A recent report from the Government Accountability Office (GAO) attempting to examine the quality of care provided at some private investment nursing homes was basically meaningless say those in the industry.
“This report really didn’t say anything,” said Cheryl Phillips, MD, senior vice president for advocacy at LeadingAge, an advocacy association for seniors. “First of all, it’s looking specifically at private investment homes, so this is not the entire for-profit industry. It is not the chains. It’s not even the publicly traded. I think an amusing summary that I had heard . . . (said about) this report is if you took a sector of a part of a business and said that some providers in part of the sector had some differences but we couldn’t tell if it meant anything.”
As private investment firms began buying up large nursing home chains, concerns about the quality of care provided at these facilities bubbled up in the media and government. Congress asked the GAO to examine the impact of private investment ownership on the quality of care provided and on the financial performance of these nursing homes.
The GAO did look at other for-profit homes, including publicly traded and chains, said Chuck Young, the GAO's managing director in the Office of Public Affairs. And the study found that while there are differences between private investment nursing homes and other for-profit and non-profit nursing homes, the differences were not significant.
To the issue of quality of care, the GAO report found that private investment ownership did not increase the likelihood of poor quality care. In fact, registered nursing staffing was greater at private investment homes in 2009 than in other types of homes, Young noted.
[See also: Nonprofit nursing homes provide better care.]
“Right now, there is a huge distrust and dislike, particularly of the large for-profit nursing homes,” said Phillips. “A belief that there is a gouging of the system. That they’re overpaid for what they do. So I am sure that GAO was trying to, in a very logical and appropriate and analytical way, to try to take one sector of that for-profit side and see if there was a difference. The problem is it was too limited in its sphere – it just looked at the private investment homes and it looked at some survey outcomes but couldn’t really make any conclusions about measuring quality.”
The real key question behind the GAO report, said Phillips, is whether or not there is a difference between not-for-profit and for-profit nursing homes on the issues of quality, service and access. Many believe there are differences, she said, but the tools being used to measure those differences may not be effective enough to get meaningful answers.
For the report, the GAO used data from the Centers for Medicare & Medicaid Services’ Online Survey, Certification, and Reporting System (OSCAR). Using a survey tool such as OSCAR may not be the right instrument to get at what the core differences are, Phillips said, because of differences within the data. Ratings about the severity of injury, for instance, are not uniform across states.
“So when you take that relatively broad segment instrument, the survey, and then you try to make comparisons about some of the sectors of the industry in some settings you come out with this watered down report that really didn’t tell us anything," she said.
The GAO report acknowledged some data limitations, said Young, "but its analyses controlled for state differences as well as other explanatory factors such as chain, facility size, occupancy and payer mix."
Follow HFN associate editor Stephanie Bouchard on Twitter @SBouchardHFN.