Non-Doctor Specialists Provide More Care in Skilled Nursing

The number of doctors practicing in skilled nursing facilities (SNFs) has dropped, while the number of non-doctor SNF specialists has nearly doubled, according to a study published in the Journal of the American Medical Association (JAMA) Internal Medicine.

Headed by Dr. Joan Teno of the Cambia Palliative Care Center of Excellence at the University of Washington in Seattle, the study analyzed Medicare Part B claims from 2007, 2010, and 2014 to identify trends.

The group found that the proportion of physicians who had filed Medicare Part B claims for care delivered in SNFs fell from 13.7% to 9.8%.


Billings submitted by non-doctor specialists — including nurse practitioners and physician assistance — rose from 22% to 31.5% during that period.

The researchers also found that the amount of nurse practitioners and physician assistants classified as nursing facility specialists nearly doubled from 1,678 to 3,074 during the study period.

There have been “broad concerns” regarding the level of quality of care at skilled nursing facilities, Mitchell Katz, M.D., director of the Los Angeles County Health Agency, stated in an editor’s note accompanying the study findings.


“One of the problems is that many nursing homes have no regular doctors, since it is not a requirement,” said Katz. “Most nursing home patients have a private doctor who signs the order for the nursing care, but it is at an office where they may not be able to get to the nursing home on a regular basis.”

Teno and colleagues acknowledge that further research is needed to understand how this specialization of care affects both the delivery of treatment and the overall experience of the resident.

“Even if we ramped up the training by several factors in medical schools, we couldn’t meet the need for geriatrics or palliative care today,” said Teno. “We’re keeping our fingers crossed that these new trends will lead to better quality of care.”

The full report can be read here.

Written by Carlo Calma

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