Hospital Ownership Conversions: Defining the Appropriate Public Oversight Role

This paper reviews recent empirical evidence on the effects of hospital ownership conversions on quality of care and provision of public goods, such as uncompensated care, and presents new results on these topics based on hospital discharge data from the Healthcare Cost and Utilization Projects (HCUP) Nationwide Inpatient Sample. My analysis of these data reveals that conversion from government or private nonprofit to for-profit ownership has no effect on in-hospital mortality, but rates of pneumonia complications increased following conversion to for-profit status. Other research, discussed in the paper, found increased mortality rates following discharge from the hospital for patients admitted to hospitals that had converted to for-profit ownership. There was no effect of such conversions on the propensity to admit uninsured or Medicaid patients. Clearly, there is considerable heterogeneity in outcomes attributable to conversions. Overall, the evidence suggests a role for public scrutiny of hospital ownership conversions.

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The Impact of Private for-Profit Hospital Ownership on Costs and Quality of Care – Evidence from Germany

CESifo Economic Studies ◽

10.1093/cesifo/ifz005 ◽

2019 ◽

Vol 65 (4) ◽

pp. 373-401 ◽

Cited By ~ 1

Author(s):

Ansgar Wübker ◽

Christiane Wuckel

Keyword(s):

Quality Of Care ◽

Hospital Costs ◽

Mortality Rates ◽

Public Hospitals ◽

Hospital Data ◽

Hospital Ownership ◽

For Profit ◽

The Usa ◽

The Impact

Abstract What is the impact of private for-profit (PfP) hospital ownership on costs and quality of care? In light of a substantial and increasing share of PfP hospitals in many hospital markets like the USA or Germany, this is an important question. We estimate the effect of PfP ownership on hospital 30-day- and 1-year-mortality outcomes and hospital costs by focusing on heart attacks and pneumonia, two very common conditions in healthcare markets. We use rich administrative hospital data from Germany for the years 2006–2015. Applying differential distance as instrument for hospital choice, we imitate randomization of patients into PfP hospitals. Our results suggest that PfP hospitals have no higher mortality rates for heart attack treatment than public ones. For pneumonia patients, we even find lower 30-day-mortality rates of PfP hospitals compared to public hospitals. Finally, we show that PfP hospitals have higher hospital costs than public or private not-for-profit hospitals for both conditions.

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Mortality at For-Profit Versus Not-For-Profit Hemodialysis Centers: A Systematic Review and Meta-analysis

International Journal of Health Services ◽

10.1177/0020731420980682 ◽

2020 ◽

pp. 002073142098068

Author(s):

Samuel Dickman ◽

Reza Mirza ◽

Maryam Kandi ◽

Michael A. Incze ◽

Lorin Dodbiba ◽

...

Keyword(s):

Systematic Review ◽

Observational Studies ◽

Meta Analysis ◽

Mortality Rates ◽

Clinical Severity ◽

For Profit ◽

Not For Profit ◽

Overlapping Data ◽

Profit Status ◽

Dialysis Facilities

We conducted a systematic review and meta-analysis to assess differences in risk-adjusted mortality rates between for-profit (FP) and not-for-profit (NFP) hemodialysis facilities. We searched 10 databases for studies published between January 2001 to December 2019 that compared mortality at private hemodialysis facilities. We included observational studies directly comparing adjusted mortality rates between FP and NFP private hemodialysis providers in any language or country. We excluded evaluations of dialysis facilities that changed their profit status, studies with overlapping data, and studies that failed to adjust for patient age and some measure of clinical severity. Pairs of reviewers independently screened all titles and abstracts and the full text of potentially eligible studies, abstracted data, and assessed risk of bias, resolving disagreement by discussion. We included nine observational studies of hemodialysis facilities representing 1,163,144 patient-years. In pooled random-effects meta-analysis, the odds ratio of mortality in FP relative to NFP facilities was 1.07 (95% CI 1.04–1.11). Patients at FP hemodialysis facilities have 7 percent greater odds of death annually than patients with similar risk profiles at NFP facilities. Approximately 3,800 excess deaths might be averted annually if U.S. FP hemodialysis operators matched NFP mortality rates.

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Hospitalization and Mortality Rates in Long-Term Care Facilities: Does For-Profit Status Matter?

Journal of the American Medical Directors Association ◽

10.1016/j.jamda.2015.06.004 ◽

2015 ◽

Vol 16 (10) ◽

pp. 874-883 ◽

Cited By ~ 26

Author(s):

Peter Tanuseputro ◽

Mathieu Chalifoux ◽

Carol Bennett ◽

Andrea Gruneir ◽

Susan E. Bronskill ◽

...

