title: Oversight of nursing homes: pruning the tree or just spotting bad apples?
abstract: OBJECTIVE
  This study investigated whether higher rates of nursing home quality citations are associated with increased risk of voluntary and involuntary facility terminations from the Medicare/Medicaid certification process.
  
  
  METHODS
  We examined nationwide Online Survey Certification and Reporting (OSCAR) data from 1992 through 2000 and used a multinomial logistic regression model with time-varying covariates to estimate the relationship between nursing home deficiencies and terminations.
  
  
  RESULTS
  In the study period, 8.7% of nursing homes voluntarily terminated and 2.4% of facilities were involuntarily terminated. Deficiencies significantly predicted both types of termination, controlling for state and market characteristics. Low occupancy and very high Medicaid mix were strongly related to voluntary and involuntary terminations (p <.05).
  
  
  CONCLUSIONS
  Nursing homes that receive a high number of deficiencies exit the Medicare/Medicaid market and have lower occupancy rates before termination, although the relationship varies considerably across states. If competition on the basis of quality is increased because of public reporting efforts, our analyses suggest that terminations, both voluntary and involuntary, will likely increase.
authors.affiliation: Center for Gerontology and Health Care Research, Brown University, Providence, RI 02912, USA. Joseph_Angelelli@Brown.edu
authors.forename: Joseph
authors.initials: J
authors.lastname: Angelelli
authors.forename: Vincent
authors.initials: V
authors.lastname: Mor
authors.forename: Orna
authors.initials: O
authors.lastname: Intrator
authors.forename: Zhanlian
authors.initials: Z
authors.lastname: Feng
authors.forename: Jacqueline
authors.initials: J
authors.lastname: Zinn
mesh_terms: D002568:Certification; D009735:Nursing Homes / Q000331:legislation & jurisprudence / Q000592:standards*; D014481:United States