The effect of a physician assistant on the hospitalization of nursing home residents

OBJECTIVES: To describe the impact of regular visits to a nursing home by a gerontologist physician assistant (PA) on the hospitalization and medical costs of patients. DESIGN: A 6-year case series (1992-1997) incorporating events before and after introduction of a PA in May 1994. The PA visited the nursing home 3 to 4 times per week, provided nearly all of the acute medical care, and alternated routine visits with supervising physicians. SETTING: A 92-bed teaching nursing home in central Georgia. MEASUREMENTS: Demographics of the nursing home population; hospitalizations of residents, including major diagnosis and length of stay; number and site of all resident deaths; costs of physician and PA services and hospital costs. RESULTS: After the introduction of the physician assistant, the number of annual hospital admissions fell by 38.0%, and the total number of hospital days per 1000 patient years fell by 68.6% (from 4170 in 1992 to 1310 in 1997). The number of nursing home visits increased by 62.1%. Annual Medicare-allowed charges for MD and PA services increased by $22,304, but this was more than offset by a decline in hospital DRG reimbursements of $96,043. CONCLUSIONS: The introduction of regular visits to nursing home patients by a physician assistant can reduce hospitalization and medical costs of these frail older people.