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Published on: September 30, 2020
Changes in Physician Workforce Composition and Rehospitalization From Post-Acute Care in Nursing Homes Between 2012
Junning Liang1, Andrew J Epstein2, Kira Ryskina3
1Division of General Internal Medicine, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.
Objectives:
Over the past decade, US nursing home workforce experienced considerable growth among advanced practitioners (APs), particularly nurse practitioners. We measured the association between workforce composition and rehospitalization from post-acute care in the nursing home.
Design:
Cohort study using Medicare claims for 2012 and 2019.
Setting And Participants:
A total of 9171 nursing homes which provided post-acute care to Medicare fee-for-service beneficiaries in both 2012 and 2019. Hospital-based facilities were excluded.
Methods:
The change in workforce composition over the study period was measured by calculating the percentages of visits performed by APs and physicians in generalist specialties and categorized into 5 groups: (1) any decrease in the percent of visits by Aps, (2) stable or small [<5 percentage point (ppt)] increase, (3) 5 to 40 ppt increase, (4) 41 to 70 ppt increase, and (5) >70 ppt increase in the proportion of visits performed by APs. Unplanned 30-day rehospitalization rates from post-acute care for each facility were measured using Medicare's quality measure specification. We estimated first-difference linear regression models to compare the rehospitalization rates between the 5 workforce composition categories, adjusting for nursing home characteristics.
Results:
Most facilities increased the proportion of care provided by APs: 23% experienced a decrease (n = 2127), 19% remained stable (n = 1710), 33% increased by 5 to 40 ppt (n = 3030), 17% increased by 41 to 70 ppt (n = 1529), and 8% increased by >70 ppt (n = 775). Rehospitalization decreased in nursing homes with a relative increase in AP visits, but the association was statistically significant only for group 3 (5-40 ppt increase; 1.1% decrease in rehospitalizations; 95% CI, -1.8% to -0.4%; P = .003).
Conclusions And Implications:
In this cohort study, a moderate shift in visits to APs was associated with a small but statistically significant decrease in rehospitalizations between 2012 and 2019. These findings support incorporation of APs into the nursing home workforce.
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