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Growth of Physicians and Nurse Practitioners Practicing Full Time in Nursing Homes

  • James S. Goodwin
    Correspondence
    Address correspondence to James S. Goodwin, MD, George and Cynthia Mitchell Distinguished Chair in Geriatric Medicine, University of Texas Medical Branch, 301 University Blvd, Galveston, TX 77555-0177, USA.
    Affiliations
    Sealy Center on Aging, The University of Texas Medical Branch at Galveston, Galveston, TX, USA

    Department of Medicine, The University of Texas Medical Branch at Galveston, Galveston, TX, USA
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  • Pooja Agrawal
    Affiliations
    School of Medicine, The University of Texas Medical Branch at Galveston, Galveston, TX, USA
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  • Shuang Li
    Affiliations
    Sealy Center on Aging, The University of Texas Medical Branch at Galveston, Galveston, TX, USA
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  • Mukaila Raji
    Affiliations
    Sealy Center on Aging, The University of Texas Medical Branch at Galveston, Galveston, TX, USA

    Department of Medicine, The University of Texas Medical Branch at Galveston, Galveston, TX, USA
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  • Yong-Fang Kuo
    Affiliations
    Sealy Center on Aging, The University of Texas Medical Branch at Galveston, Galveston, TX, USA

    Department of Medicine, The University of Texas Medical Branch at Galveston, Galveston, TX, USA

    Department of Preventive Medicine and Population Health, The University of Texas Medical Branch at Galveston, Galveston, TX, USA
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      Abstract

      Objectives

      The objective was to describe the growth of physicians, nurse practitioners (NPs), and physician assistants (PAs) who practice full time in nursing homes, to assess resident and nursing home characteristics associated with receiving care from full-time providers, and describe variation among nursing homes in use of full-time providers.

      Design

      Retrospective cohort study.

      Setting and Participants

      A 20% national sample Medicare data on long-term care residents in 2008 to 2018 and the physicians, NPs, and PAs who submitted charges to Medicare for their care.

      Methods

      We measured the percentage of provider charges for services rendered in nursing homes, in addition to resident and facility characteristics.

      Results

      Full-time nursing home providers increased from 26.0% of all nursing home providers in 2008 to 44.6% in 2017. The largest increase was in NPs: from 1986 in 2008 to 4479 in 2017. Resident age, sex, Medicaid eligibility, and race/ethnicity had minimal association with the odds of having a full-time provider, whereas residents with an NP primary care provider were 23.0 times more likely (95% confidence interval = 21.6, 24.6) to have a full-time provider. Residents who received care from both a physician and an NP or PA increased from 33.6% in 2008 to 62.5% in 2018. There was large variation among facilities in the percentage of residents with full-time providers, from 5.72% of residents with full-time providers in the bottom quintile of facilities to 91.44% in the top quintile. Individual nursing homes accounted for 59% of the variation in whether a resident had a full-time provider.

      Conclusions and Implications

      The percentage of nursing home residents with full-time providers continues to grow, with very large variation among nursing homes.

