Patient Safety and Quality
Nursing homes more often voluntarily terminate from Medicare and Medicaid programs in States with strong quality regulations
Medicare—and Medicaid—certified nursing homes must meet a variety of regulations put in place by Federal and State governments. More than 95 percent are certified by either Medicare or Medicaid. State-imposed nursing home terminations of certification occur rarely in most States. However, nursing homes in States with strong quality regulations are more likely to voluntarily terminate from the Medicaid or Medicare certification programs, finds a new study. State policymakers need to assess the impact of this increase in terminations on quality of and access to nursing home care, suggests William D. Spector, Ph.D., a researcher with the Agency for Healthcare Research and Quality (AHRQ).
Dr. Spector and colleagues used information on terminations from the Medicaid and Medicare programs from the 2006 and 2007 National Online Survey, Certification and Reporting data and constructed a regulatory stringency index for each State based on a prior survey of State licensing and certification directors. The stringency of State regulation varied widely. States considered the most stringent were Connecticut, Kansas, Oregon, and Washington, D.C. Some of the least stringent States were Hawaii, Pennsylvania, South Dakota, and Kentucky.
A direct relationship was found between voluntary termination and a State's level of regulatory stringency. During 2006-2007, the national 2-year voluntary termination rate was 2.16 percent. Washington, D.C. had the highest rate of voluntary terminations (10 percent). Nursing homes in States with high regulatory enforcement were 50 percent more likely to voluntarily terminate their Medicare-Medicaid certification than nursing homes in other States. Characteristics of voluntary terminated nursing homes were small size, low occupancy rate, and being for-profit, hospital-based, or non-chain-affiliated. In addition, these homes tended to be in highly competitive geographical areas and in States with lower Medicaid reimbursement rates.
More details are in "State regulatory enforcement and nursing home termination from the Medicare and Medicaid programs," by Yue Li, Ph.D., Charlene Harrington, Ph.D., Dr. Spector, and Dana B. Mukamel, Ph.D., in the December 2010 HSR: Health Services Research 45(6) Part I, pp. 1796-1814.
Research Activities, June 2011: Patient Safety and Quality: Nursing homes more often voluntarily terminate from Medicare and Medicaid programs in States with strong quality regulations