Study: Is Nursing Home Quality Affected by Corporate Structure?

The Department of Health and Human Services intends to negotiate a contract with Harvard University located in Cambridge, MA on a sole source basis for the Assistant Secretary for Planning and Evaluation (ASPE)/Office of the Secretary for a study entitled - Is Nursing Home Quality Affected by Corporate Structure? The acquisition is for a one year period. Purpose - Many people believe that facilities owned by private equity firms have poorer quality of care than other ownership arrangements. An article in the New York Times stating this belief triggered hearings by both the House and the Senate in the fall of 2007 and again in the spring of 2008. While this is a common belief, no careful research has been undertaken to systematically address this important policy question. Background - A major concern with restructuring or buy-outs by private equity firms is that private equity firms operate free of oversight and public accountability. Information that a facility is owned by a private equity firm or any third-party ownership is not reported on Medicare's Nursing Home Compare website, for example. As more national chains move toward divestiture and corporate restructuring, consumer groups and labor unions have voiced concerns that private equity ownership of nursing home chains and corporate holding of physical assets by REIT groups result in poorer quality of care. No effort has examined the corporate structure to see if there is a difference among private equity ownership (e.g., - Wall Street investors vs. pension groups) or if non-profit facilities have third-party relationships that are similar to private equity ownership that may also impact on quality. CMS Provider Enrollment Chain Ownership System (PECOS) is intended to capture detailed ownership information whenever a nursing home changes ownership. However, two problems exist with the PECOS data. First, the data is incomplete according to CMS officials, and second, the data collected may not capture all individuals with ownership less than 5 percent, the management contracts, real estate divestitures and other corporate restructuring that nursing home chains have implemented. The State of Texas has been collecting detailed information on ownership, down to the individual investor level, starting in 2000. This means that individual persons or corporations that have any ownership stake in the facility are identified. The Texas Ownership Management and Tracking (OMT) system includes detailed information on ownership to the individual investor level and also collects information on management contracts. We think that the level of data in the Texas data is essential and, in conjunction with federal survey data and federal quality indicator data, could sharpen our understanding of the relationship between ownership and quality. Summary of Approach - The study will be secondary data analysis of nursing homes with varying corporate structures using the Online Survey, Certification and Reporting (OSCAR) data, quality measure results based on the minimum data set (MDS), and Texas's Ownership Management and Tracking System (OMT) to more closely examine changing nursing home corporate restructuring and its relationship to quality of care in Texas nursing homes. The OMT system includes detailed information on ownership to the individual investor level and also collects information on management contracts. It is fully developed, while PECOS is not. The nursing homes in Texas are not necessarily representative of nursing homes nationally. However, this project absolutely requires detailed ownership data that are not available for nursing homes nationally. Texas OMT data will identify the change in ownership over time, from 2000 to 2007, or the latest year that data are available, and will describe corporate structures found. Information on deficiencies and staffing levels from the OSCAR database will be matched to corporate structure data in order to analyze the effect of corporate structure on quality for nursing homes in Texas. Policy Research Questions - This project will address policy research questions including, but not limited to, the following: - What are the corporate structures of nursing homes in Texas and how have they changed over time? What relationships exist between the business entities holding the nursing home license and any third-party ownership, such as private equity firms? How do corporate structures differ by for-profit and non-profit facilities? - How does corporate structure, third-party ownership (such as private equity firm), multi-facility status, profit status and other facility characteristics affect quality and staffing? ASPE intends to produce one comprehensive report during this one-year project. The report will discuss the types of corporate structures, the current ownership by private investment firms, the change of ownership over time, and the impact of corporate structure on quality as measured by deficiencies, quality measures, and staffing. The contractor should be the familiar with the content and have access to OSCAR, quality measures data, and the Texas OMT data. The contractor shall present a discussion of the generalization of using data from only nursing homes in Texas, including the usefulness of the study given these limitations. This study will look at the effect of corporate structure on quality and staffing in nursing homes. However, other factors also affect quality. The contractor shall be familiar with the trends in nursing home quality and the factors that affect quality, and shall present how these other factors will be controlled in this study. Harvard University has sole access to this proprietary database. Detailed ownership data are essential to this project. Texas collects the person or corporation who has any portion of ownership in the business of providing nursing homes services in the state. In addition the data identifies partnerships and contractual arrangements for services. The premise of this project is to determine the effect of different ownership and corporate structure on quality of care in nursing homes. Without complete ownership information, we would not be able to identify corporate structure and the effect on quality. Only Harvard currently has access to the data. The statutory authority for other than full and open competition is 41 U.S.C. 253(c)(1), in accordance with FAR Part 6.302-3, only one responsible source and no other supplies or services will satisfy agency requirements. Vendors who are interested in this acquisition must demonstrate in writing that they can meet the Government's requirement by August 6, 2008. Responses must include a written narrative statement of capability, including detailed technical information and other technical literature demonstrating the ability to satisfy the stated requirements. Failure to submit adequate documentation will result in the Government proceeding with a sole source award to Harvard University. A determination by the Government not to open the requirement based upon responses to this notice is solely within the discretion of the Government. No solicitation document is available. The purpose of this announcement is to determine whether there may be other sources with the requisite qualifications to perform the work described above.