Comparative Performance of Private Equity–Owned US Nursing Homes During the COVID-19 Pandemic

Braun, Robert; Yun, Hyunkyung; Casalino, Lawrence P.; Myslinski, Zachary; Kuwonza, Farai M.; Jung, Hye Young; Unruh, Mark Aaron

doi:10.1001/jamanetworkopen.2020.26702

Cited by 57 publications

(94 citation statements)

References 31 publications

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“…Most studies were situated in the United States (US) (Abrams et al, 2020;Bowblis & Applebaum, 2020;Braun et al, 2020;Bui et al, 2020;Chatterjee et al, 2020;Dean et al, 2020;Gorges & Konetzka, 2020;Harrington et al, 2020;He et al, 2020;Li et al, 2020a;Li et al, 2020c;Sugg et al, 2020;Unruh et al, 2020;Xu et al, 2020). Some studies looked at outcomes data from specific states such as California (Harrington et al, 2020;He et al, 2020) and West Virginia (Bui et al, 2020).…”

Section: Resultsmentioning

confidence: 99%

“…Some studies looked at outcomes data from specific states such as California (Harrington et al, 2020;He et al, 2020) and West Virginia (Bui et al, 2020). The US-based studies show a great overlap with the data sources they used -including sources from the Centers for Medicare & Medicaid Services (CMS), LTCFocus, and the Certification and Survey Provider Enhanced Reporting (CASPER) system (Abrams et al, 2020;Bowblis & Applebaum, 2020;Braun et al, 2020;Dean et al, 2020;He et al, 2020;Gorges & Konetzka, 2020;Li et al, 2020c;Li et al, 2020a;Sugg et al, 2020;Unruh et al, 2020;Xu et al, 2020). Three studies were from Canada Fisman et al, 2020;Stall et al, 2020), all focused on the province of Ontario (Stall et al, 2020;Fisman et al, 2020).…”

Section: Resultsmentioning

confidence: 99%

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Relationship between the Ownership Status of Nursing Homes and Their Outcomes During the COVID-19 Pandemic: A Rapid Literature Review

Kruse¹,

Mah²,

Metsemakers³

et al. 2021

Journal of Long Term Care

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BackgroundThe coronavirus disease 2019 (COVID-19) pandemic has exposed several cracks in our healthcare, social care and long-term care systems. The nursing home sector, in particular, has been disproportionally affected by the COVID-19 virus (Comas-Herrera & Zalakain, 2020). In a study of 22 countries, an alarming 41% of their COVID-19 related deaths occurred in nursing homes, while only, on average, 0.7% of the total population live in nursing homes (Comas-Herrera et al., 2021). Nursing home residents are typically frail older adults often characterised as living with multiple chronic diseases and functional impairments, making them more susceptible to severe complications and mortality as a result of a COVID-19 infection (Barnett &

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Relationship between the Ownership Status of Nursing Homes and Their Outcomes During the COVID-19 Pandemic: A Rapid Literature Review

Kruse¹,

Mah²,

Metsemakers³

et al. 2021

Journal of Long Term Care

View full text Add to dashboard Cite

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“…Ten studies compared FPs and NPs (11/28), in which NPs included both private NPs and public providers, although this was not always explicitly described. Two studies focused on private equity (PE) providers in their categorisation of ownership 31,32 . Eighteen studies also included chain affiliated (CA) providers as a separate covariate to investigate COVID-19 related outcomes.…”

Section: Description Of Studiesmentioning

confidence: 99%

“…Importantly, FPs were more likely to report PPE shortages 29,31,45 , which was interpreted by some to mean that this provider type was less willing to challenge the financial bottom-line by making additional investments, even during a pandemic 13,29 . Yet private equity did not report PPE shortages 31,32 , raising questions about whether the profit motive is the main driving factor. FP providers were more likely to be affiliated with corporate chains, which was reported by some to mediate the effect of FP status on COVID-19 outcomes.…”

Section: Indirect Ownership Effectsmentioning

confidence: 99%

Ownership and COVID-19 in care homes for older people: A living systematic review of outbreaks, infections, and mortalities

