Starting this month, more than 2,200 hospitals will receive a reduction in Medicare payments due to excessive 30-day readmissions. Of those hospitals, 307 will receive the maximum penalty; a 1% reduction in their Medicare payments. Next October, the maximum penalty will increase to 2%, and in fiscal year 2015 it will increase again to 3%. To avoid these penalties, hospitals and healthcare organizations have invested time and money into developing readmission reduction strategies, such as having providers make follow-up calls and home visits to recently discharged patients. Other initiatives have aimed at improving communication with postacute care facilities, such as skilled nursing facilities (SNF). However, improving care in the postacute setting may produce the best results. A recent statement from the Medicare Payment Advisory Commission said 25% of hospital admissions are potentially preventable and could be avoided with improved primary care in the SNF setting. A 2010 report published in the Journal of the American Geriatrics Society said that two-thirds of hospitalizations in Georgia could have been prevented with improved on-site primary care. As hospitals feel more pressure to reduce patients’ length of stay, SNFs are caring for patients with more complex conditions, and to put it simply, SNF patients need more attention from physicians. According to a recent article by Curaspan Health Group, ambulatory care doctors may spend as little as half a day each month providing care in a SNF. With the primary care shortage, primary care physicians are also finding it difficult to visit their patients in the SNF setting as they struggle to maintain a full schedule of patient visits in their office. Some SNFs have recognized the need for physicians in the SNF setting and have hired physicians to work in the SNF fulltime. This has created a new physician specialty called the SNFist. SNFists exclusively treat patients within one or more SNFs and are typically paid a salary or fee by the nursing home(s). The model allows for patients who are at high-risk for readmission to be continually monitored by a physician who can intervene if a condition worsens. SNFists can also develop a relationship with patients, families, and caregivers to improve transitions into the community. Paul Katz, MD, a creator of the SNFist concept, estimates that there are only a few thousand practicing SNFists, but the model may become more popular if it shows results. The specialty may also be desirable to private practice physicians who are looking for the stability of employment. In any case, it’s worth keeping on your radar.