257179 Does nursing home quality regulation lead to better quality?

Tuesday, October 30, 2012 : 4:42 PM - 4:54 PM

Dana B. Mukamel, PhD , Department of Medicine, Health Policy Research Institute, University of California, Irvine, Irvine, CA
David L. Weimer, PhD , LaFollette School of Public Affairs, University of Wisconsin - Madison, Madison, WI
Heather Ladd, MS , Health Policy Research Institute, University of California, Irvine, Irvine
Charlene Harrington, PhD , Social and Behavioral Sciences, University of California San Francisco, San Francisco, CA
William D. Spector, PhD , Agency for Healthcare Research & Quality, Rockville, MD
Yue Li, PhD , Department of Community and Preventive Medicine, University of Rochester Medical Center, Rochester, NY
Prior studies found that nursing homes located in states with more stringent regulations experience higher costs. This study investigates the complementary hypothesis that more stringent regulation is associated with better quality by examining all 15,511 Medicare and Medicaid certified nursing homes nationally using Medicare cost reports and the MDS. We estimated eight, two-stage least square regression models, in which the dependent variables were risk adjusted quality measures, nursing staffing level per case-mix-adjusted days (RNs, LPNs, and CNAs), and hotel expenditures. The independent variables included the Harrington Index of regulation stringency and controls for competition, market income, wage index, beds, ownership, and chain affiliation. To account for endogeneity of regulation and quality, the stringency index was instrumented by the Economic Freedom Index of North America, Area 2 - “Takings and Discriminatory Taxation.” The incremental F-statistic for the test of weak IV was 17.64, exceeding the critical value of 10, leading to the rejection of the weak IV hypothesis. The R2 of the estimated models ranged from a low of 0.01 for the risk-adjusted urinary incontinence model to a high of 0.55 for the hotel expenditures model. Risk-adjusted ADL decline and urinary incontinence, CNA, and LPN hours were significantly better in states with more stringent regulations. An increase of 1 standard deviation in stringency resulted in improvement ranging between 4.4% and 7.5% of the mean quality measures. This study quantifies the quality improvement associated with costs imposed by regulations.

Learning Areas:
Administration, management, leadership
Advocacy for health and health education
Biostatistics, economics
Public health or related laws, regulations, standards, or guidelines
Public health or related public policy
Public health or related research

Learning Objectives:
1. Identify the impact of state regulation on nursing home quality 2. Discuss the cost effectiveness of state regulation of nursing home quality 3. Assess the policy implications of nursing home quality

Keywords: Nursing Homes, Quality

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am a Professor at the University of California, Irvine and an expert in health services research and have conducted extensive research on nursing homes quality of care and end-of-life practices.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.