The number of doctors and advanced practitioners in the United States who focus on nursing home care rose by more than a third between 2012 and 2015, according to a new study from researchers at the Perelman School of Medicine at the University of Pennsylvania.
Of all physicians and advanced practitioners who do any work in nursing homes, 21 percent now specialize in nursing home care. The trend, the authors said, suggests the rise of a significant new specialty in medical practice, though how it will affect patient outcomes and continuity of care is yet to be seen.
One possibility is that clinicians who practice exclusively in a nursing home could improve patient outcomes, and reduce costs, by applying their expertise in processes of care. But there's also the chance that some patients would no longer be seen by their primary care providers.
There are presently more than 15,000 nursing homes in the U.S., with a total capacity of nearly 1.7 million beds. But the quality of healthcare in these facilities varies considerably. Research has shown, for example, that in 2014 the rate of avoidable hospitalizations for the worst-performing nursing homes was high (14 percent), nearly double the rate for the best-performing nursing homes. And costs of nursing home care are high, accounting for 75 percent of regional variation in Medicare costs.
Concerns over care quality have prompted the Centers for Medicare and Medicaid Services to propose a number of reforms as well as penalties for low-quality care in nursing homes. The nursing home industry may now be adapting to this stricter regulatory environment by employing physicians who specialize in nursing home care.
In the study, researchers used a Medicare database to analyze all Part B Medicare fee-for-service billings by generalist physicians, nurse practitioners and physician assistants who provided nursing home-based care during 2012-2015. Nursing-home specialists were defined as those clinicians billing at least 90 percent of episodes from a nursing home.
The number of these specialists rose from 5,127 in 2012 to 6,857 in 2015, a jump of 33.7 percent. Adjusted for the patient population, this rise was even greater: from 3.35 nursing home specialists per 1,000 occupied beds to 4.58, an increase of 36.7 percent. During the same period, the overall number of clinicians billing from nursing homes was almost unchanged.
Nursing home specialists made up only about 21 percent of all nursing home clinicians in 2015, so the results may mark the earliest phase of a trend towards nursing home specialization.