Rohit Pradhan

The nursing home industry serves one of the most vulnerable populations, and its financial sustainability is a matter of public concern. However, limited empirical evidence exists on the impact of ownership and chain affiliation on nursing home financial performance. The aim of this study was to examine the joint effects of ownership and chain affiliation on the financial performance of the nursing home industry for the study period 1999-2004 on a national sample of 11,236 nursing homes per year. Data included the Medicare Cost Reports; the Online Survey, Certification, and Reporting file; and the Area Resource File. Dependent variables included operating and total margins. Independent variables included four ownership/chain affiliation combinations: for-profit chain, for-profit independent, not-for-profit chain, and not-for-profit independent. Random effects generalized least square regressions were performed. Results show that for-profit nursing homes delivered better financial performance than not-for-profit facilities did across both operating and total margins. However, the relationship between chain affiliation and financial performance was more nuanced. In the case of operating margin, chain-affiliated facilities delivered superior financial performance irrespective of ownership type; however, in the case of total margin, independents outperformed chain-affiliated facilities among for-profits. Our findings show an interactive effect of ownership and chain affiliation on nursing home financial performance, suggesting the pursuit of different organizational strategies by different ownership/chain affiliation subgroups (for-profit chain, for-profit independent, not-for-profit chain, and not-for-profit independent), with implications for financial performance. For-profit independent nursing homes managed to be the top performing group in terms of overall financial despite the operating financial advantage of for-profit chain-affiliated nursing homes. Similarly, not-for-profit independent nursing homes and not-for-profit chain homes had comparable overall financial performance despite the operating financial advantage of chain homes.

Private equity has acquired multiple large nursing home chains within the last few years; by 2007, it owned six of the 10 largest chains. Critics allege that Private equity nursing homes compromise quality of care in pursuit of profits and have called for greater regulatory oversight. Using multiple secondary datasets like OSCAR, MDS and Medicare cost reports, this study examines the quality and financial performance of private equity nursing homes in Florida. Results suggest that private equity facilities deliver superior financial performance with little difference in quality compared to other investor owned nursing homes. Policy and managerial implications are discussed.

Private equity has acquired multiple large nursing home chains within the last few years; by 2007, it owned six of the 10 largest chains. Critics allege that Private equity nursing homes compromise quality of care in pursuit of profits and have called for greater regulatory oversight. Using multiple secondary datasets like OSCAR, MDS and Medicare cost reports, this study examines the quality and financial performance of private equity nursing homes in Florida. Results suggest that private equity facilities deliver superior financial performance with little difference in quality compared to other investor owned nursing homes. Policy and managerial implications are discussed.

Organizational structures of healthcare organizations has increasingly become a focus of medical research. In the CAFÉ project we aim to provide a web-service enabling ontology-driven comparison of the organizational characteristics of trauma centers and trauma systems. Trauma remains one of the biggest challenges to healthcare systems worldwide. Research has demonstrated that coordinated efforts like trauma systems and trauma centers are key components of addressing this challenge. Evaluation and comparison of these organizations is essential. However, this research challenge is frequently compounded by the lack of a shared terminology and the lack of effective information technology solutions for assessing and comparing these organizations. In this paper we present the Ontology of Organizational Structures of Trauma systems and Trauma centers (OOSTT) that provides the ontological foundation to CAFÉ's web-based questionnaire infrastructure. We present the usage of the ontology ...

The objective of this study is to develop evidence regarding the potential effect of the consolidation of Ohio local health departments (LHD), from independent city run public health agencies into county wide organizational forms, on expenditures, staffing levels and service offerings of LHDs. Longitudinal data drawn from the Ohio Department of Health's Annual Financial Reports for the period between 2000 and 2011 are utilized for the analyses. Additional covariates such as community demographics and organizational characteristics are obtained from the PHAST Data Repository which is an ongoing collaborative data integration project drawing together multiple sources of data such as US Census data, the Area Resource Files and the NACCHO Profiles. In order to address the potential for both selection bias in which LHDs chose to consolidate and endogenous determination of spending decisions, the extended two part model for longitudinal data suggested by Deb, Munkin and Trivedi (2006)...