Keyword(s):

Long Term Care ◽

Mortality Rates ◽

Term Care ◽

For Profit ◽

Care Facilities ◽

Profit Status

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Civil Money Penalty Enforcement Actions for Quality Deficiencies in Nursing Homes

The Gerontologist ◽

10.1093/geront/gnz180 ◽

2019 ◽

Vol 60 (5) ◽

pp. 868-877

Author(s):

Xiaochuan Wang ◽

Denise Gammonley ◽

Felicia Bender

Keyword(s):

Quality Of Life ◽

Nursing Homes ◽

Fixed Effects ◽

State Level ◽

Regulatory Oversight ◽

Cross Sectional ◽

For Profit ◽

Profit Status ◽

Fixed Effects Regression

Abstract Background and Objectives Civil money penalties (CMP) are fines collected by CMS. A portion of these CMPs are redistributed to states for purposes including improving resident care and quality of life through reinvestment in quality improvement projects. This study examined state variation in civil money penalty enforcement actions for quality of life (QOL) and quality of care (QOC) deficiencies in nursing homes. Research Design and Methods 2015–2016 cross-sectional CASPER nursing home survey data obtained from the CMS QCOR database were used to explore the pattern of enforcement actions for QOL and QOC deficiencies across states. Fixed effects regression models examined relationships between state-level characteristics, quality deficiencies, and enforcement actions imposed by states. Results State enforcement actions resulting in a CMP were more likely for QOC deficiencies (M = 0.143, SD = 0.097) than for QOL deficiencies (M = 0.070, SD = 0.056) and states exhibited variability in imposing enforcement actions. The presence of severe QOC deficiencies resulting in actual resident harm contributed to CMP enforcement actions for both QOL and QOC deficiencies. States with primarily for-profit status providers had more enforcement actions. Discussion and Implications The variability noted in state enforcement for quality deficiencies actions parallels inconsistencies in state regulatory oversight of nursing homes.

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Antecedents of Hospital Ownership Conversions, Mergers, and Closures

INQUIRY The Journal of Health Care Organization Provision and Financing ◽

10.5034/inquiryjrnl_40.1.39 ◽

2003 ◽

Vol 40 (1) ◽

pp. 39-56 ◽

Cited By ~ 30

Author(s):

Frank A. Sloan ◽

Jan Ostermann ◽

Christopher J. Conover

Keyword(s):

Market Power ◽

Profit Margin ◽

Government Ownership ◽

Hospital Ownership ◽

Hospital Mergers ◽

For Profit ◽

Profit Status

This study assesses the determinants of conversions in hospital ownership from 1986 through 1996. To place such changes in context, we also analyze causes of hospital mergers and closures, which are often alternatives to hospital ownership conversion. A consistent result from our analysis is that an important antecedent of ownership conversions is a low profit margin. Conversions from private nonprofit or government ownership to for-profit status are preceded by chronically low margins and high debt-to-asset ratios. By contrast, conversions from for-profit ownership occur quickly following declines in margins. Many mergers seem motivated by a desire to increase market power—a consideration not evident for conversions.

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Abstract 502: Weekend Effect on Subarachnoid Hemorrhage: A Stroke of Bad Luck

Arteriosclerosis Thrombosis and Vascular Biology ◽

10.1161/atvb.34.suppl_1.502 ◽

2014 ◽

Vol 34 (suppl_1) ◽

Author(s):

Mahdi Khoshchehreh ◽

Katherine Yu ◽

Joseph Tran ◽

Shaista Malik

Keyword(s):

Subarachnoid Hemorrhage ◽

Odds Ratio ◽

Nationwide Inpatient Sample ◽

Diagnostic Procedures ◽

Mortality Rates ◽

Primary Diagnosis ◽

Weekend Effect ◽

Discharge Data ◽

Patient Demographics ◽

Therapeutic Procedures

Background and Purpose: Recently, there has been a significant emergence of literature suggesting patients who present with time-sensitive medical conditions such as myocardial infarction or pulmonary embolism on the weekend have higher mortality and poorer outcomes compared to those admitted on weekdays, otherwise known as the “weekend effect.” The literature is sparse concerning the presence of the “weekend effect” in patients admitted with a primary diagnosis of subarachnoid hemorrhage (SAH). Methods: Using discharge data for patients with a primary diagnosis of SAH from the 2009 Nationwide Inpatient Sample, we compared the mortality rates and timing of proper diagnostic procedures between weekend and weekday admissions. All analyses were adjusted for patient demographics and existing comorbidities. Results: 830,739 admissions of SAH were identified of which 26.5% were weekend admissions. After adjusting for patient demographics and comorbidities, the odds ratio for weekend admissions was 1.11 (95% CI; 1.03-1.19). We found significant fewer diagnostic/therapeutic procedures performed on first day of admission among weekend admitted patients. (OR 0.80, 95% CI, 0.74-0.87). Conclusion: Patients presenting with SAH on the weekend have a higher mortality rate when compared to those admitted on the weekdays, and have a longer time to diagnostic and therapeutic procedures.

