High Medicaid Nursing Homes

Organizational and Market Factors Associated With Financial Performance

Bibliographic Data

ID13775546
AuthorsRobert Weech-Maldonado (0000-0002-5005-0909, The University of Alabama at Birmingham, USA, corresponding author), Justin Lord (0000-0002-4557-955X, Louisiana State University Shreveport, USA), Rohit Pradhan (0009-0006-3762-7212, University of Arkansas for Medical Sciences, Little Rock, USA), Ganisher Davlyatov (0000-0001-9410-9696, The University of Alabama at Birmingham, USA), Neeraj Dayama (0000-0002-4273-9415, University of Arkansas for Medical Sciences, Little Rock, USA), Shivani Gupta (0000-0003-3690-8902, The University of Southern Mississippi, Hattiesburg, USA), Larry R Hearld (0000-0002-2304-0246, University of Alabama at Birmingham), Larry Hearld (The University of Alabama at Birmingham, USA)
Year2019
Volume56
Pages46958018825061-46958018825061
Publication date2019-01-01
Peer ReviewedYes
Open AccessYes
TypeARTICLE
VenueINQUIRY The Journal of Health Care Organization Provision and Financing (JOURNAL)
Journal identifiersISSN: 0046-9580 • E-ISSN: 1945-7243
PublisherSAGE Publishing (PUBLISHER • US)
DOI10.1177/0046958018825061
PMID30739512
OpenAlexW2914555328
LanguageEN
Citations received5
References cited37

High Medicaid nursing homes (85% and higher of Medicaid residents) operate in resource-constrained environments. High Medicaid nursing homes (on average) have lower quality and poorer financial performance. However, there is significant variation in performance among high Medicaid nursing homes. The purpose of this study is to examine the organizational and market factors that may be associated with better financial performance among high Medicaid nursing homes. Data sources included Long-Term Care Focus (LTCFocus), Centers for Medicare and Medicaid Services' (CMS) Medicare Cost Reports, CMS Nursing Home Compare, and the Area Health Resource File (AHRF) for 2009-2015. There were approximately 1108 facilities with high Medicaid per year. The dependent variables are nursing homes operating and total margin. The independent variables included size, chain affiliation, occupancy rate, percent Medicare, market competition, and county socioeconomic status. Control variables included staffing variables, resident quality, for-profit status, acuity index, percent minorities in the facility, percent Medicaid residents, metropolitan area, and Medicare Advantage penetration. Data were analyzed using generalized estimating equations with state and year fixed effects. Results suggest that organizational and market slack resources are associated with performance differentials among high Medicaid nursing homes. Higher financial performing facilities are characterized as having nurse practitioners/physician assistants, more beds, higher occupancy rate, higher Medicare and Medicaid census, and being for-profit and located in less competitive markets. Higher levels of Registered Nurse (RN) skill mix result in lower financial performance in high Medicaid nursing homes. Policy and managerial implications of the study are discussed

Business · Economic growth · Economics · Family medicine · Health care · Medicaid · Metropolitan area · Nursing homes · Frailty in Older Adults · Geriatric Care and Nursing Homes · Health disparities and outcomes · Medicine · Nursing

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