Penn Study Uncovers Less Doctor Visits for Nursing Home Residents
Posted On behalf of Schmidt Kramer on Apr 02, 2019 in Nursing Home Negligence & Abuse
Nationwide, nursing facilities are evolving to not only include the long-term care of frail residents, but also complicated post-hospital care. Patients are being discharged sicker and quicker from the hospital to nursing homes in an effort to decrease readmission rates. However, once patients are in a nursing facility, the majority are not able to see a doctor as quickly as needed or ever, in some circumstances.
Doctor involvement in nursing facilities is essential in order to deliver quality care. Without a doctor’s knowledge, skillset and experience in caring for sick residents, they can suffer additional injuries, a worsened condition or even death.
A new University of Pennsylvania study published in Health Affairs, a leading journal of health policy, has uncovered that nursing home residents cannot be certain of seeing a doctor. The study was led by Kira Ryskina, an internist and health policy researcher at the University of Pennsylvania’s Perelman School of Medicine. Her experience working in nursing homes as well as feedback from her own patients and their families led her to conduct this study.
Doctor Visits in Nursing Homes
The study analyzed the records of 2.4 million Medicare patients discharged from hospitals to nursing facilities between January of 2012 and October of 2014. It was found that 10.4 percent of patients never got to see a doctor, nurse practitioner or physician assistant. Twenty-eight percent of patients were either readmitted to a hospital while 14 percent died within 30 days of being admitted into a nursing home.
Of the patients that saw the doctor once, about 72 percent were examined within four days of entering a facility. Almost less than half the patients who saw a doctor, 14.3 percent, were readmitted to a hospital compared to those who never got to see a doctor. Another 7.2 percent of patients also died within that same time period.
Based on the findings, Ryskina believes there is minimal evidence to suggest that nursing homes, especially in smaller and rural areas, are doing an exceptional job at making sure that sickly residents are seen more quickly than others. In fact, patients in these areas wait the longest on average to see a doctor – 8.1 days versus 3.2 days at larger nursing facilities.
Holding Hospitals and Nursing Facilities Accountable
Medicare’s prospective payment system holds hospitals accountable for what happens when their patients leave. In other words, hospitals can be penalized if patients return to the hospital too quickly.
The pogram's current policy states that nursing home patients must be seen by a doctor within 30 days after being discharged from the hospital. However, there no official guidelines on how fast newly-admitted patients should be seen by a doctor.
Generally, doctors are not on-site at nursing facilities on a daily basis. This often means that the most vulnerable patients admitted into nursing homes need more attentive care or should not have been discharged from the hospital in the first place.
Ryskina hopes this latest study sheds a light on the needs of complex patients at risk for further hospitalization. Ensuring quicker assessments would be a challenge for facilities, but doctors should not rule out delivering health care services in other ways, including through the use of telemedicine, to remotely deliver clinical health care that would not be consistently available in rural communities.
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