A new study finds nursing home ownership changes may be a symptom of poor nursing home quality, rather than the cause of it.
Using newly available federal data on nursing home transactions, researchers from the University of Washington Department of Rehabilitation Medicine evaluated the impact of 1,459 sales on about 11,000 nursing homes and their short-stay patients.
Over four years, they found that urban skilled nursing facilities with lower occupancy rates, larger Medicaid populations and lower staffing had higher odds of changing owners, as did for-profit facilities and chains.
However, few substantial impacts on short-stay quality measures were found when those sales were overlaid with outcomes among Medicare-covered residents. Instead, the study revealed that across measures tracking readmission rates, emergency department visits and community discharge among those short-stay residents, only the emergency visit measure worsened. Such visits increased by 0.32% after a change in ownership.
But the researchers also noted that facilities with a change in ownership had worse outcomes over the full study period compared to those that went unsold.
“The finding that worse short-stay patient outcomes occurred in SNFs with changes in ownership group throughout the study period, combined with the finding that changes in ownership were more common in SNFs with characteristics that have previously been associated with lower quality, suggests that changes in ownership may be a symptom, rather than a cause, of lower quality,” they wrote in JAMA Network Open Tuesday.
The study is believed to be the first to evaluate the impact of sales on short-stay measures, outside of work that looked exclusively at private equity acquisitions. It was made possible by the expansion of publicly available CMS datasets on changes in ownership.
The researchers, led by Rachel Prusynski, DPT, PhD, did not use cost reports to measure the influence of margin on sale likelihood or operations. They instead relied on characteristics (such as occupancy, Medicaid population levels and staffing) that could be linked with financial pressure.
“Changes in ownership for SNFs are frequent, with 3,245 SNFs sold in the US between 2016 and 2021. In addition to potentially shifting funds away from patient care, SNF sales may further disrupt administrative and clinical processes, including staffing, admission practices, or discharge consideration,” they wrote.
“Ownership changes may shift a facility’s interest in admitting more profitable Medicare patients. Additionally, SNFs are subject to financial penalties or bonuses based on outcomes for short-stay patients through the SNF Value-Based Purchasing program. Short-stay patient admission and outcomes thus factor heavily into the financial picture of individual SNFs,” the team added.
The authors noted that their data ran only through 2019 and that the effects of the pandemic were not yet evident. They encouraged future research that would look at a more recent period and lean on additional ownership data, including a breakdown of ownership types, that CMS is planning to publish in the near future.
In the meantime, they cautioned against new regulations that might try to regulate nursing home sales, arguing they might not influence care quality for short-stay residents.
“Efforts targeted toward improving clinical care and administrative processes, such as nurse and therapy staffing, may be more directly impactful for improving quality outcomes for patients in SNFs,” they wrote.
