Certificate-Of-Need Regulation and Healthcare Service Quality: Evidence from the Nursing Home Industry

Fayissa, Bichaka; Alsaif, Saleh; Mansour, Fady; Leonce, Tesa E.; Mixon, Franklin G.

doi:10.3390/healthcare8040423

Cited by 13 publications

(5 citation statements)

References 39 publications

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“…If anything, the regulations seem to raise spending per service as well as per patient (Noether 1988;Mitchell 2016;Bailey 2019). The evidence on quality has been more mixed (Vaughan-Sarrazin et al 2002;Lorch et al 2012) but recent papers that assess quality through multiple metrics and attempt to control for spurious causation conclude that CON laws do not enhance and likely undermine quality of care (Stratmann and Wille 2016;Ohsfeldt and Li 2018;Bailey 2018;Fayissa et al 2020;Ghosh et al 2020;Chiu 2021;Baker and Stratmann 2021). By far the most studied aspect of CON regulation is access.…”

Section: Certificate-of-needmentioning

confidence: 99%

The Economics of a Bed Shortage: Certificate-of-Need Regulation and Hospital Bed Utilization during the COVID-19 Pandemic

Mitchell

Stratmann

2021

JRFM

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Certificate-of-need (CON) laws are intended to restrain health care spending by limiting the acquisition of duplicative capital and the initiation of unnecessary services. Critics contend that need is difficult to objectively assess, especially considering the risks and uncertainty inherent in health care. We compare statewide bed utilization rates and hospital-level bed utilization rates in bed CON and non-bed CON states during the COVID-19 pandemic. Controlling for other possibly confounding factors, we find that states with bed CONs had 12 percent higher bed utilization rates and 58 percent more days in which more than 70 percent of their beds were used. Individual hospitals in bed CON states were 27 percent more likely to utilize all of their beds. States that relaxed CON requirements to make it easier for hospitals to meet the surge in demand did not experience any statistically significant decreases in bed utilization or number of days above 70 percent of capacity. Nor were hospitals in states that relaxed their CON requirements any less likely to use all their beds. Certificate-of-need laws seem to have exacerbated the risk of running out of beds during the COVID-19 pandemic. State efforts to relax these rules had little immediate effect on reducing this risk.

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Section: Certificate-of-needmentioning

confidence: 99%

The Economics of a Bed Shortage: Certificate-of-Need Regulation and Hospital Bed Utilization during the COVID-19 Pandemic

Mitchell

Stratmann

2021

JRFM

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“…Online patient reviews (OPRs) are a good mechanism for capturing the consumer perspective of NH quality, and consumers use them in their selection process [ 5 ]. The previous research is focused on the USA, probably due to the existence of databases about NH quality [ 6 , 7 , 8 , 9 , 10 ]. However, outside of the USA, studies regarding NH quality are scarce.…”

Section: Introductionmentioning

confidence: 99%

Nursing Homes: Affiliation to Large Chains, Quality and Public–Private Collaboration

2022

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The objective of this paper was to estimate the influence of being affiliated with an NH chain on perceived consumer quality, and whether this relationship is affected by maintaining a collaboration agreement with public administrations. We used a combination of theoretical foundations: (1) From the consumer perspective, we focussed on online reviews of the quality of nursing homes (NHs); (2) from the industrial organisation literature, we proposed arguments regarding the advantages and disadvantages of belonging to a chain; (3) the theory of transaction costs was used to explain public–private collaboration. The study was carried out on a sample of 642 chain-affiliated Spanish NHs, with data from quality scores downloaded from the website topMayores.es. We distinguished between the six largest chains and the rest. We applied linear regression models. The results show that NHs affiliated with one of the largest NH chains obtained worse quality scores in the assessment made by users, although quality scores improved for the largest chains of NHs involved in an agreement with the public administration.

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“…Specifically, the states identified as having CON provisions for hospice were: AL, AR, FL, HI, KY, LA, MD, NY, NC, RI, SC, TN, WA, WV, and DC. 1 Though variations may exist in state CON regulations, this variable was treated as a binary variable (CON = 1; Non-CON = 0) to examine various associations, which was consistent with prior studies evaluating the impact of CON status such as in the nursing home industry 28 or in hospital activity. 8 Of note, Louisiana was included in the CON count as it operates a Facility Need Review process for hospice, instead of a CON process, but since it operates in a similar manner, researchers typically include the state in the CON count.…”

Section: Methodsmentioning

confidence: 99%

Associations Between Certificate of Need Policies and Hospice Quality Outcomes

Gaines

Cagle

2023

Am J Hosp Palliat Care

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Background Certificate of need (CON) laws are state-based regulations requiring approval of new healthcare entities and capital expenditures. Varying by state, these regulations impact hospices in 14 states and DC, with several states re-examining provisions. Aim This cross-sectional study examined the association of CON status on hospice quality outcomes using the hospice item set metric (HIS). Design Data from the February 2022 Medicare Hospice Provider and General Information reports of 4870 US hospices were used to compare group means of the 8 HIS measures across CON status. Multiple regression analysis was used to predict HIS outcomes by CON status while controlling for ownership and size. Results Approximately 86% of hospices are in states without a hospice CON provision. The unadjusted mean HIS scores for all measures were higher in CON states (M range 94.40-99.59) than Non-CON (M range 90.50-99.53) with significant differences in all except treatment preferences. In the adjusted model, linear regression analyses showed hospice CON states had significantly higher HIS ratings than those from Non-CON states for beliefs and values addressed (β = .05, P = .009), pain assessment (β = .05, P = .009), dyspnea treatment (β = .08, P < .001) and the composite measure (β = .09, P < .001). Treatment preferences, pain screening, dyspnea screening, and opioid bowel treatment were not statistically significant ( P > .05). Conclusion The study suggests that CON regulations may have a modest, but beneficial impact on hospice-reported quality outcomes, particularly for small and medium-sized hospices. Further research is needed to explore other factors that contribute to HIS outcomes.

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Certificate-Of-Need Regulation and Healthcare Service Quality: Evidence from the Nursing Home Industry

Cited by 13 publications

References 39 publications

The Economics of a Bed Shortage: Certificate-of-Need Regulation and Hospital Bed Utilization during the COVID-19 Pandemic

The Economics of a Bed Shortage: Certificate-of-Need Regulation and Hospital Bed Utilization during the COVID-19 Pandemic

Nursing Homes: Affiliation to Large Chains, Quality and Public–Private Collaboration

Associations Between Certificate of Need Policies and Hospice Quality Outcomes

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