Growth of Physicians and Nurse Practitioners Practicing Full Time in Nursing Homes |
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| Institution: | 1. Sealy Center on Aging, The University of Texas Medical Branch at Galveston, Galveston, TX, USA;2. Department of Medicine, The University of Texas Medical Branch at Galveston, Galveston, TX, USA;3. School of Medicine, The University of Texas Medical Branch at Galveston, Galveston, TX, USA;4. Department of Preventive Medicine and Population Health, The University of Texas Medical Branch at Galveston, Galveston, TX, USA;1. Medical Director, Baltimore, MD, USA;2. Department of Organizational Systems and Adult Health, University of Maryland School of Nursing, Baltimore, MD, USA;1. Medical Director, Baltimore, MD, USA;2. University of Maryland School of Nursing, Baltimore, MD, USA;3. Hickory Ridge Nursing and Rehab Center, Akron, OH, USA;4. Edgemoor DP SNF, Behavioral Health Services, Health and Human Services Agency, County of San Diego, San Diego, CA, USA;5. Geriatric and Palliative Medicine, University of Michigan, Ann Arbor, MI, USA;6. PC, Oswego, NY, USA;7. NYU Long Island School of Medicine, NYU Langone–Long Island Geriatrics Fellowship, New York, NY, USA;8. Capital Caring Health, Falls Church, VA, USA;9. Alpine Fireside Health Center, Rockford, IL, USA;10. ProMedical Associates, Inc, Newark, NJ, USA;1. Service de médecine interne gériatrie, Pôle Personnes Agées, Centre Hospitalier Universitaire, Dijon, Bourgogne Franche-Comté, France;2. Institut National de la Santé et de la Recherche Médicale U1093 Cognition Action Plasticité, Université de Bourgogne Franche-Comté, Dijon, Bourgogne Franche-Comté, France |
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| Abstract: | ObjectivesThe 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.DesignRetrospective cohort study.Setting and ParticipantsA 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.MethodsWe measured the percentage of provider charges for services rendered in nursing homes, in addition to resident and facility characteristics.ResultsFull-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 ImplicationsThe percentage of nursing home residents with full-time providers continues to grow, with very large variation among nursing homes. |
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| Keywords: | Nurse practitioner physician assistant nursing home long-term care |
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