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More non-doctors providing U.S. nursing home healthcare

More non-doctors providing U.S. nursing home healthcare
From Reuters - July 14, 2017

As the U.S. healthcare system grows to accommodate more aging patients, nursing home care is increasingly being delivered by specialized nurses and physician assistants, according to a recent study.

In the past decade, the number of doctors in nursing homes has dropped as the number of skilled nursing facility specialists has almost doubled, the researchers report in JAMA Internal Medicine.

Whether this trend is a good one is not clear, the authors write.

Medicare was created more than 40 years ago around farmers who had problems with access to hernia care. Now our focus is on frail older women with chronic illnesses, said lead author Dr. Joan Teno of the Cambia Palliative Care Center of Excellence at the University of Washington in Seattle.

The patients often have functional impairments and need skilled help, she told Reuters Health by phone. Patients also need coordinated care because for each new chronic illness, they often meet new doctors and specialists, which can lead to medical errors, lack of coordination and inefficiency, Teno explained.

Our current system supports silos of care, she said. But now healthcare policy experts are pushing for programs that coordinate care, provide consistent staffing for older patients and train nurses for geriatric care.

What were seeing is an emerging set of programs targeting this older cohort. Its important to start asking whats best for the patient and family instead of the system.

Teno and colleagues used national Medicare Part B claims from 2007, 2010 and 2014 to identify trends in the numbers of physicians, nurse practitioners and physician assistants working in nursing homes or skilled nursing facilities.

The research team found that the proportion of physicians who had ever billed for care delivered in these facilities fell from 13.7 percent to 9.8 percent. Although the number of physicians classified as skilled nursing facility specialists rose from 1,496 to 2,225, that represented an increase from just 0.3 percent of all physicians to 0.5 percent.

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