After SNFist Adoption, Nursing Homes Shift Toward Postacute Admissions

The adoption of SNFists across thousands of US nursing homes was associated with an uptick in the number of postacute care admissions but no change in 30-day rehospitalization rates, according to a study published online in JAMA Network Open.

“The number of physicians and advanced practitioners who focus their practice in nursing homes (NHs), often referred to as ‘SNFists’ (ie, physicians, nurse practitioners, and physician assistants concentrating their practice in the nursing home or skilled nursing facility [SNF] setting) has increased dramatically,” wrote corresponding author Hye-Young Jung, PhD, of Weill Cornell Medical College, New York, New York, and coauthors. “Little is known about the association of the nursing home medical care delivery models that use SNFists with the quality of postacute care.”

The study included 4482 nursing homes in the United States. In 2013, 13.5% of the facilities had SNFists, which were defined as generalist physicians and advanced practitioners with 80% or more of their Medicare Part B services delivered in NHs. By 2013, more than half—52.9%—of the facilities in the study had SNFists.

According to the study, 30-day rehospitalization rates after SNFist adoption remained stable. However, nursing homes that adopted SNFists showed an increase in their percentage of residents covered by Medicare: 0.60 percentage points in the year of SNFist adoption and by 0.54 percentage points 1 year after adoption compared with nursing homes that did not adopt SNFists. The volume of patients admitted for postacute care also increased a relative 12% after SNFist adoption, but there was no statistically significant change in nursing homes’ mean acuity index after SNFist adoption.

“This cohort study used a rigorous event study approach to isolate the association of SNFist adoption with nursing home rehospitalization rates, an important measure of postacute care quality that is salient to patients, caregivers, facilities, and policy makers,” researchers wrote. “Facilities that adopted SNFists were able to shift the case mix to postacute care without an increase in rehospitalization rates, which may incentivize facilities to adopt models of care based on SNFists.”

References

Kim S, Ryskina KL, Jung HY. Use of clinicians who focus on nursing home care among US nursing homes and unplanned rehospitalization. JAMA Netw Open. 2023;6(6):e2318265. doi:10.1001/jamanetworkopen.2023.18265