Bach-Mortensen

Verboom

Esposti

2021

Preprint

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BackgroundThe adult social care sector is being increasingly outsourced to for-profit providers, but the impacts of privatisation on service quality and resident outcomes are unclear. During the COVID-19 pandemic, for-profit providers have been accused of failing their residents by prioritising profits over care, prevention, and caution, which has been reported to result in a higher prevalence of COVID-19 infections and deaths in for-profit care homes. Although many of these reports are anecdotal or based on news reports, there is a growing body of academic research investigating ownership variation across COVID-19 outcomes, which has not been systematically appraised and synthesised.ObjectivesTo identify, appraise, and synthesise the available research on ownership variation in COVID-19 outcomes (outbreaks, infections, deaths, shortage of personal protective equipment (PPE) and staff) across for-profit, public, and non-profit care homes for older people, and to update our findings as new research becomes available.DesignLiving systematic review.MethodsThis review was prospectively registered with Prospero (CRD42020218673). We searched 17 databases and performed forward and backward citation tracking of all included studies. Search results were screened and reviewed in duplicate. Risk of bias (RoB) was assessed in duplicate according to the COSMOS-E guidance. The results were synthesised according to RoB, model adjustment, and country context and visualised using harvest plots.ResultsTwenty-eight studies across five countries were included, with 75% of included studies conducted in the Unites States. For-profit ownership was not consistently associated with a higher probability of COVID-19 outbreaks across included studies. However, there was compelling evidence of worse COVID-19 outcomes following an outbreak; with for-profit care homes having higher rates of accumulative infections and deaths. For-profit providers were also associated with shortages in PPE, which may have contributed to the higher incidence of infections and deaths.Chain affiliation was often found to be correlated with higher risk of outbreaks, but not consistently associated with an elevated number of deaths and infections. Private equity ownership was not consistently associated with worse COVID-19 outcomes.ConclusionFor-profit status was a consistent risk factor for higher cumulative COVID-19 infections and deaths. Thus, ownership among providers may be a key modifiable factor which can be regulated to improve health outcomes in vulnerable populations and reduce health disparities. This review will be updated as new research becomes published, which may change the conclusion of our synthesis.

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“…10 Despite the growing recognition of private equity involvement in health care, 3,[11][12][13] there has been little systematic examination of its scope, impact on access and spending, and unintended consequences. Furthermore, the bulk of the extant literature has been limited to nursing homes 9,14,15 and physician practices. [10][11][12][13]16 Recently, Joseph Bruch and colleagues published the first examination of changes in process measures and aggregated clinical outcomes for private equity-acquired short-term acute care hospitals.…”

mentioning

confidence: 99%

Private Equity Investments In Health Care: An Overview Of Hospital And Health System Leveraged Buyouts, 2003–17

et al. 2021

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Private equity firms have increased their participation in the US health care system, raising questions about incentive alignment and downstream effects on patients. However, there is a lack of systematic characterization of private equity acquisition of short-term acute care hospitals. We present an overview of the scope of private equity-backed hospital acquisitions over the course of 2003-17, comparing the financial and operational differences between those hospitals and hospitals that remained unacquired through 2017. A total of 42 private equity deals occurred, involving 282 unique hospitals across 36 states. In unadjusted analyses, hospitals that were acquired had larger bed sizes, more discharges, and more full-time-equivalent staff positions in 2003 relative to nonacquired hospitals; private equity-acquired hospitals also had higher charge-to-cost ratios and higher operating margins, and this gap widened during our study period. These findings motivate evaluations by policy makers and researchers on the impact, if any, of private equity acquisition on health care access, spending, and risk-adjusted outcomes.

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Comparative Performance of Private Equity–Owned US Nursing Homes During the COVID-19 Pandemic

Cited by 57 publications

References 31 publications

Relationship between the Ownership Status of Nursing Homes and Their Outcomes During the COVID-19 Pandemic: A Rapid Literature Review

Relationship between the Ownership Status of Nursing Homes and Their Outcomes During the COVID-19 Pandemic: A Rapid Literature Review

Ownership and COVID-19 in care homes for older people: A living systematic review of outbreaks, infections, and mortalities

Private Equity Investments In Health Care: An Overview Of Hospital And Health System Leveraged Buyouts, 2003–17

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