Public Reporting and Market Area Exit Decisions by Home Health Agencies

Abstract

Principal Findings:We found a small and weak effect of public reporting on selective exits: a 10-percent increase in reporting (reporting one more indicator) increased the probability of leaving an area with lesseducated people by 0.3 percentage points, compared with leaving an area with high education. Conclusion:The small level of market-area exits under public reporting is unlikely to be practically meaningful, suggesting that HHC did not lead to a disruption in access to home health care through selective exits during the initial year of the program.

Out Of Reach: Inequities In The Use Of High-Quality Home Health Agencies

“…Although there has been limited work examining the impact of residential segregation on access to home health agencies, previous research suggests that agencies left socioeconomically disadvantaged markets after the initiation of home health public reporting in 2003 in an effort to protect their reputation and quality ratings. 35 From what is known about the linkage between residential segregation and socioeconomic disadvantage, these socioeconomically disadvantaged markets may have been racially segregated as well. 5 Further, qualitative research findings suggest that disparities in access may exist because home health agency staff (for example, nurses and aides) decline to provide services in predominantly Black, Hispanic, and lower-income neighborhoods because of their perceptions of safety concerns and hazardous conditions.…”

Evidence for Action: Addressing Systemic Racism Across Long-Term Services and Supports

“…26,57e59 The net result is that communities with lower resources, including those where older BIPOC Americans reside, tend to have lower-quality providers, and in some cases these lower-quality providers may exit the market, further limiting access. 57,58 Current national reporting of LTSS quality of care on the Centers for Medicare & Medicaid Services (CMS) Care Compare website focuses on quality of care and regulatory metrics such as the number of deficiencies. These measures do not address the role of person-reported outcomes such as resident quality of life or family satisfaction, which would provide consumers with information on cultural aspects of care (eg, meals and activities).…”

“…Previous work has called for more culturally sensitive quality measures, including quality of life and family satisfaction, to make public reporting a more useful tool for BIPOC users. 57,58 If public reporting is to help address existing disparities, CMS needs to undertake efforts that put equity at the center. We provide 3 specific recommendations for CMS: (1) develop an overall health equity measure which would help capture how well providers meet the needs of diverse populations; (2) calculate existing Care Compare quality scores by race and ethnicity to be used internally and shared with states to develop culturally appropriate policies; and (3) report race and ethnicityespecific quality measures on state-level report cards to incentivize action among states and tailor solutions to the local context.…”

Malpractice Environment vs Direct Litigation: What Drives Nursing Home Exit?

“…We conceptualize nursing homes as profit-maximizing firms that decide to stay in the market or exit in any given period, drawing on models of entry and exit commonly used in prior studies of health care organizations. 21 - 25 The nursing home industry is dominated by for-profit facilities, 26 but even nonprofit nursing homes must be concerned with maintaining financial viability, similar to organizations in the hospital sector, which is dominated by nonprofit facilities. 27 , 28 We assert that nonprofit nursing homes also include profits in their objective function as well as quality or quantity, because we assume that the marginal decision around exit is analogous.…”