Providers that are not ready for full-time facility-based employee physicians may want to consider contracting with physicians who have specific long term care knowledge and training. Sometimes called “SNFologists” or “SNFists,” these are practitioners who spend the bulk of their professional time in the long term care setting.
"We are moving toward the term ‘long term care specialist’ because many of these physicians serve patients beyond traditional skilled nursing facilities,” says California-based self-proclaimed long term care specialist Karl Steinberg, MD, CMD.
Steinberg’s experience as a specialist dates back to the 1990s. He recalls, “My medical group had a lot of Medicare HMO patients. We saw that some of them would go to the emergency room for an uncomplicated compression fracture of the spine or a urinary tract infection, and we realized that we could provide comparable care and save money by putting them in a skilled nursing facility instead of the hospital.”

 A New Idea Emerges

Steinberg and his colleagues created the concept of a skilled nursing facility (SNF) team where the clinicians spent half of their time in the office, half in the facility. “We did this for 10 years or so, then went to full-time SNF care,” he says. “On the average day, we call SNF nurse coordinators and see where there are residents who need to be seen. We work out coverage among ourselves. Then I load up the dogs [Tessa and Sophie go to work with him most days] and head out.”
At the facility, he sees residents, addresses issues or concerns the nurses have, and signs paperwork as needed.
His ongoing presence in the facilities not only strengthens Steinberg’s relationships with the staff and residents, it also increases family satisfaction.
“Communication with families is really important. I can’t tell you how often I call family members and they say, ‘I’m so glad you called.’ They’re really grateful for a chance to talk to the doctor,” he says. They are more likely to see the physician as a team member and advocate.
Even if these practitioners only come onsite a few times a week, they can have a positive impact on care. As Steinberg explains, “They will establish a presence and keep a finger on the pulse of what is happening with the patients.” He adds that this is key considering “the acuity of patients we’re seeing in long term care.”
More frequent visits are often helpful—if not necessary—for these higher-acuity patients and can help prevent complications, trips to the emergency room, and hospitalizations.