Sickle cell disease (HbSS) is the most common variant of β-globin gene, resulting from the replacement of glutamic acid by valine at position 6 in the β chain. Under the action of certain factors, such as cold, fever, dehydration, and infections, sickle cell crisis is usually precipitated. The crisis predisposes to aggregation of sickle cells, which may produce vaso-occlusion of

Purpose: Private equity has acquired multiple large nursing home chains within the last few years; by 2007, it owned six of the 10 largest chains. Critics have alleged that private equity nursing homes compromise on quality of care in pursuit of profits and have called for ...

Nursing homes (NHs) are a critical part of the US healthcare system providing care to the sick and fragile elderly, and research suggests that they can benefit from the implementation of health information technology (HIT). However, for multiple reasons—exclusion from HITECH incentives; limited financial wherewithal; hazy return on investments (ROI), they have lagged in HIT implementation compared to other significant components of the US healthcare system. Utilizing the resource-based view (RBV) of the firm, the purpose of this study was to examine the longitudinal impact of HIT on NH financial performance potentially building a sustainable economic argument for its implementation. To examine this relationship, we merged data from five different sources between the years 2009-2013-: Health Information and Management Systems Society, LTCFocus, Online Survey Certification and Reporting/Certification and Survey Provider Enhanced Reporting, Area Health Resource Files, and Medicare Cost...

The purpose of this research is to explore the factors associated with the availability of specialized resources required to care for obese residents in high Medicaid nursing homes (NHs) (85% or higher). Due to the vagaries of payment models---Medicaid payments lag other modes of NH reimbursements—high Medicaid NHs typically report poorer quality and financial performance. Operating in a financial perilous environment, and with obesity among the elderly on the rise, high Medicaid NH may particularly struggle to obtain the appropriate resources essential to cater to obese residents' needs.Utilizing the resource-dependent theory, we hypothesized that occupancy rate, acuity index, and payer mix may be positively associated with the availability of obesity related specialized equipment in high Medicaid NHs. The study was conducted by merging survey and secondary data sources for the year 2017-2018. Obesity related data was collected via mail surveys sent to Directors of Nursing in h...

Funding for this study was provided by the Robert Wood Johnson Foundation through the Practice Based Research Network (PBRN) at the University of Kentucky and the Research Association for Public Health Improvement (RAPHI) at Case Western Reserve University. Recent studies suggest that consolidating Local Health Departments (LHDs) may improve public health services, increase efficiency, and reduce public health expenditures. To identify factors motivating LHD consolidations that may enhance public health service provision, we investigate potential factors motivating LHD consolidations in Ohio since 2000. Using logistic regression analysis and interviews with local health officials, we find that the financial condition of cities involved in consolidations and the presence of a “Strong Mayor” municipal government system are strong predictors of consolidation decisions in Ohio between 2001 and 2013. Because of variations in LHD governance arrangements across states, further research is ...

High Medicaid nursing homes (85% and higher of Medicaid residents) operate in resource-constrained environments. High Medicaid nursing homes (on average) have lower quality and poorer financial performance. However, there is significant variation in performance among high Medicaid nursing homes. The purpose of this study is to examine the organizational and market factors that may be associated with better financial performance among high Medicaid nursing homes. Data sources included Long-Term Care Focus (LTCFocus), Centers for Medicare and Medicaid Services’ (CMS) Medicare Cost Reports, CMS Nursing Home Compare, and the Area Health Resource File (AHRF) for 2009-2015. There were approximately 1108 facilities with high Medicaid per year. The dependent variables are nursing homes operating and total margin. The independent variables included size, chain affiliation, occupancy rate, percent Medicare, market competition, and county socioeconomic status. Control variables included staffi...

