https://mailchi.mp/cc1fe752f93c/the-weekly-gist-july-14-2023?e=d1e747d2d8

A hospital CEO recently relayed a story about challenges in access and coverage for pulmonology services in their market. A key group of pulmonologists there had scaled back hospital coverage and stopped seeing outpatients entirely.

“We’re hearing that they are spending almost all of their time seeing patients in skilled nursing facilities (SNFs),” she shared. Shortly after, we heard from another health system that their cardiologists had started rounding frequently in long-term care sites. This seemed unusual, given that payment for specialist consults in SNFs and other long-term care facilities is meager—it’s hard enough to find hospitalists or rehabilitation physicians to provide coverage and round at these sites.

However, it struck us that both of these health systems were located in markets with a high penetration of Medicare Advantage (MA) plans, and we wonder whether MA plans have increased payment to specialists to motivate them to consult in skilled nursing settings?

It’s unclear if policies have changed, but it would make sense. If a cardiologist could evaluate a patient in a SNF and avert an ambulance ride and hospital admission, the MA plan would save money.

But if health plans chose to do this at scale, it could prompt a significant shift in how some doctors spend their time, while leaving access gaps in other settings. If you’re seeing similar changes in your market, we’d be interested in hearing more!