# Post-acute care of older adults: the role of skilled nursing facility specialists

> **NIH NIH R01** · UNIVERSITY OF PENNSYLVANIA · 2024 · $368,768

## Abstract

PROJECT SUMMARY
Post-acute care in skilled nursing facilities (SNFs) is common, and outcomes are poor and variable. Over the
past decade, SNFs have been a target of efforts to improve outcomes while controlling spending, but robust
gains remain elusive. Our prior work showed that the number of physicians who specialize in SNF-based care
(i.e., “SNFists”) grew rapidly over the past decade. In this study, we will examine whether physicians
specializing in SNF-based care improve functional outcomes and reduce potentially avoidable healthcare
utilization (such as hospital readmissions) of patients receiving post-acute care in SNFs. We will also examine
patient functional outcomes and healthcare utilization of SNFists vs. non-SNFists under value-based
purchasing initiatives. To accomplish these goals, we will expand an existing dataset of Medicare claims and
SNF clinical assessment data for Medicare fee-for-service beneficiaries discharged from an acute care hospital
to a SNF from 2012 through 2018. Using this database, we will examine the trends in physician specialization
in SNF care in the context of value-based purchasing (i.e., whether the discharging hospital participated in
bundled payments or an Accountable Care Organization), market competition, and other market and physician
characteristics. Next, we will measure the impact of physician specialization in SNF care on patient outcomes
and potentially avoidable healthcare utilization using difference-in-differences cross-temporal matching. Lastly,
we will conduct semi-structured interviews with key personnel (e.g., director of nursing) in SNFs to
quantitatively identify training, practice strategies and care processes that differ between physicians who
specialize in SNF care and those who do not. When complete, these studies will inform practice and policy to
optimize (increase or reduce) post-acute care patients' access to physicians who specialize in SNF-based
care.

## Key facts

- **NIH application ID:** 10864967
- **Project number:** 5R01AG066841-05
- **Recipient organization:** UNIVERSITY OF PENNSYLVANIA
- **Principal Investigator:** Kira L Ryskina
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2024
- **Award amount:** $368,768
- **Award type:** 5
- **Project period:** 2020-08-01 → 2026-05-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10864967

## Citation

> US National Institutes of Health, RePORTER application 10864967, Post-acute care of older adults: the role of skilled nursing facility specialists (5R01AG066841-05). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/10864967. Licensed CC0.

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