Growing Number of Doctors as Nursing Home Specialists

As the population of the United States ages and Medicare places more emphasis on nursing home care quality, more hospitals are concentrating care among physicians trained to treat hospitalized patients.

A recent research letter in JAMA found that the number of doctors who are “nursing home specialists” increased by more than one-third between 2012 and 2015. Previous research has found that nursing home care is common, but the quality of care is variable. The development of this new specialty could help to improve that care.

According to the study’s lead author, Kira L. Ryskina, MD, MS, an assistant professor at the Perelman School of Medicine, nursing home specialists have the potential to change healthcare delivery, but the effect on outcomes is still unclear.

“On one hand, clinicians who practice in the nursing home exclusively could improve patient outcomes and reduce costs by leveraging expertise in nursing home processes of care, for example,” Ryskina said in a statement. “But, concentrating patient care among nursing home specialists could also mean that patients are no longer seen by their primary care providers, who traditionally follow patients for years and across care settings.”

Ryskina and colleagues analyzed the Provider Utilization Files containing Part B Medicare fee-for-service billings and identified generalist physicians and advanced practitioners who provided nursing home care from 2012 to 2015. Clinicians who billed at least 90% of episodes from the nursing home were classified as nursing home specialists.

While the number of clinicians billing for nursing home care was stable during the study period, the number of nursing home specialists increased 33.7%. Those specializing in post-acute care and advanced practitioners were the most common types of nursing home specialists.

Growth in nursing home specialists is uneven across the country. While 78.7% of hospital referral regions included reported an increase in these specialists per occupied bed, 20% experience a decrease in the number of nursing home specialists per occupied bed.

“The variation in adoption of specialists indicates a lack of consensus regarding the benefits of specialization,” Ryskina said.

As of 2015, nursing home specialists accounted for just 21% of all nursing home clinicians, which may indicate that the trend toward nursing home specialization is still in its nascent stages.

“Hospitals in recent years have sought to improve care by concentrating it among ‘hospitalist’ physicians who focus on treating hospitalized patients,” Ryskina said. “Twenty years ago, the hospitalist movement started in the same way, wherein hospitals were under pressure to reduce costs, and readmissions. We might be seeing the beginnings of a similar trend in nursing home care.”