A higher employment of physicians and advanced practitioners at nursing homes – or SNFists – isn’t associated with statistically significant changes in rehospitalization rates.
Instead, facility adoption of these SNFists may represent a strategy by nursing homes to maintain rehospitalization rates as operators attempt to shift patient case mix in favor of those receiving post-acute care, a population that typically results in higher profit margins for nursing homes.
That’s according to a study published in JAMA Network Open, which included a national cohort of 4,482 facilities. The number of these facilities adopting SNFists increased dramatically from 13.5% in 2013 to 52.9% in 2018.
Nursing homes in Eastern states tended to have a higher prevalence of facilities that adopted SNFists. States in the Midwest, South and West Coast also had higher prevalences compared to other regions.
“Although 30-day rehospitalization rates after SNFist adoption remained stable, [nursing homes] that adopted SNFists experienced an increase in the percentage of residents covered by Medicare and in the volume of patients admitted for post-acute care,” researchers said. “This may be attractive to [nursing homes] because Medicare payments for post-acute care are more profitable than Medicaid payments for long-term care.”
In other words, SNFists were perhaps a tool to help operators shift their care models to focus more on Medicare beneficiaries in order to help with their bottom line, according to study findings.
Rehospitalizations were stable, since hospitals are sensitive to increases in rehospitalization rates, researchers said. Even the tiniest increase could result in area hospital systems reconsidering whether a nursing home should be in their referral network.
“In addition, [nursing homes] incur financial penalties through the SNF [Value-Based Purchasing, or VBP] Program if they have high rehospitalization rates, currently the initiative’s only performance measure,” researchers wrote. “The absence of a decrease in performance on this measure while increasing the volume of patients receiving post-acute care after SNFist adoption may incentivize [nursing homes] to pursue this strategy for medical care delivery.”
With more measures due to be added, as well as a proposal for the existing measure to be replaced with a new iteration of the SNF VBP, researchers said the adoption of SNFists may be an investment toward these anticipated changes as well.
Researchers compared the SNFists to hospitalists in both acute care settings and post-acute care. Hospitalists, or physicians and advanced practitioners specializing in inpatient care and working at hospitals as opposed to SNFs, were found to reduce length of stay, lower mortality rates after hospitalization for pneumonia, heart failure and orthopedic conditions – but in the acute care setting only.
Hospitalists in post-acute care were associated with higher costs; other physician specializations were linked to avoidable health care use for patients with heart failure and dementia, the study found.
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