The number of physicians who practice in a nursing home – commonly referred to as SNFists – have increased 48% between 2014 and 2017, but there is still no formal medical designation for the role.
The Center for Medicare & Medicaid Services (CMS) hasn’t provided a standard definition of what such a position would entail either, despite SNFists providing higher quality care for residents than other physicians, according to a June article published in the Journal of the American Medical Directors Association (JAMDA).
The authors in January 2021 interviewed 35 physicians across the country who serve or have previously served as medical directors and/or attending physicians in nursing homes. There are more than 6,000 SNFists practicing in nursing homes as of 2017, according to JAMDA.
The term ‘SNFist,’ JAMDA authors said, is used in medical literature and by CMS.
JAMDA’s article identified six barriers to defining and placing value on the SNFist role – the first being an unclear definition of and loose qualifications for SNFists and how that might impact quality of care.
A streamlined list of competencies and performance measures are the “first step” toward linking SNFist care and outcomes, researchers added.
CMS should also identify specific skills and medical knowledge needed for competent SNFist practice as another way to make the role clearer, interviewees said.
While there’s been an increased prevalence of the role overall, “little is known” about the role; studies based on administrative data suggests SNFists are associated with fewer hospitalizations and an improvement in process measures of care, JAMDA authors said.
“SNFists are distinguished by their unique practice approach and often provide services that are unbillable or under-reimbursed,” JAMDA authors said, a third barrier such physicians want CMS to address.
This particular issue has been a disincentive to physicians thinking about becoming SNFists, according to the article.
“Policy makers may consider reimbursing for services currently not covered by Medicare that are frequently performed by SNFists and increase the level of payments for services that are reimbursed to incentivize more physicians to specialize in NH care,” researchers said.
Coupled with unbillable, under-reimbursed services, the SNFist claims he or she provides better outcomes but it depends on the performance measure, yet another barrier to address, all while staying in the nursing home during the Covid to care for residents.
Potential performance measures for SNFists, researchers said, include infection control, deprescribing antipsychotics and fewer hospitalizations.
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