ADOPTION OF SNFISTS BY US NURSING HOMES DID NOT REDUCE REHOSPITALIZATION RATES AMONG POST–ACUTE CARE PATIENTS

Abstract

Abstract SNFists, physicians and advanced practitioners who focus their practice in nursing homes, have grown in prevalence in recent years. In this retrospective cohort study, we measured the role of nursing home adoption of SNFists in rehospitalization rates. We used 100% Medicare facility and professional claims for hospitalized fee-for-service beneficiaries discharged to nursing homes in 2012-2019. We defined SNFists as generalist physicians and nurse practitioners with at least 80% of their Medicare Part B claims for nursing home care. All nursing homes that did not have a SNFist in 2012 were followed through 2019. We used an event study approach with staggered SNFist adoption to estimate the effect of a nursing home adopting at least one SNFist on the facility’s unplanned 30-day rehospitalization rate, adjusted for patient case mix, facility and market characteristics. Models included facility and year fixed effects. Standard errors were clustered at the facility level. Of the 6,616 nursing homes in the sample, 77% adopted SNFists by 2019. Nursing homes that adopted SNFists did not experience a statistically significant change in rehospitalization rate compared to those that did not adopt: rehospitalization rates decreased by 0.02 percentage points (95% CI -0.35 to 0.32; p=0.93) one year after SNFist adoption and by 0.15 percentage points (95% CI -1.01 to 0.70; p=0.73) six years after adoption, compared to the baseline difference between the groups in the year before adoption. In sum, despite the wide adoption of SNFists by US nursing homes, we did not observe an associated decrease in rehospitalization rates.