      Keywords

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      References

        • Harris-Kojetin L.D.
        • Sengupta M.
        • Lendon J.P.
        • et al.
        Long-term care providers and services users in the United States, 2015-2016. National Center for Health Statistics.
        Vital Health Stat 3. 2016; 38 (1–105): x-xii
        • Ouslander J.G.
        • Lamb G.
        • Perloe M.
        • et al.
        Potentially avoidable hospitalizations of nursing home residents: Frequency, causes, and costs [See editorial comments by Drs. Jean F. Wyman and William R. Hazzard, pp 760–761].
        J Am Geriatr Soc. 2010; 58: 627-635
        • Burke R.E.
        • Rooks S.P.
        • Levy C.
        • et al.
        Identifying potentially preventable emergency department visits by nursing home residents in the United States.
        J Am Med Dir Assoc. 2015; 16: 395-399
        • Kuo Y.F.
        • Raji M.A.
        • Goodwin J.S.
        Association between proportion of provider clinical effort in nursing homes and potentially avoidable hospitalizations and medical costs of nursing home residents.
        J Am Geriatrics Soc. 2013; 61: 1750-1757
        • Teno J.M.
        • Gozalo P.L.
        • Trivedi A.N.
        • et al.
        Temporal trends in the numbers of skilled nursing facility specialists from 2007 through 2014.
        JAMA Intern Med. 2017; 177: 1376-1378
        • Ryskina K.L.
        • Polsky D.
        • Werner R.M.
        Physicians and advanced practitioners specializing in nursing home, 2012-2015.
        JAMA. 2017; 318: 2040-2042
        • Xue Y.
        • Goodwin J.S.
        • Adhikari D.
        • et al.
        Trends in primary care provision to Medicare beneficiaries by physicians, nurse practitioners, or physician assistants: 2008-2014.
        J Prim Care Community Health. 2017; 8: 256-263
        • Centers of Medicare & Medicaid Services
        Medicare data on physician and specialty (MD_PPAS).
        (Available at:) (Accessed January 27, 2021)
        • Goodwin J.S.
        • Li S.
        • Zhou J.
        • et al.
        Comparison of methods to identify long term care nursing home residence with administrative data.
        BMC Health Serv Res. 2017; 17: 376
        • Centers of Medicare & Medicaid Services
        Nursing home Compare. Medicare.gov.
        (Available at:) (Accessed January 27, 2021)
        • Tamirisa N.P.
        • Sheffield K.M.
        • Parmar A.D.
        • et al.
        Surgeon and facility variation in the use of minimally invasive breast biopsy in Texas.
        Ann Surg. 2015; 262: 171-178
        • Rogers M.A.
        • Blumberg N.
        • Saint S.
        • et al.
        Hospital variation in transfusion and infection after cardiac surgery: A cohort study.
        BMC Med. 2009; 7: 37
        • Shahinian V.B.
        • Kuo Y.F.
        • Freeman J.L.
        • Goodwin J.S.
        Determinants of androgen deprivation therapy use for prostate cancer: Role of the urologist.
        J Natl Cancer Inst. 2006; 98: 839-845
        • Hong I.
        • Karmarkar A.
        • Chan W.
        • et al.
        Discharge patterns for ischemic and hemorrhagic stroke patterns going from acute care hospitals to inpatient and skilled nursing rehabilitation.
        Am J Phys Med Rehabil. 2018; 97: 636-645
        • Kuo Y.F.
        • Sharma G.
        • Freeman J.L.
        • Goodwin J.S.
        Growth in the care of older patients by hospitalists in the United States.
        N Eng J Med. 2009; 360: 1102-1112
        • Smith A.
        Wealth of Nations.
        Penguin Books, London1970 (first published 1776)
        • Li S.
        • Middleton A.
        • Ottenbacher K.J.
        • Goodwin J.S.
        Trajectories over the first year of long-term care nursing home residence.
        J Am Med Dir Assoc. 2018; 19: 333-341
        • Ryskina K.L.
        • Yuan Y.
        • Werner R.M.
        Postacute care outcomes and Medicare payments for patients treated by physicians and advanced practitioners who specialize in nursing home practice.
        Health Serv Res. 2019; 54: 564-574
        • Kuo Y.F.
        • Goodwin J.S.
        • Raji M.
        • et al.
        Use of Medicare data to identify team-based primary care: Is it possible?.
        Med Care. 2019; 57: 905-912
        • Azad N.A.
        • Mielniczik L.
        A call for collaboration: Improving cardiogeriatric care.
        Can J Cardiol. 2016; 32: 1041-1044
        • Kuo Y.R.
        • Adhikari D.
        • Eke C.G.
        • et al.
        Processes and outcomes of congestive heart failure care by different types of primary care models.
        J Card Fail. 2018; 24: 9-18
        • Stefanacci R.G.
        Will nurse practitioners replace physicians as attendings in long-term care?.
        J Am Med Dir Assoc. 2001; 2: 222-224
        • Ryskina K.L.
        • Song W.
        • Sharma V.
        • et al.
        Characterizing physician in nursing homes using claims-based measures: Correlation with nursing home administrators’ perceptions.
        Med Care Res Rev. 2021; 78: 806-815

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