Nursing Home Compare Star Ratings Before Versus After a Change in Nursing Home Ownership

Overview

Journal J Am Geriatr Soc

Specialty Geriatrics

Date 2024 Jul 29

PMID 39074916

Authors

Kira L Ryskina

Emily Tu

Junning Liang

Seiyoun Kim

Rachel M Werner

Affiliations

Soon will be listed here.

Abstract

Background: Efforts to increase transparency and accountability of nursing homes, and thus improve quality, now include information about changes in nursing home ownership. However, little is known about how change in ownership affects nursing home quality.

Methods: We conducted a retrospective cohort study of 15,471 U.S. nursing homes between January 2016 and December 2022, identifying all changes in ownership during that period. We used logistic regression to measure the association between nursing home characteristics and the odds of a change in ownership. A difference-in-differences model with multiple time periods was used to examine the impact of a change in ownership on the Medicare Nursing Home Compare 5-star ratings.

Results: One in five (23%) facilities changed ownership between 2016 and 2022. Nursing homes that were urban, for-profit, part of a chain, located in the South, had >50 beds, lower occupancy, higher percentage of stays covered by Medicaid, higher percentage of residents with non-white race, or a 1-star (poor) rating were more likely to undergo a change in ownership. There was a small statistically significant decrease in 5-star ratings after a change in ownership (-0.09 points on a 5-point scale; 95% CI -0.13 to -0.04; p < 0.001), driven primarily by a decrease in staffing ratings (-0.19 points; 95% CI -0.24 to -0.14; p < 0.001), and health inspections ratings (-0.07 points; 95% CI -0.11 to -0.03; p = 0.001). This was mitigated by an increase in quality measure ratings (0.15 points; 95% CI 0.10-0.20; p < 0.001).

Conclusion: Nursing Home Compare ratings decreased slightly after a change in facility ownership, driven by lower staffing and health inspection ratings and mitigated somewhat by higher quality measure ratings. These conflicting trends underscore the need for transparency around changes in facility ownership and a better understanding of consequences of changes in ownership that are salient to patients and families.

References

Brauner D, Werner R, Shippee T, Cursio J, Sharma H, Konetzka R . Does Nursing Home Compare Reflect Patient Safety In Nursing Homes?. Health Aff (Millwood). 2018; 37(11):1770-1778. PMC: 6405288. DOI: 10.1377/hlthaff.2018.0721. View

Konetzka R, Brauner D, Shega J, Werner R . The effects of public reporting on physical restraints and antipsychotic use in nursing home residents with severe cognitive impairment. J Am Geriatr Soc. 2014; 62(3):454-61. PMC: 6345266. DOI: 10.1111/jgs.12711. View

Borsa A, Bejarano G, Ellen M, Bruch J . Evaluating trends in private equity ownership and impacts on health outcomes, costs, and quality: systematic review. BMJ. 2023; 382:e075244. PMC: 10354830. DOI: 10.1136/bmj-2023-075244. View

ONeill C, Harrington C, Kitchener M, Saliba D . Quality of care in nursing homes: an analysis of relationships among profit, quality, and ownership. Med Care. 2003; 41(12):1318-30. DOI: 10.1097/01.MLR.0000100586.33970.58. View

Werner R, Coe N . Nursing Home Staffing Levels Did Not Change Significantly During COVID-19. Health Aff (Millwood). 2021; 40(5):795-801. PMC: 9594992. DOI: 10.1377/hlthaff.2020.02351. View

Chen A, Skinner R, Braun R, Konetzka R, Stevenson D, Grabowski D . New CMS Nursing Home Ownership Data: Major Gaps And Discrepancies. Health Aff (Millwood). 2024; 43(3):318-326. DOI: 10.1377/hlthaff.2023.01110. View

Braun R, Yun H, Casalino L, Myslinski Z, Kuwonza F, Jung H . Comparative Performance of Private Equity-Owned US Nursing Homes During the COVID-19 Pandemic. JAMA Netw Open. 2020; 3(10):e2026702. PMC: 7593807. DOI: 10.1001/jamanetworkopen.2020.26702. View

Harrington C, Olney B, Carrillo H, Kang T . Nurse staffing and deficiencies in the largest for-profit nursing home chains and chains owned by private equity companies. Health Serv Res. 2011; 47(1 Pt 1):106-28. PMC: 3447240. DOI: 10.1111/j.1475-6773.2011.01311.x. View

Rahman M, Norton E, Grabowski D . Do hospital-owned skilled nursing facilities provide better post-acute care quality?. J Health Econ. 2016; 50:36-46. PMC: 5127756. DOI: 10.1016/j.jhealeco.2016.08.004. View

10.

Lindmark T, Engstrom M, Trygged S . Psychosocial Work Environment and Well-Being of Direct-Care Staff Under Different Nursing Home Ownership Types: A Systematic Review. J Appl Gerontol. 2022; 42(2):347-359. PMC: 9841825. DOI: 10.1177/07334648221131468. View

11.

Prusynski R, Humbert A, Mroz T . Skilled Nursing Facility Changes in Ownership and Short-Stay Medicare Patient Outcomes. JAMA Netw Open. 2023; 6(9):e2334551. PMC: 10509722. DOI: 10.1001/jamanetworkopen.2023.34551. View

12.

Braun R, Jung H, Casalino L, Myslinski Z, Unruh M . Association of Private Equity Investment in US Nursing Homes With the Quality and Cost of Care for Long-Stay Residents. JAMA Health Forum. 2022; 2(11):e213817. PMC: 8796926. DOI: 10.1001/jamahealthforum.2021.3817. View

13.

Grabowski D, Stevenson D . Ownership conversions and nursing home performance. Health Serv Res. 2008; 43(4):1184-203. PMC: 2517264. DOI: 10.1111/j.1475-6773.2008.00841.x. View

14.

Ryskina K, Konetzka R, Werner R . Association Between 5-Star Nursing Home Report Card Ratings and Potentially Preventable Hospitalizations. Inquiry. 2018; 55:46958018787323. PMC: 6055104. DOI: 10.1177/0046958018787323. View

15.

Werner R, Konetzka R, Kruse G . Impact of public reporting on unreported quality of care. Health Serv Res. 2009; 44(2 Pt 1):379-98. PMC: 2677045. DOI: 10.1111/j.1475-6773.2008.00915.x. View

16.

Grabowski D, Hirth R, Intrator O, Li Y, Richardson J, Stevenson D . Low-Quality Nursing Homes Were More Likely Than Other Nursing Homes To Be Bought Or Sold By Chains In 1993-2010. Health Aff (Millwood). 2016; 35(5):907-14. DOI: 10.1377/hlthaff.2015.1042. View