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How Many Nursing Home Clinicians Are Nursing Home Specialists?

December 01, 2017

Researchers sought to determine how many nursing home (NH) specialists provide clinical care in NHs as opposed to other nonspecialist providers such as generalist physicians and advance practice practitioners.

One of the strategies adopted by hospitals to improve care over the past decade has been to employ physicians specializing in treating hospitalized patients. Authors Kira L Ryskina, MD, MS, University of Pennsylvania Perelman School of Medicine (Philadelphia, PA), and coauthors investigated to see if this strategy similarly may be occurring in NHs.

Authors used Provider Utilization Files containing all Part B Medicare fee-for-service billings to identify internal medicine, geriatrics, general practice, and family medicine physicians, as well as nurse practitioners and physician assistants who provided NH-based care from 2012 through 2015. Episodes of care by clinician were aggregated to measure the proportion of episodes that were NH-based. NH clinicians who were billed at least 90% of episodes from NHs were defined as NH specialists.

Of the 319,264 unique generalist clinicians identified, 50,227 (15.7%) billed for NH care from 2012 through 2015. Authors said:

The number of clinicians billing for nursing home care remained relatively stable (-0.4%; from 33,218 to 33,087; P for trend, .97), whereas the total number of generalists increased (15.6%; from 224,358 to 259,373; P < .001). The number of nursing home specialists increased from 5127 to 6857 (P <.001), a relative increase of 33.7%.

Overall, from 2012 to 2015, the number of clinicians who specialized in NH practice increased, whereas the number of generalists who provided any NH-based care was stable. There was also a considerable regional variation in the rate of adoption of NH specialists, which may indicate a lack of consensus regarding the benefits of specialization (JAMA. 2017;318[20]:2040-2042).

The authors concluded that, despite the large relative increase, NH specialists made up only 21% of NH clinicians in 2015. However, their effect on patient care may still be considerable as they provide a disproportionate share of the visits.

Authors acknowledged limitations of the study stemming from coding inaccuracies in billing data and inability to assess care to persons not covered by Medicare fee-for-service.—Amanda Del Signore

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