The rising SNFist could curtail readmissions

A new breed of primary care providers could curb readmissions. The emerging SNFists, sometimes called SNFologists, are full-time physicians in skilled nursing facilities, who are more readily available to patients, particularly older ones, with multiple comorbidities at risk for readmission, according to Hospitals & Health Networks Daily.

Last week, the Medicare Payment Advisory Commission (MedPAC) said a quarter of hospital admissions could have been avoided if seniors received better care at home or in an outpatient setting.

MedPAC's report builds on previous research that found seniors are particularly vulnerable for readmissions. A 2010 study in the Journal of the American Geriatrics Society found that two-thirds of hospitalizations in Georgia were preventable and largely due to a lack of on-site primary care.

Under the SNFist model, employed or contracted physicians can fill in the primary care gap by tending to elderly patients in the skilled nursing setting. For instance, urinary tract infections and pneumonia cases don't necessary mean readmissions because those conditions could be treated right in the nursing home, according to an article by Curaspan Health Group, a patient management software company.

"An ambulatory care doctor might only be in the nursing home for half a day each month," Jose Gonzalez, medical director of Extended Care Physicians, Coastal Region, in Wilmington, N.C., said. "We visit patients in each of our buildings at least one day a week."

In addition to curtailing readmissions, the SNFist model has other advantages, including improved communication with families and increased patient attention.

Currently made up of only a couple thousand nursing home specialists, according to Toronto-based Baycrest Chief Medical Officer Paul Katz, the developing primary care specialty, nevertheless, may face barriers.

Recruiting for such SNFists may be even more difficult in an existing primary care physician shortage. Reimbursement also may be difficult, with increased recovery auditors' attention on nursing homes.

For more information:
- read the H&HN column
- here's the MedPAC transcript (.pdf)
- check out the Journal of the American Geriatrics study (.pdf)
- see the Curaspan article

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