More Doctors Specialize in Nursing Home Care, Study Shows

Increasing numbers of doctors and advanced practitioners in the U.S. are focusing on nursing home care, which could indicate a trend toward the specialty as the U.S. population ages.

Of all the doctors and advance practitioners who do any work in nursing homes, 21% specialize in nursing home care, a new study published Tuesday in the Journal of the American Medical Association (JAMA) shows.

The researchers, from the University of Pennsylvania’s Perelman School of Medicine and the Crescenz Veterans Affairs Medical Center, defined “nursing home specialists” as those clinicians billing at least 90 percent of episodes from a nursing home.

“The number of actual clinicians doing nursing home care stayed pretty stable,” Kira Ryskina of the University of Pennsylvania told Skilled Nursing News. “In that context, the fact that the nursing home specialists had their number increase by a third over this really short period of time is really dramatic, and we suspect that it’s the beginning of a trend. But there’s no way to tell.”

The team used a Medicare database to study all the Part B Medicare fee-for-service billings by nurse practitioners, physician assistants and generalist physicians who provided nursing home-based care from 2012 to 2015.

The number of nursing home specialists increased from 5,127 in 2012 to 6,857 in 2015, a gain of 33.7%. Adjusting for patient population revealed that the number of nursing home specialists per 1,000 occupied beds rose from 3.35 in 2012 to 4.58 in 2015, an increase of 36.7%.

The overall total number of clinicians who billed from nursing homes numbered 33,218 in 2012, compared to 33,087 in 2015.

It may be too soon to call the rise of nursing home specialists a bona fide trend, but the rate of increase gained steam from 2014 to 2015, compared with the early years of the study, Ryskina noted. In addition, a large segment of the clinicians seeing the increase in this area are advanced practitioners, she added.

There were regional variations, however, with about 80% of U.S. hospital referral regions seeing increases in nursing home specialists per bed and about 20% seeing declines. But there was no unifying or correlating factor.

“One thing that we did notice was that in the Northwest there’s still a continuous rise of post-acute care in that region, and market consolidation of nursing homes there, and that might drive some of the specialization trends,” Ryskina told SNN. “So if the same company is buying a lot of the nursing homes, they might implement a lot of the same practices with regard to staffing.”

But she stressed that nursing home specialization didn’t have a direct correlation with other variables in the skilled nursing space, such as patient outcomes and costs.

“There was no consistent universal explanation,” Ryskina said. “So the effect on patient outcomes and patient costs are not clear yet.”

Still, there are some possibilities. Patients who enter nursing homes for short periods of time have different needs from those of long-term care residents, and it’s possible the former could see their care fragmented as they move from hospital to SNF to home, Ryskina said. For example, short-term nursing home patients could lose more of their connection with a primary care doctor, who generally follows patients for years over various care settings.

“For a long-term care resident, if there’s a staff physician or a staff clinician specializing in nursing home care, you could imagine they’ll benefit,” she added.

Written by Maggie Flynn

Maggie Flynn
Business reporter
When she's not working, Maggie enjoys running, reading, writing and sports, in no particular order. Favorite things include murder mysteries, Lake Michigan and the Pittsburgh Penguins.

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