GRANHDPOP
Government Reimbursement and Nursing Home Doctors' Patterns of Practice
Funded by: Office of the Assistant Secretary for Planning and Evaluation
Project Period: 10/03 - 5/05
Abstract
Objective: Physicians, even those with a nursing home
practice, have been shown to spend very little time caring for nursing home
residents. Furthermore, anecdotal evidence suggests that nursing home residents
may have difficulty accessing physicians in a timely manner. This 18-month
project is examining physician practice patterns and reimbursement for physicians
in nursing homes. Based on this study, the Division of Health Care Policy and
Research (HCPR) will identify policy issues and develop research designs related
to the delivery of primary care services to nursing home residents.
Methods: First, HCPR will describe physician practice
in nursing homes and the factors that influence primary care. Then, four domains
of influence in the delivery of nursing home care will be addressed. The
domains of interest include: 1) physician characteristics, 2) practice
organization, 3) payment structure, and 4) nursing facility traits. The
following examples pertain to each domain:
- Physician characteristics include the training and background of physicians that treat nursing home residents, and variation in the extent of their practice devoted to nursing home residents;
- Practice organization describes models of practice including salaried Health Maintenance Organization practices, solo practitioner, and use of nurse practitioners and physician assistants;
- Payment structure examines billing of Medicare Part B claims and non-traditional reimbursement such as capitation; and
- Nursing facility traits include nursing home characteristics that encourage or deter physicians from treating nursing home patients.
Within these domains, the critical factors that shape observed practice patterns of
nursing home physicians will be described. These factors have been identified through
a literature review, technical advisory group meeting and stakeholder interviews.
Current evidence on the impact of these factors on the design of practice models; on
the accessibility of physician services to nursing home residents; and on the cost and
quality of services will also be presented in the final report.
HCPR will advance research designs that could provide information on factors
influencing access to primary care in nursing homes and the cost of physician services
in nursing homes. The study designs will place an emphasis on secondary data sources
to answer relevant policy questions identified through the literature review and
stakeholder discussions.
Current Project Status: The literature review and technical
advisory group meeting are complete. Stakeholder interviews are in progress with
anticipated completion in October 2005. The final report will be submitted in May
2005.
Key Staff: Kramer, Eilertsen, Epstein, Min, Schlenker
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