Nursing home patients who see a doctor soon after admission have a lower chance of returning to the hospital regardless of prognosis, a recent study on physician access finds.

Patients seen by a physician or other advanced practice provider within a day of a skilled nursing admission were less likely to be rehospitalized compared to patients seen two days post-admission or later. But various obstacles tend to push those physician visits well beyond the first few days of care, University of Pennsylvania researchers found.

“Timely evaluation by a physician or APP after SNF admission may protect against rehospitalization,” the authors reported in JAMDA, the Journal of the American Medical Directors Association. “Investment in the workforce such as training programs, practice innovations and equitable reimbursement for SNF visits after hospital discharge may mitigate [physician] labor shortages that were exacerbated by the COVID pandemic.”

Nursing homes don’t necessarily prioritize visits for sicker patients, largely because of policy and reimbursement issues that limit the presence of physicians in many facilities, said study co-author Kira Ryskina, MD, assistant professor at the University of Pennsylvania’s Perelman School of Medicine.

“We know from our other work that many SNF physicians split their time between other roles, including seeing patients in another hospital or clinic, so they may not always make it to the SNF when a patient is admitted,” Ryskina said. “Their visit schedule may be set in advance or depend on day-to-day availability.”

She acknowledged that few nursing homes can afford to staff full-time doctors or nurse practitioners, and that the frequency of on-site visits can vary from daily to monthly in some locations. While Medicare regulations require an interdisciplinary care to develop a care plan within 14 days of admission, a physician visit isn’t required until the 30-day mark.

In 2019, Ryskina and colleagues found that 1 in 10 nursing home patients never see a physician during their stay, and those patients are far more likely to return to a hospital or die.

Those themes persisted in the latest study, published in December and publicized by the University of Pennsylvania this week. The researchers found the risk of rehospitalization increased from 3% to as much as 35% for each additional day that a patient waited to be seen by a doctor or other clinician.

“The regulatory landscape, reimbursement, educational efforts, and organizational practices related to physician and NP practice in SNFs are outdated and do not address patient needs,” Rysknia said. “For example, existing mandates limit NPs’ ability to perform some of the required assessments of SNF patients. Payers underinvest in remote care options, limiting patient access to only local providers willing to commute to SNFs to see patients in person. Also, training in SNF-based care for physicians remains inadequate — for instance, internal medicine residency programs virtually ignore this practice setting.”