Postacute care outcomes and medicare payments for patients treated by physicians and advanced practitioners who specialize in nursing home practice

Abstract

Objective To measure the association between clinician specialization in nursing home (NH) practice and outcomes of patients who received postacute care in skilled nursing facilities (SNFs). Data Sources Medicare claims and NH assessments for 2 118 941 hospital discharges to 14 526 SNFs in January 2012‐October 2014 and MD‐PPAS data for 52 379 clinicians. Study Design Generalist physicians and advanced practitioners with ≥ 90 percent of claims for NH‐based care were considered NH specialists. The primary clinician during each SNF stay was determined based on plurality of claims during that stay. We estimated the effect of being treated by a NH specialist on 30‐day rehospitalizations, successful discharge to community, and 60‐day episode‐of‐care Medicare payments (Parts A and B). All models included patient demographics, clinical variables, and SNF fixed effects. Principal Findings Nursing home specialists' patients were less likely to be rehospitalized (14.71 percent vs 16.23 percent; adjusted difference, −1.51 percent, 95% CI −1.78 to −1.24), more likely to be successfully discharged to community (56.33 percent vs 55.49 percent; adjusted difference, 0.84 percent, 95% CI 0.54 to 1.14), but had higher 60‐day Medicare payments ($31 628 vs $31 292; adjusted difference, $335; 95% CI $242 to $429). Conclusions Clinicians who specialize in NH practice may achieve better postacute care outcomes at slightly higher costs.

Long-Term Care, Residential Facilities, and COVID-19: An Overview of Federal and State Policy Responses

“…For example, prior evidence supports the use of advanced practitioners in nursing homes, 13 as well as physicians who specialize in nursing home practice. 14 We also need to understand the effects of public reporting of COVID-19 cases and deaths, as well as COVID-related funding penalties, on the quality of and access to nursing home and residential caredincluding facility closures. Fiscally vulnerable facilitiesdfacilities that mainly house Medicaid residents, operate on narrow financial margins, and have limited resourcesdmay be disproportionally affected by the recently issued CMS penalties for infection control lapses.…”

Expectations and Experiences with Physician Care Among Patients Receiving Post-Acute Care in US Skilled Nursing Facilities

“…In a national study of facilities with both types of clinicians, patients under the care of SNFists had 1.5% lower rehospitalization rate and 0.8% higher rate of successful discharge to community [10]. However, patients of SNFists experienced higher Medicare payments during the sixty days following hospital discharge, compared to patients of physicians who did not specialize in SNF practice [10]. Little is known about patient and caregiver experiences and perceptions of SNFist care.…”

Expectations and Experiences with Physician Care among Patients Receiving Post-Acute Care in US Skilled Nursing Facilities

“…There is evidence that patients under the care of SNFists have better outcomes. In a national study of facilities with both types of physicians, patients under the care of SNFists had 1.5% lower rehospitalization rate and 0.8% higher rate of successful discharge to community [10]. Little is known about patient and caregiver experiences and perceptions of SNFist care.…”

“…Some physicians and nurse practitioners are increasingly focusing their practice exclusively on treating patients in these facilities (colloquially known as "SNFists") [7][8][9]. Although one study using Medicare data found that patients under the care of SNFists have slightly better clinical outcomes [10], it did not evaluate patient perceptions of their care.…”