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December 4, 2017

A new specialty? More providers are becoming 'nursing home specialists,' study finds

Daily Briefing

    The number of physicians and advanced practitioners serving as "nursing home specialists" increased by more than a third between 2012 and 2015—but it's still too early to know the long-term effects of this trend, according to a study published in JAMA.

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    Study details

    For the study, researchers from the Perelman School of Medicine at the University of Pennsylvania looked at Part B Medicare fee-for-service billings to determine how many doctors, NPs, and advanced practitioners specialized in nursing home care from 2012 to 2015. The researchers defined a "nursing home specialist" as someone who billed at least 90% of his or her care episodes from a nursing home.

    The researchers found that the number of nursing home specialists increased 33.7% from 2012 to 2015, from 5,127 to 6,857. The jump increased further when the researchers adjusted the figures for patient population: Overall, the number of nursing home specialists per 1,000 occupied nursing home beds increased by 36.7%, from 3.35 per 1,000 in 2012 to 4.58 per 1,000 in 2015. In comparison, the researchers found that the total number of generalists providing any care in a nursing home setting fell marginally, from 33,218 in 2012 to 33,087 in 2015.

    Despite the increase of nursing home specialists, they comprised just 21% of all providers who delivered at least some nursing home based care in 2015, the researchers found. The increase of nursing home specialists also varied by region: about 80% of hospital referral regions had increases in nursing home specialists per nursing home bed, while 20% had decreases, the study found. Kira Ryskina, the study's lead author and an assistant professor at the Perelman School, said the findings on variation "indicat[e] a lack of consensus regarding the benefits of specialization."


    The researchers cautioned that while the findings suggested nursing home care could be on the rise as a specialty, it was still too soon to discern how the shift would affect health care delivery. "We don't know how this trend will play out in the long term, but nursing home specialists have the potential to change the way health care is delivered in this setting," Ryskina said.

    For instance, Ryskina said an increase of nursing home specialists "could improve patient outcomes and reduce costs by leveraging expertise in nursing home processes of care." However, on the flipside, she pointed out that "concentrating patient care among nursing home specialists could also mean that patients are no longer seen by their primary care providers, who traditionally follow patients for years and across care settings."

    According to Ryskina, the trend may be a response by the nursing home industry to increase regulation by CMS. "Twenty years ago, the Hospitalist movement started in the same way, wherein hospitals were under pressure to reduce costs, and readmissions," she said. "We might be seeing the beginnings of a similar trend in nursing home care" (Finnegan, FierceHealthcare, 11/29; Gooch, Becker's Hospital Review, 11/29; Commins, HealthLeaders Media, 11/29).

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