title: State regulatory enforcement and nursing home termination from the medicare and medicaid programs.
abstract: 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.
authors.affiliation: 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
authors.forename: Yue
authors.initials: Y
authors.lastname: Li
authors.forename: Charlene
authors.initials: C
authors.lastname: Harrington
authors.forename: William D
authors.initials: WD
authors.lastname: Spector
authors.forename: Dana B
authors.initials: DB
authors.lastname: Mukamel
mesh_terms: D006271:Health Facility Closure / Q000331:legislation & jurisprudence* / Q000592:standards; D035846:Law Enforcement; D008484:Medicaid; D006278:Medicare; D009735:Nursing Homes; D014481:United States
references.citation: Inquiry. 2003 Spring;40(1):94-104
references.pmid: 12836911
references.citation: Med Care Res Rev. 2005 Feb;62(1):111-32
references.pmid: 15643031
references.citation: J Health Econ. 1996 Feb;15(1):23-48
references.pmid: 10157427
references.citation: J Health Econ. 2003 Jan;22(1):1-22
references.pmid: 12564715
references.citation: Health Serv Res. 2007 Jun;42(3 Pt 1):1105-29
references.pmid: 17489906
references.citation: Arch Intern Med. 2005 Jun 13;165(11):1280-5
references.pmid: 15956008
references.citation: Soc Sci Med. 2009 Mar;68(5):933-40
references.pmid: 19128865
references.citation: Inquiry. 2002 Spring;39(1):56-66
references.pmid: 12067076
references.citation: Gerontologist. 2003 Apr;43 Spec No 2:67-75
references.pmid: 12711726
references.citation: Med Care. 2009 Oct;47(10):1039-45
references.pmid: 19648834
references.citation: Med Care Res Rev. 2008 Aug;65(4):514-27
references.pmid: 18369236
references.citation: Am J Public Health. 1995 Jun;85(6):771-6
references.pmid: 7762708
references.citation: Arch Intern Med. 2004 Jul 26;164(14):1508-12
references.pmid: 15277280
references.citation: Health Aff (Millwood). 2009 Jan-Feb;28(1):246-61
references.pmid: 19124877
references.citation: Med Care Res Rev. 1999 Dec;56(4):471-94
references.pmid: 10589205
references.citation: J Health Soc Behav. 1996 Sep;37(3):238-51
references.pmid: 8898495
references.citation: JAMA. 1994 Feb 2;271(5):358-62
references.pmid: 8283585
references.citation: Gerontologist. 2002 Aug;42(4):475-87
references.pmid: 12145375
references.citation: Health Aff (Millwood). 2001 Nov-Dec;20(6):128-44
references.pmid: 11816652
references.citation: J Health Polit Policy Law. 1997 Jun;22(3):839-78
references.pmid: 9185020
references.citation: Gerontologist. 2004 Feb;44(1):13-23
references.pmid: 14978317
references.citation: Med Care. 2002 Oct;40(10):868-78
references.pmid: 12395021
references.citation: J Am Geriatr Soc. 1997 Aug;45(8):1002-10
references.pmid: 9256855
references.citation: J Health Polit Policy Law. 2004 Feb;29(1):43-73
references.pmid: 15027837
references.citation: Med Care. 2007 Aug;45(8):739-45
references.pmid: 17667307
references.citation: Health Serv Res. 2009 Jun;44(3):1088-109
references.pmid: 19674434
references.citation: J Am Geriatr Soc. 1995 Nov;43(11):1237-42
references.pmid: 7594157
references.citation: J Health Econ. 1985 Sep;4(3):237-59
references.pmid: 10300554
references.citation: J Am Med Dir Assoc. 2006 Oct;7(8):486-92
references.pmid: 17027625
references.citation: Health Serv Res. 2005 Aug;40(4):1040-55
references.pmid: 16033491
references.citation: Milbank Q. 2007 Dec;85(4):579-610
references.pmid: 18070331