Physicians focusing on nursing home care trending upward, study finds

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An increasing number of physicians choosing to specialize in nursing home care may kick off a trend similar to the growth of the hospitalist speciality, according to a new study.

The research, led by a team at the Perelman School of Medicine at the University of Pennsylvania, analyzed Medicare claims by physicians, nurse practitioners and physician assistants to determine how many billed at least 90% of their episodes from a nursing home.

The study's findings, published Tuesday in JAMA, showed the number of physicians focusing on nursing home care grew by more than a third (33.7%) between 2012 and 2015 — from 5,127 to 6,857. That can be translated from 3.35 specialists per 1,000 occupied nursing home beds to 4.58.

The increase may be spurred in part by providers looking to improve quality in order to adhere to stricter federal guidelines, suggested lead researcher Kira L. Ryskina, M.D.

“Hospitals in recent years have sought to improve care by concentrating it among 'hospitalist' physicians who focus on treating hospitalized patients," Ryskina said. "Twenty years ago, the hospitalist movement started in the same way, wherein hospitals were under pressure to reduce costs, and readmissions. We might be seeing the beginnings of a similar trend in nursing home care."

In total, 21% of all nursing home clinicians specialized in nursing home care in 2015.

While the study found some regional variation in the increase — around 80% of regions saw increases in nursing home specialists per bed, while 20% did not — the results show the start of a trend that shouldn't be overlooked, Ryskina said.

"The impact of that trend on patient care may already be considerable, though, because specialists provide a disproportionate share of the care," she noted.

Whether or not the increase in skilled nursing specialists improves care outcomes or affects the continuum of care will require further study, researchers said.