High Medicaid Nursing Homes: Organizational and Market Factors Associated With Financial Performance

Weech‐Maldonado, Robert; Lord, Justin; Pradhan, Rohit; Davlyatov, Ganisher; Dayama, Neeraj; Gupta, Shivani; Hearld, Larry R.

doi:10.1177/0046958018825061

Cited by 20 publications

(26 citation statements)

References 41 publications

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“…Moreover, in recent decades, there has been an increase in the growth of chain affiliation in the NH industry [ 11 ]. The affiliation of for-profit NHs with chains has been addressed in the literature that analyses the performance of NHs, especially in relation to financial performance [ 11 , 14 , 15 , 16 ] and, to a lesser extent, in relation to quality [ 12 , 17 , 18 ]. Belonging to a chain allows the standardisation of certain care processes, which can contribute to improving [ 19 ] or worsening the quality [ 17 ].…”

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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Section: Introductionmentioning

confidence: 99%

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

2022

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“…Nevertheless, on a national basis, the STM benchmark is not economically feasible for most NHs. The average profit margin of NHs is below 1% ( Weech-Maldonado et al, 2019 ), and increased operating expenditures to reach the STM benchmark would cause a significant number of NHs to become unprofitable. Without being offset by additional revenue, implementing the STM benchmark would cause nearly three quarters of the NH industry to lose money providing services to residents and could result in the majority of NHs declaring bankruptcy or closing.…”

Section: Discussionmentioning

confidence: 99%

The Need for an Economically Feasible Nursing Home Staffing Regulation: Evaluating an Acuity-Based Nursing Staff Benchmark

Bowblis

2022

Innovation in Aging

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Background and Objectives Despite concerns about the adequacy of nursing home (NH) staffing, the federal agency responsible for NH certification and regulation has never adopted an explicit quantitative nursing staff standard. Harrington and colleagues (2020) have proposed a benchmark for this purpose based on the 1995/97 Staff Time Measurement (STM) studies. This paper aims to assess the extent to which NHs staff to this proposed STM benchmark, the extent to which regulators already implicitly apply the STM benchmark, and compute the additional operating expenses NHs would incur to adhere to the STM benchmark. Research Design and Methods Using NH Compare Archive data, the STM benchmark was compared to staffing levels reported by the facility and whether NHs received a nursing staff deficiency. Using financial information from Medicare Cost Reports, the additional annual operating expenses required to staff to the STM benchmark were calculated for each state and nationwide. Results The vast majority of NHs did not staff to the STM benchmark; 80.2% for registered nurses and 60.0% for total nursing staff. Deficiency patterns showed that NH regulators were not using the STM benchmark to determine sufficiency of nursing staff. Implementing the STM benchmark as a regulatory standard would increase operating expenses for 59.1% of NHs, at an average annual cost of half million dollars per facility. The nationwide increase in operating expense is estimated to be at least$4.9 billion per year. Discussion and Implications Without clear guidance on the staffing level needed to be sufficiently staffed, most NHs are subject to a community standard of care, which some have argued could be associated with suboptimal staffing levels. Implementing an acuity-based benchmark could result in improved staffing levels, but also comes with significant economic costs. The STM benchmark is not economically feasible at current Medicare and Medicaid reimbursement levels.

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“…These measures were carefully selected based upon a comprehensive literature review and have been shown in prior research to be associated with nancial performance of nursing homes and other health care organizations. [10,[29][30][31][32][33][34] Total de ciencies was lagged by one year in the analytical models to address the endogeneity arising from improved quality of care derived from HIT adoption having a positive in uence on nancial performance. [11,29] See Table 1 for the data source of these measures, their de nition/operationalization in the study (Table 1).…”

Section: Control Variablesmentioning

confidence: 99%

Does Nursing Home Health Information Technology Adoption Improve Financial Performance? A Longitudinal Study

Dayama¹,

Felix

Pradhan

et al. 2022

Preprint

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Purpose: The purpose of this study was to examine the longitudinal impact of nursing home Health Information Technology (HIT) adoption on their financial performance. Although nursing homes are an important part of the US healthcare system providing care to the sick and fragile elderly, they were not included in the HITECH incentives for HIT adoption, unlike other hospitals and physicians. As HIT systems are expensive, nursing homes often face uncertainty whether the investment is justifiable. Methods: To examine this relationship, we merged existing data from five sources between 2009–2013–Health Information and Management Systems Society, LTCFocus, Online Survey Certification and Reporting/Certification and Survey Provider Enhanced Reporting, Area Health Resource Files, and Medicare Cost Reports. Results: We found that nursing homes with higher HIT adoption had 2 percentage points higher operating margin and 7 percentage points lower operating cost per resident day. nursing homes that adopted HIT applications improved their financial performance mainly via reduced operating costs. Conclusions: Improved practice efficiency, reduced paperwork, reduced redundant tests, better coordination of care, and reduced medical errors due to HIT may play a role in reducing operating costs. From policy standpoint, our study indicates that by increasing financial performance, HIT adoption may help nursing homes offset efforts to reduce federal and state healthcare spending and increasing costs in response to the COVID-19 pandemic. For nursing home administrators, our findings suggest a potential business case—there may be long-term financial returns for the initial financial burden of HIT implementation.

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High Medicaid Nursing Homes: Organizational and Market Factors Associated With Financial Performance

Cited by 20 publications

References 41 publications

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

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

The Need for an Economically Feasible Nursing Home Staffing Regulation: Evaluating an Acuity-Based Nursing Staff Benchmark

Does Nursing Home Health Information Technology Adoption Improve Financial Performance? A Longitudinal Study

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