Just as hospitalists changed the way hospitals care for inpatients, there’s an increasing number of nursing home specialists entering the long-term care field.
The number of doctors and advanced practitioners in the United States who focus on nursing home care increased by more than a third between 2012 and 2015, according to a new study published in JAMA. And of those clinicians who work in nursing homes, 21% now specialize in nursing home care.
Researchers at the Perelman School of Medicine at the University of Pennsylvania say the trend suggests the start of a new specialty in medical practice.
"We don't know how this trend will play out in the long term, but nursing home specialists have the potential to change the way healthcare is delivered in this setting," lead author Kira Ryskina, M.D., an assistant professor at Perelman, said in an announcement about the study.
It’s too soon to say how the trend will affect patient outcomes and continuity of care for nursing home residents, the researchers said. But clinicians who practice exclusively in nursing homes could improve outcomes and reduce costs by bringing expertise to processes of care, Ryskina said.
That may mean nursing home residents no longer get treatment from primary care providers, who traditionally follow patients for years and across care settings, she noted.
The researchers used Part B Medicare fee-for-service billings to identify physicians, nurse practitioners and physician assistants who provided care in nursing homes from 2012 to 2015. They defined nursing home specialists as those who bill at least 90% of episodes of care from the nursing home.
The number of specialists rose from 5,127 to 6,857, an increase of 33.7%.
With concerns about the quality of care in the country’s more than 15,000 nursing homes, the government has proposed a number of reforms and penalties for low-quality care.
The researchers said the nursing home industry may be responding to the tougher regulatory environment by employing physicians who specialize in caring for their residents, much the same way hospitals sought to reduce readmissions and costs by concentrating care among hospitalists.
Site-specific specialists on the rise... Physicians and Advanced Practitioners Specializing in Nursing Home Care, 2012-2015 https://t.co/NDzo7DpICe @PennLDI @healthecon_dan
— Kira Ryskina (@KiraRyskinaMD) November 28, 2017
Although the number of nursing home specialists increased, they still made up only about 21% of all nursing home clinicians in 2015.
Working in nursing homes is not new for many doctors. It’s not unusual for doctors to supplement their income with a nursing home practice or to take on the job of medical director at a nursing home.