Does Clinician Volume Influence Postacute Nursing Home Outcomes?

Key Highlights

• Clinician panel size in nursing homes was not associated with 30-day rehospitalizations, emergency department visits, successful discharge to community, or functional improvement.
• More than half of nursing home clinicians saw fewer than 10 patients per year.
• Findings suggest that improving postacute outcomes should focus on facility-level characteristics rather than individual clinician patient volume.

In a large national cohort study, researchers found that the size of a physician or advanced practitioner’s patient panel in nursing homes was not associated with differences in outcomes for older adults admitted for postacute care. Rates of rehospitalization, emergency department visits, successful community discharge, and functional improvement at discharge did not vary significantly across clinician volume levels, indicating that panel size is not a key driver of quality in this setting.

Over 1.2 million Medicare beneficiaries receive postacute care in U.S. nursing homes annually, and outcomes such as successful community discharge vary widely across facilities. Previous research has suggested that physician case volume in surgical specialties influences patient outcomes, prompting interest in whether similar associations exist in nonprocedural settings such as nursing homes. Calls have been made to concentrate nursing home care among dedicated physician specialists; however, the potential role of patient volume has not been well examined. This study aimed to clarify whether clinician panel size influences outcomes for patients receiving short-term skilled nursing or rehabilitative therapy following hospitalization.

The cohort study used Medicare Part A and Part B claims, the nursing home minimum data set, and other linked data sources from 2012 to 2019. Participants included Medicare fee-for-service beneficiaries aged 65 years or older discharged to a nursing home for postacute care. Patients were attributed to physicians (general practice, family medicine, internal medicine, geriatrics, physical medicine and rehabilitation, or hospital medicine) or advanced practitioners (nurse practitioners or physician assistants). Clinician patient volume was measured as the number of unique patients seen annually and categorized into deciles. Outcomes assessed were 30-day rehospitalization, emergency department visits, successful discharge to the community, and functional improvement using the activities of daily living scale.

The final sample included 6,193,638 patient-years, representing 4.8 million unique patients and 77,732 clinicians. The median patient-weighted clinician volume was 68 patients annually, but at the clinician level the median was only nine, highlighting that most clinicians saw relatively few patients from nursing homes. Patients of lower-volume clinicians were older, more cognitively impaired, and more likely to receive care in nonprofit or rural facilities.

Despite these differences, outcomes did not differ significantly by clinician volume. For the lowest vs highest decile of patient volume, the incidence rate ratio was 1.05 (95% CI, 0.76-1.46) for rehospitalization, 0.96 (95% CI, 0.86-1.07) for successful discharge, 1.03 (95% CI, 0.90-1.19) for emergency department visits, and 0.96 (95% CI, 0.88-1.40) for functional improvement. Sensitivity analyses stratified by urban versus rural settings and by physician versus advanced practitioner yielded similar null findings, with few exceptions that were not consistent across subgroups.

Limitations of the study include the open possibility of unmeasured confounding by patient or facility characteristics, the exclusion of Medicare Advantage patients, and the focus only on postacute—not long-term—nursing home care. Nonrandom assignment of patients to higher- or lower-volume clinicians within facilities may also have influenced results.

“In this cohort study of Medicare beneficiaries, we did not find an association between clinician panel size and nursing home postacute care outcomes,” the investigators concluded. “These findings may inform the design of care models for clinicians practicing in nursing homes.”

Reference
Peacock B, Kim S, Pan Z, et al. Clinician volume and outcomes among patients admitted to nursing homes for postacute care. JAMA Netw Open. 2025;8(8):e2527234. doi:10.1001/jamanetworkopen.2025.2723