State regulatory enforcement and nursing home termination from the medicare and medicaid programs.
OBJECTIVE
Nursing homes certified by the Medicare and/or Medicaid program are subject to federally mandated and state-enforced quality and safety standards. We examined the relationship between state quality enforcement and nursing home terminations from the two programs.


METHODS
Using data from a survey of state licensure and certification agencies and other secondary databases, we performed bivariate and multivariate analyses on the strength of state quality regulation in 2005, and nursing home voluntary terminations (decisions made by the facility) or involuntary terminations (imposed by the state) in 2006-2007.


RESULTS
Involuntary terminations were rarely imposed by state regulators, while voluntary terminations were relatively more common (2.16 percent in 2006-2007) and varied considerably across states. After controlling for facility, market, and state covariates, nursing homes in states implementing stronger quality enforcement were more likely to voluntarily terminate from the Medicare and Medicaid programs (odds ratio = 1.53, p = .018).


CONCLUSIONS
Although involuntary nursing home terminations occurred rarely in most states, nursing homes in states with stronger quality regulations tend to voluntarily exit the publicly financed market. Because of the consequences of voluntary terminations on patient care and access, state regulators need to consider the effects of increased enforcement on both enhanced quality and the costs of termination.
Li
Yue
Y
Department of Internal Medicine, University of Iowa & Iowa City VA Medical Center, SE610 GH, 200 Hawkins Dr, Iowa City, IA 52242, USA. yue-li@uiowa.edu
Harrington
Charlene
C
Spector
William D
WD
Mukamel
Dana B
DB
D006271:Health Facility Closure / Q000331:legislation & jurisprudence* / Q000592:standards; D035846:Law Enforcement; D008484:Medicaid; D006278:Medicare; D009735:Nursing Homes; D014481:United States
Inquiry. 2003 Spring;40(1):94-104
12836911
Med Care Res Rev. 2005 Feb;62(1):111-32
15643031
J Health Econ. 1996 Feb;15(1):23-48
10157427
J Health Econ. 2003 Jan;22(1):1-22
12564715
Health Serv Res. 2007 Jun;42(3 Pt 1):1105-29
17489906
Arch Intern Med. 2005 Jun 13;165(11):1280-5
15956008
Soc Sci Med. 2009 Mar;68(5):933-40
19128865
Inquiry. 2002 Spring;39(1):56-66
12067076
Gerontologist. 2003 Apr;43 Spec No 2:67-75
12711726
Med Care. 2009 Oct;47(10):1039-45
19648834
Med Care Res Rev. 2008 Aug;65(4):514-27
18369236
Am J Public Health. 1995 Jun;85(6):771-6
7762708
Arch Intern Med. 2004 Jul 26;164(14):1508-12
15277280
Health Aff (Millwood). 2009 Jan-Feb;28(1):246-61
19124877
Med Care Res Rev. 1999 Dec;56(4):471-94
10589205
J Health Soc Behav. 1996 Sep;37(3):238-51
8898495
JAMA. 1994 Feb 2;271(5):358-62
8283585
Gerontologist. 2002 Aug;42(4):475-87
12145375
Health Aff (Millwood). 2001 Nov-Dec;20(6):128-44
11816652
J Health Polit Policy Law. 1997 Jun;22(3):839-78
9185020
Gerontologist. 2004 Feb;44(1):13-23
14978317
Med Care. 2002 Oct;40(10):868-78
12395021
J Am Geriatr Soc. 1997 Aug;45(8):1002-10
9256855
J Health Polit Policy Law. 2004 Feb;29(1):43-73
15027837
Med Care. 2007 Aug;45(8):739-45
17667307
Health Serv Res. 2009 Jun;44(3):1088-109
19674434
J Am Geriatr Soc. 1995 Nov;43(11):1237-42
7594157
J Health Econ. 1985 Sep;4(3):237-59
10300554
J Am Med Dir Assoc. 2006 Oct;7(8):486-92
17027625
Health Serv Res. 2005 Aug;40(4):1040-55
16033491
Milbank Q. 2007 Dec;85(4):579-610
18070331