Characteristics of Clinician Providers in Nursing Facilities and the Home

Project start: 9/01/2022

The US adult population is aging while increasing in clinical complexity, which will exacerbate an already strained health care workforce. There are long-standing concerns around ensuring an adequate workforce in nursing facilities. Workforce challenges associated with nursing facilities are multi-pronged – both the supply and training of the workforce may be inadequate. Calls for the education of “nursing home specialists” who focus on delivering care in nursing facilities to a patient population that is often geriatric with both acute and chronic conditions began in 2009.

Since then, the configuration and delivery of care in nursing facilities has shifted; by 2015, 21% of generalists who provided care in nursing facilities were specialists, with steady growth reported from 2012 to 2015. Several key gaps in knowledge remain, however: (1) information on trends are dated; (2) the contributions of nurse practitioners and physician assistants have not been measured; (3) the impact of geographic and organizational-level characteristics on the types of clinicians providing care in nursing facilities have not been described; and (4) the clinician workforce in nursing facilities by specialty and share of services delivered is unknown.

At the same time, there has been growth in medical services provided to individuals at home, particularly for community-dwelling Medicare beneficiaries with mobility impairments. Rigorous research has reported home-based primary care to be high quality, cost saving, and accessible. The number of participating home care providers in traditional Medicare increased from about 14,100 in 2012 to around 16,600 in 2016.

This project will examine the organizational, geographic, and workforce characteristics of physicians, nurse practitioners, and physician assistants that deliver care to Medicare beneficiaries in nursing facilities and in the home. We will use secondary data from the Medicare Data on Provider Practice and Specialty (MD-PPAS) produced by CMS to identify clinicians that bill for services in nursing facilities and in homes/personal residences.


Key Questions

This project aims to answer three questions:

  • What are trends from 2017-2020 in the specialty of clinicians, including physicians, nurse practitioners, and physician assistants, who bill for care provided in nursing home facilities and in homes, by share of care delivered in these settings?
  • What are the organizational characteristics (e.g., composition of clinicians in practices, corporate owned) of clinicians who bill services in nursing facilities and in homes, by share of care delivered in these settings and by type of clinician?
  • How do characteristics of clinicians who bill for services in these settings vary by geographic characteristics (e.g., region, population density, population characteristics)?


For more information, contact Taressa Fraze.