood, Mo.

GLC – Wedgemere and GLC – Oak Hill, Mass.