This is part 3 of a series of 9 partnerships every assisted living community should have that was first presented at the Marcus Evans Long Term Care Summit In Florida. See the side bar for the complete list of partnerships in the series.

We started to take a look at the number of physician, nurse practitioner, and physicians assistant visits we had per community per month. We discovered communities of the same size had vast differences in the number of visits per resident per month.

Digging deeper, we found that communities with higher numbers of visits per month consistently had longer lengths of stay. And, conversely, those with the fewest visits had the shortest lengths of stay.

It Got More Interesting

9 Partnerships
1 – Therapy / Home Health
2 – Physician Group
3 – Skilled Nursing Facilities
4 – Pharmacy
5 – Home Care Companies
6 – A Real Estate Company
7 – DME & Ambulance Companies
8 – Hospice
9 – A Coach

With a little detective work we found that when a practitioner was in our communities 3 or more times a week, they were able to do follow-up visits with residents who were sick and make adjustments to their treatment regimen. As a result, there was a marked decrease in hospital transfers.

The best mix of medical professionals was to have Nurse Practitioners or Physician Assistants doing visits 3 days a week and then have an MD do dedication and major diagnosis management quarterly as well as after each hospitalization.

Optimal Numbers

We saw that the optimum number of visits averaged 3 visits per month. That doesn’t mean that every resident is be seen 3 times a month, because many residents had medical issues that required 2-3 times visits in a particular week, for several weeks; while other residents in good health required far fewer visits.


We took a look at the correlation between hospital readmissions and physician visits and found that when our practitioners were only in a facility once a week, our hospitalization rate was as high as 10%!

That meant that 10% of our residents were going to the hospital on a monthly basis!

Then when we looked at the communities where we had an average of 3 visits per resident per month our hospitalization rate per month was less than 2%.

The Big Hit

We know that on average 70% of the residents who go to the hospital and are admitted will end up going to skilled nursing. And then on average 30% of the residents who go to a skilled facility will not go back to assisted living or their own home. This means your assisted living census is likely to be decreased by 21% annually due to a lack of physician visits and a high hospitalization rate!

The Weird Vacation Phenomenon

As we continued digging into our numbers, we noticed something strange. We found that during the month of December in almost every community, our hospitalization rate increased. It wasn’t because people got the flu more often, or because it was colder or because people stay indoors more during December. Instead, we discovered it was related to the number of practitioner visits that took place during that month.

We had increased hospitalizations in December because it was when our practitioners were taking vacations. If the practitioner is on vacation, we learned it was critical that they had a substitute making their rounds.

Some Guidelines 

These guidelines will make your physician partnership really work for you and your residents:

  • Have the same NP or PA on your campus 3 days a week.
  • Average 3 visits per resident per month.
  • Residents need to have medication and disease management visits by a physician at least once a quarter and after every hospitalization.
  • When practitioners are on vacation, there must be a substitute who maintains their schedule.


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