Trends In Hospitals And Skilled Nursing Facilities Sharing Medical Providers, 2008-16

Abstract

Hospitals and skilled nursing facilities (SNFs) face increasing pressure to improve care coordination and reduce unnecessary readmissions. One strategy to accomplish this is to share physicians and advanced practice clinicians, so that the same providers see patients in both settings. Using 2008-16 Medicare claims, we found that as SNFs moved increasingly toward using SNF specialists, there was a steady decline in the number of facilities sharing medical providers and in the proportion of SNF primary care delivered by provider practices with both hospital and SNF clinicians (hospital-SNF practices). In SNF fixed effects analyses, we found that SNFs that increased primary care visits by hospital-SNF practices had slightly fewer readmissions, shorter lengths-of-stay, and increased successful community discharges. These findings suggest that SNFs that share medical providers with hospitals may see some benefit from that linkage, although the magnitude of the benefit may be small.

Keywords: Advanced practice clinicians; Health care providers; Hospitals; Medicare; Medicare savings programs; Nurse practitioners; Nursing homes; Physician assistants; Physicians; Primary care; Primary care providers; Skilled nursing facilities; health policy.

Exhibit 1. Percent of skilled nursing facility (SNF) primary care visits by hospital-SNF practices and by SNF practices, 2008–16

SOURCE Authors’ analysis of 2008–16 Medicare claims linked to the Minimum Data Set. NOTE SNFist is skilled nursing facility specialist.