Table 5.

Processes of Care, Outcomes, and Costs of Patients Under the Care of SNFist vs. Non-SNFists in the Nursing Home

Author (year)	Population	Methods	Outcomes
Kuo et al. (2013)	12,249 residents admitted to long-term care in 1,094 Texas nursing homes between 2006 and 2008, under the care of generalist physicians or advanced practitioners	Outcomes were adjusted using CMS specifications, multilevel survival, and two-part log gamma models were used to estimate hospitalization and cost outcomes, respectively	Residents under the care of providers whose nursing home practice composed of less than 5% of their clinical effort had a 52% higher risk of potentially avoidable hospitalization and their care cost Medicare $2,179 more per year compared to residents under the care of providers whose nursing home practice represented at least 85% of their total effort
Ryskina, Yuan et al. (2019)	2.1 million Medicare fee-for-service beneficiaries admitted to 14,526 skilled nursing facilities for post-acute care from 2012 to 2014, under the care of generalist physicians or advanced practitioners	Outcomes were adjusted using the CMS risk-adjustment methodology for hospital readmissions, demographics, as well as time-invariant nursing home characteristics using nursing home fixed effects	Patients under the care of SNFists experienced more provider visits (5.7 vs. 3.9, p < .001), were less likely to be readmitted to the hospital within 30 days of skilled nursing facility admission (14.7 vs. 16.2, p < .001), more likely to be successfully discharged to the community, but had slightly higher Medicare payments in the 60 days following SNF admission ($31,628 vs. $31,292; adjusted difference, $335; p < .001)
Ryskina, Lam et al. (2019)	Regional analysis of nursing home quality measures for 305 hospital referral regions using Nursing Home Compare and Medicare provider utilization files between 2012 and 2016	Six clinical quality measures were a priori deemed to be under the influence of physicians: short- and long-term stay antipsychotic use, use of restraints, urinary tract infections, depression symptoms, and the use of indwelling catheters	If the regions in the lowest decile of SNFist prevalence were to increase their use of SNFists to the degree of the regions in the highest decile, those regions would reduce antipsychotic medication use by 5% and indwelling bladder catheter use by 6%

Note: CMS = Centers for Medicare & Medicaid Services; SNF = skilled nursing facility.