Low-Quality Nursing Homes Were More Likely Than Other Nursing Homes To Be Bought Or Sold By Chains In 1993

05 May

Low-Quality Nursing Homes Were More Likely Than Other Nursing Homes To Be Bought Or Sold By Chains In 1993–2010

Jerry Rhoads Blog 537 0

Abstract (reprint from study results)

The study aimed to find how nursing home residents are affected by chain transactions, Grabowski says

Two defining features of the nursing home industry are the tremendous churn in chain ownership and the perception of low-quality care at many facilities. We examined whether nursing homes that underwent chain-related transactions, such as mergers and acquisitions, experienced a larger number of health deficiency citations than nursing homes that maintained common ownership over the same period. Using facility-level data for the period 1993–2010, we found that those nursing homes that underwent chain-related transactions had more deficiency citations in the years preceding and following a transaction than those nursing homes that maintained common ownership. Thus, we did not find that these transactions led to a decline in quality. Instead, we found that chains targeted nursing homes that were already having quality problems and that these problems persisted after the transaction. Given the high frequency of nursing home chain transactions, policy makers will need to continue to invest in tracking, reporting, and overseeing these transactions. One important step would be to report more detailed data on chain ownership, transactions, and aggregate chain quality on the Nursing Home Compare website, the federal government’s online report card for nursing homes.

¹David C. Grabowski (grabowski@med.harvard.edu) is a professor of health care policy at Harvard Medical School, in Boston, Massachusetts.
²Richard A. Hirth is a professor of health management and policy at the University of Michigan, in Ann Arbor.
³Orna Intrator is a professor of public health sciences at the University of Rochester, in New York.
⁴Yue Li is an associate professor of community and preventive medicine at the University of Rochester.
⁵John Richardson is a PhD candidate in health management and policy at the University of Michigan.
⁶David G. Stevenson is an associate professor in the Department of Health Policy at Vanderbilt University School of Medicine, in Nashville, Tennessee.
⁷Qing Zheng is a PhD candidate in health management and policy at the University of Michigan.
⁸Jane Banaszak-Holl is an associate professor of health management and policy at the University of Michigan.

Blogger comment:

Mr. Grabowsski, I read your abstract and article regarding low quality linked to corporate takeovers. I would appreciate your thoughts on my input as proof validating the very important results that you and your associates have uncovered. We should somehow collaborate to get true quality measures into law and done by an independent watchdog using re-enforcement methods. Thank your for taking the time to respond.

I am a CPA, Nursing Home Administrator and Owner. My background is 20 years in public accounting (Arthur Andersen & Co., Clifton Gunderson & Co. and J. L. Rhoads and Company). I have specialized in health care since the enactment of Medicare and wrote the white paper for HEW “Prospective Payment in long term care” in 1977. I am extensively published on the subject of reimbursement, operations and quality measurement. My experience is in the front lines not academic. Your abstract is more than interesting since my book “The Monopsony Game” deals with pyramids of nursing homes and its negative impact on quality. I had to re-title the book due to copyright concerns by the publisher. It is now titled “Failing Government Taketh Away” … both are available on Amazon or my books and blog web site www.americanenterpriseparty.com .

This book chronicles how the State of Iowa and Arkansas forced the Rhoads family (my wife, son and I) out of business due to my writings and background in implementing the QUIP quality measurement program in Illinois in the 1980’s. It is the only definitive method of measuring quality in nursing homes and was forced out, after 10 years of success, because of the chains lobbying the legislature. QUIP stands for quality incentive program that establishes the six star facilities in the State being the best and the one and two star facilities being the worst. The current CMS five star system is counting mistakes not successes as the QUIP system did by rewarding retroactive bonus payments based on attaining each star. My two large facilities (200 + beds) that I managed were no stars when I took them over and six stars when they got sold by the owners to chains who immediately reversed what my staff had accomplished. This goes a long ways to proving your premise but lacks the power of my emphasis on a true quality measurement program . By using the re-enforcement awards rather than enforcement civil penalties will attain the true measurement of quality of life by measuring holistic care not just how to change diapers and passing pills. The six current minimum standards need to be converted to maximum standards tied to the six stars of quality.

Of course , in Illinois during this period, there were two surveys QUIP and Needs Met based on quality of care. These are chronicled in my book “Restore Elderpride” also available on Amazon. My proposal is to be a resource to your sponsors on providing proof that the pyramiding, referred to in the Monopsony Game, that started in the 70’s is not the problem but the result. The problem is the Government pulling the strings to keep health care under its control by using payment for input not output (DRG’s, RVU’s, RUG’s, OPPS, OASIS) then bundling payment for an industry that has yet to be standardized … the first step to managing cost and quality. The is covered in my book “The Boomers Are Coming”.

Low-Quality Nursing Homes Were More Likely Than Other Nursing Homes To Be Bought Or Sold By Chains In 1993–2010

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