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The unintended impact of Obamacare on SNFs

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Eduardo Gonzalez
Eduardo Gonzalez

The Affordable Care Act, commonly known as, “ObamaCare,” is well understood to be in place primarily to assist Americans in need of healthcare insurance. It might be safe to assume then, that Obamacare should not affect most residents of nursing homes since many already have some type of insurance, such as an HMO, Medicare and/or Medicaid. ObamaCare, however, brings a range of unintended consequences and potential challenges to Skilled Nursing Facilities that administrators must face in order to identify solutions long term.

The biggest challenge in the near future for SNFs is the shortage of physicians.

A 2012 study conducted by the Annals of Family Medicine[1], projected that by 2025 the country will have a shortage of approximately 52,000 primary care physicians. A 2009 Physicians Foundation report[2] put that number at 200,000.

Part of the problem is the growing number of retiring physicians. The Association of American Medical Colleges (AAMC) estimates that approximately 250,000 physicians will retire within the next ten years — nearly one-third of all physicians.

Obamacare appears to exacerbate the problem.

This past October, CNN reported[3] that the entire American healthcare system could crash once Obamacare is implemented, due to the expected increased demand for patient care coupled with the shortage of physicians. The New York Post stated that “The Massachusetts Medical Society issued a report in July that found half of the primary-care doctors refused to accept new patients because they're fully booked. And the average waiting times to see a family doctor and internist after requesting an appointment is 39 and 50 days, respectively.” [4]

Why is this a problem for SNFs?

For years, SNFs have been challenged with finding physicians that are willing to provide services for patients in a residential care facility, especially in rural America. When asked why they are reticent some physicians have commented that:

  •  Very few study nursing home care in medical school

How many medical students make it their professional goal and area of focus to provide care in a nursing home? Most medical students dream of working in, what they consider, the middle of the action, such as at a hospital or in an ER. Many plan to establish their own practice.

Most physicians end up providing care at SNFs by default. For instance, their patient got too old and needed more care and so was admitted to a SNF. Subsequently, the family requested the physician to continue the patient's care at the facility.

  • The pay is too low

Physicians typically make very little for each visit to a SNF. In fact, some have stated that MediCaid pays just $10 per visit and only covers one visit per month. Compare this to the $60-$100 per patient multiplied by 3 to 4 patients seen per hour that a physician might collect in private practice.

  • There are too many regulations
Physicians that agree to provide care within SNFs, quickly learn about all the requirements placed on these facilities with which the physician must now comply.
  • There is too much liability

For some, the liability to provide this type of resident care, being on call 24/7, and the unrealistic expectations of some residents and/or their family members becomes an undesirable proposition and opens up the risk for too much liability.

What can be done to address the physician shortage.

Some healthcare companies, thinking outside of the box, have created consultant positions for physicians, where the SNF pays a monthly flat rate to the physician for services provided. Given the mandated Corporate Compliance program that all SNFs must now abide by, a very fine line may be getting crossed regarding the Federal Anti-Kickback Statute. Basically, the physician should be hired by the resident and not appointed by the facility.

An alternative is for SNFs to, “market” themselves directly to the medical community, especially “new” physicians. As medical groups make announcements of new physicians joining their organizations, the SNF administrator and Director of Nursing should immediately invite the new physician to visit the facility and meet key staff. This should not be delegated to the marketing or admission staff. This is a meeting of executive leadership with physicians that are being encouraged to learn more about the professional care that is needed for long-term resident patients. Ultimately, physicians will be more inclined to provide services in facilities where the leadership has been proactive in their quality of care and where a personal relationship has been established. In fact, by establishing this relationship, the physician may also be more likely to refer his or her patients to the facility when long-term care is needed.

The residential care and SNF industry must rally.

The long-term care industry must rally and work together to address the growing shortage of physicians. The industry needs to teach, educate and stimulate physicians so they understand the importance of providing care for residents. Healthcare associations, private corporations, independent owners, administrators, and directors of nursing, must act now to identify solutions before this physician shortage reaches crisis status and SNFs are impacted more than any other healthcare provider in America.

Eduardo Gonzalez, NHAP and RCFEA, has worked in healthcare facilities for over 20 years, with terms as owner, administrator and executive leader. Currently, he provides risk management consulting for Priority Healthcare, LLC


[1] http://www.annfammed.org/content/10/6/503.full.pdf+html

[2] http://www.med.unc.edu/socialmed/old-folders-and-pages/files/documents/Physicians%20And%20Their%20Practices.pdf

[3] http://www.cnn.com/2013/10/02/health/obamacare-doctor-shortage/index.html

[4] http://nypost.com/2013/11/04/states-face-obamacare-doctor-shortage/

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