Association Between Proportion of Provider Clinical Effort in Nursing Homes and Potentially Avoidable Hospitalizations and Medical Costs of Nursing Home Residents

Objectives To assess potential avoidable hospitalizations of nursing home ( NH ) residents as a function of the percentage of clinical effort their primary care provider ( PCP ) devotes to NH practice. Design Retrospective cohort study. Setting NH s in Texas. Participants Residents newly admitted to long‐term NH s in 2006 to 2008 were identified by linking the Minimum Data Set to 100% Texas Medicare claims data (N = 12,249). Measurements The care that residents received over successive 6‐month periods was measured as a time‐dependent covariate. Potentially avoidable hospitalizations and Medicare costs were assessed over 6 to 48 months. Results Seventy percent of NH residents had a physician as their major PCP , 25% had an advance practice nurse ( APN ), and 5% had a physician assistant ( PA ). Physician PCP s who derived less than 20% of their Medicare billings from NH residents cared for 36% of all NH residents. Most NH residents with APN or PA PCP s had providers with 85% or more of Medicare billings generated in NH s. Residents with PCP s who devoted less than 5% of their clinical effort to NH care were at 52% higher risk of potentially avoidable hospitalization than those whose PCP s devoted 85% or more of their clinical effort to NH s (hazard ratio = 1.52, 95% confidence interval = 1.25–1.83) and had $2,179 higher annual Medicare spending, controlling for PCP discipline. Conclusion The percentage of clinical effort that providers devote to NH s is associated with risk of avoidable hospitalization.