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
- 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
- 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
- Identifying potentially preventable emergency department visits by nursing home residents in the United States.J Am Med Dir Assoc. 2015; 16: 395-399
- 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
- Temporal trends in the numbers of skilled nursing facility specialists from 2007 through 2014.JAMA Intern Med. 2017; 177: 1376-1378
- Physicians and advanced practitioners specializing in nursing home, 2012-2015.JAMA. 2017; 318: 2040-2042
- 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
- Medicare data on physician and specialty (MD_PPAS).(Available at:) (Accessed January 27, 2021)
- Comparison of methods to identify long term care nursing home residence with administrative data.BMC Health Serv Res. 2017; 17: 376
- Nursing home Compare. Medicare.gov.(Available at:) (Accessed January 27, 2021)
- Surgeon and facility variation in the use of minimally invasive breast biopsy in Texas.Ann Surg. 2015; 262: 171-178
- Hospital variation in transfusion and infection after cardiac surgery: A cohort study.BMC Med. 2009; 7: 37
- Determinants of androgen deprivation therapy use for prostate cancer: Role of the urologist.J Natl Cancer Inst. 2006; 98: 839-845
- 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
- Growth in the care of older patients by hospitalists in the United States.N Eng J Med. 2009; 360: 1102-1112
- Wealth of Nations.Penguin Books, London1970 (first published 1776)
- Trajectories over the first year of long-term care nursing home residence.J Am Med Dir Assoc. 2018; 19: 333-341
- 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
- Use of Medicare data to identify team-based primary care: Is it possible?.Med Care. 2019; 57: 905-912
- A call for collaboration: Improving cardiogeriatric care.Can J Cardiol. 2016; 32: 1041-1044
- Processes and outcomes of congestive heart failure care by different types of primary care models.J Card Fail. 2018; 24: 9-18
- Will nurse practitioners replace physicians as attendings in long-term care?.J Am Med Dir Assoc. 2001; 2: 222-224
- Characterizing physician in nursing homes using claims-based measures: Correlation with nursing home administrators’ perceptions.Med Care Res Rev. 2021; 78: 806-815
Article info
Publication history
Published online: July 15, 2021
Footnotes
This work was supported by the National Institutes of Health, United States (Grants R01 HS020642, P30AG024832, UL1TR001439).
The authors declare no conflicts of interest.
Identification
Copyright
© 2021 AMDA - The Society for Post-Acute and Long-Term Care Medicine.
ScienceDirect
Access this article on ScienceDirectRelated Podcast
December 15, 2021
December 2021 Issue: Full-Time Nursing Home Practice / Deprescribing / Pain Management / Ventilators
Featuring Dr. Philip Sloane, Dr. Mallory Brown; Recorded: December 8, 2021.
https://mcdn.podbean.com/mf/download/reaa6p/dec2021final.mp3
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