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Hospital Lobbying and Performance

Journal of Governmental & Nonprofit Accounting ◽

10.2308/jogna-2020-009 ◽

2021 ◽

Author(s):

Yangmei Wang ◽

Yuewu Li ◽

Jiao Li

Keyword(s):

Hospital Performance ◽

Business Organizations ◽

Hospital Ownership ◽

Uncompensated Care ◽

Return On Assets ◽

For Profit ◽

Not For Profit ◽

Government Hospitals ◽

And Performance ◽

Care Costs

Lobbying is a primary avenue through which business organizations attempt to influence legislation, regulations, or policies. In this study, we examine the association between lobbying and hospital performance and find that the effects of lobbying activities on hospital performance vary according to the distinct types of hospital ownership. Specifically, we find that lobbying raises employee salaries in not-for-profit (NFP) hospitals, reduces uncompensated care costs in both for-profit and NFP hospitals, and increases return on assets (ROA) in for-profit hospitals. We also find that the effects of lobbying on employee salaries, uncompensated care costs, and ROA are not significant in government hospitals. Taken together, our findings suggest that NFP hospitals lobby to protect employees’ interests, while for-profit hospitals lobby to maximize investors’ interests. Our paper provides evidence to illustrate that the goals and effects of hospital lobbying vary according to hospital ownership types.

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The Conversion Conundrum: The State and Federal Response to Hospitals’ Changes in Charitable Status

American Journal of Law & Medicine ◽

10.1017/s0098858800010716 ◽

1997 ◽

Vol 23 (2-3) ◽

pp. 221-250

Author(s):

Lawrence E. Singer

Keyword(s):

Joint Venture ◽

Low Cost ◽

State Level ◽

The State ◽

Nonprofit Hospitals ◽

For Profit ◽

Tax Exempt ◽

Federal Response ◽

Profit Status ◽

Hospital Conversions

The pressures encountered by hospitals in the current era of reimbursement declines and stiffened competition are well known. As the “ultimate” payors—primarily employers and government—aggressively continue to seek low cost care, the response of the hospital industry has been to move toward consolidation and efficiency-enhancing mechanisms.Increasingly, nonprofit, tax-exempt hospitals have come to believe that they are at a significant disadvantage vis-á-vis their for-profit brethren in their ability to attract the capital needed to compete in the market. A growing trend among nonprofit hospitals, therefore, is to sell to or enter into a joint venture with a proprietary organization, or alternatively to convert to for-profit status. In 1995, fifty-eight nonprofit hospitals became for-profit; hospital conversions to for-profit status in 1996 are projected to outstrip the pace established the prior year.The conversion trend has not gone unnoticed at the state level. Recently, several states have proposed or enacted laws regulating sales and conversions of nonprofit hospitals, and many more states are contemplating such legislation.

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Purchasing Quality Nursing Home Care in the Veterans Health Administration

Innovation in Aging ◽

10.1093/geroni/igaa055 ◽

2020 ◽

Vol 4 (6) ◽

Author(s):

Orna Intrator ◽

Edward Alan Miller ◽

Portia Y Cornell ◽

Cari Levy ◽

Christopher W Halladay ◽

...

Keyword(s):

The United States ◽

Veterans Affairs ◽

Nursing Home Care ◽

Veterans Health ◽

Health Administration ◽

Star Rating ◽

For Profit ◽

Veterans Affairs Medical Centers ◽

And Performance

Abstract Background and Objectives U.S. Department of Veterans Affairs Medical Centers (VAMCs) contract with nursing homes (NHs) in their community to serve Veterans. This study compares the characteristics and performance of Veterans Affairs (VA)-paid and non-VA-paid NHs both nationally and within local VAMC markets. Research Design and Methods VA-paid NHs were identified, characterized, and linked to VAMC markets using data drawn from VA administrative files. NHs in the United States in December 2015 were eligible for the analysis, including. 1,307 VA-paid NHs and 14,253 non-VA-paid NHs with NH Compare measures in 128 VAMC markets with any VA-paid NHs. Measurements were derived from the Centers for Medicare and Medicaid Services (CMS) five-star rating system, NH Compare. Results VA-paid NHs had more beds, residents per day, and were more likely to be for-profit relative to non-VA-paid NHs. Nationally, the average CMS NH Compare star rating was slightly lower among VA-paid NHs than non-VA-paid NHs (3.05 vs. 3.21, p = .04). This difference was seen in all 3 domains: inspection (3.11 vs. 3.23, p < .001), quality (2.68 vs. 2.83, p < .001), and total nurse staffing (3.36 vs. 3.42, p < .10). There was wide variability across VAMC markets in the ratio of average star rating of VA-paid and non-VA-paid NHs (mean ratio = 0.93, interquartile range = 0.78–1.08). Discussion and Implications With increased community NH use expected following the implementation of the MISSION Act, comparison of the quality of purchased services to other available services becomes critical for ensuring quality, including for NH care. Methods presented in this article can be used to examine the quality of purchased care following the MISSION Act implementation. In particular, dashboards such as that for VA-paid NHs that compare to similar non-VA-paid NHs can provide useful information to quality improvement efforts.

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