Private equity has acquired multiple large nursing home chains within the past few years; by 2007, it owned 6 of the 10 largest chains. Despite widespread public and policy interest, evidence on the purported impact of private equity on nursing home performance is limited. In our review, we begin by briefly reviewing the organizational and environmental changes in the nursing home industry that facilitated private equity investments. We offer a conceptual framework to hypothesize the relationship between private equity ownership and nursing home performance. Finally, we offer a research agenda focused on the important parameters of nursing home performance: financial performance, and quality of care.

The hospital-physician relationship (HPR) has been the focus of many scholars given the potential impact of this relationship on hospitals' ability to achieve socially and organizationally desirable health care outcomes. Hospitals are dominated by professionals and share many commonalities with professional service firms (PSFs). In this chapter, we explore an alternative HPR based on the governance models prevalent in PSFs. DESIGN/METHODOLOGY APPROACH: We summarize the issues presented by current HPRs and discuss the governance models dominant in PSFs. We identify the non-equity partnership model as a governance archetype for hospitals; this model accounts for both the professional dominance in health care decisions and the increasing demand for higher accountability and efficiency. There should be careful consideration of existing regulations such as the Stark law and the antikickback statue before the proposed governance model and the compensation structure for physician partners is adopted. While our governance archetype is based on a review of the literature on HPRs and PSFs, further research is needed to test our model. Given the dominance of not-for-profit (NFP) ownership in the hospital industry, we believe the non-equity partnership model can help align physician incentives with those of the hospital, and strengthen HPRs to meet the demands of the changing health care environment. This is the first chapter to explore an alternative hospital-physician integration strategy by examining the governance models in PSFs, which similar to hospitals have a high reliance on a predominantly professional staff.

PurposeThe volume of international patients has been growing in the past 15 years, with developing countries gaining a larger market share. The international patients market is lucrative, given that hospitals may be able to attract an affluent clientele, and many patients from foreign countries who seek care require complicated procedures and treatments. The purpose of this paper is to build on previous work in the international business and health services fields, to develop a model that predicts a hospital's ability to attract international patients.Design/methodology/approachThe paper is a synthesis of the literature on export ventures and patient choice to predict a hospital's “export” performance.FindingsIt is estimated that around 70,000 foreign patients travel each year to the USA to receive inpatient medical care. These patients not only benefit hospitals and medical professionals but also benefit the local community through money spent in hotels, restaurants, shoppi...

As "safety net providers," public hospitals have played a major role in health care delivery, especially in serving the indigent and the uninsured. For several decades, public hospitals have been operating in a challenging environment, and some of them have experienced financial difficulties. The purpose of this study was to explore the organizational and environmental factors associated with public hospitals' financial distress. This study used a national sample of public hospitals based on longitudinal panel data from 1997 to 2009, resulting in a sample size of 7,257 hospital-year observations. The Altman Z-score method was applied to assess hospitals' financial condition. The significant findings from a random effects logistic regression model with state and year fixed-effects indicated that higher Medicare HMO penetration was associated with financial distress. Organizational variables such as health network, size, occupancy rate, and outpatient mix decreased the odds of financial distress; and membership in a multihospital system increased the odds of financial distress.

Obesity rates are high among all age groups, including older adults. Obesity negatively affects health and functional ability, increasing the risk for nursing home (NH) admission. The current study examines trends over 11 years in moderate to severe obesity rates among NH residents. A generalized least squares regression model for panel data was used to test the effect of time (years) on the rates. A significant increase in rates and significant variation in rates were observed. Little research has focused on the issue of obesity in NHs. High and increasing rates and variation in rates raise questions on demand and access to NH care for obese older adults. Additional research is needed to consider factors other than time that may affect NHs' ability to admit moderate to severely obese individuals. Understanding these trends will help NHs prepare for future demand, ensure equal access, quality care, and financing of services. [Res Gerontol Nurs. 20xx; x(x):xx-xx.].