FYI, Eric
________________________________
From: Frank Goldsmith <crinum@xxxxxxxx>
Sent: Thursday, March 4, 2021 11:09 AM
To: Frank Goldsmith <crinum@xxxxxxxx>
Subject: Private equity ownership is killing people at nursing homes
Extremely important legislation
Should be enacted in States also
Frank. SBHSC
Begin forwarded message:
From: singlepayer-editor <editor@xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx>
Date: March 4, 2021 at 11:03:19 AM EST
To: singlepayernews@xxxxxxxxxxxxxxxxxx
Subject: [Singlepayernews] Private equity ownership is killing people at
nursing homes
Investor-owned, for-profit health care facilities—hospitals, nursing homes,
dialysis centers--cause unnecessary suffering and death. The point is made
well by Dylan Scott in the article below where he reports on the findings of a
recent study by the National Bureau of Economic Research.
Representative Pramila Jayapal is preparing to re-introduce her national single
payer legislation, Improved Medicare for All, in the new congress. Please
write or call her, to encourage her to include in the legislation, a ban on
investor-owned, for-profit facilities and conversion of them to maintain these
resources for health care. She can be reached at 2346 Rayburn House Office
Building, Washington. DC 20515, @RepJayapal, Phone: 202-225-3106, or email her
at
https://jayapal.house.gov/contact/<https://na01.safelinks.protection.outlook.com/?url=https%3A%2F%2Fjayapal.house.gov%2Fcontact%2F&data=04%7C01%7C%7C7e89f9c0c80649edbae508d8df27f813%7C84df9e7fe9f640afb435aaaaaaaaaaaa%7C1%7C0%7C637504710039409677%7CUnknown%7CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D%7C1000&sdata=j2EZEDP3EPzERrcPLNIC%2BNMBm%2Fd6l0D6UcEMg0eVVDI%3D&reserved=0>
Private equity ownership is killing people at nursing homes
A new study describes the human toll of private equity firms buying up nursing
homes.
By Dylan
Scott<https://na01.safelinks.protection.outlook.com/?url=https%3A%2F%2Fwww.vox.com%2Fauthors%2Fdylan-scott&data=04%7C01%7C%7C7e89f9c0c80649edbae508d8df27f813%7C84df9e7fe9f640afb435aaaaaaaaaaaa%7C1%7C0%7C637504710039419674%7CUnknown%7CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D%7C1000&sdata=DLvB6Pt7WYc2C4gmn%2BRBbO7dphGDJe7gSSDiJ0qubE8%3D&reserved=0>@dylanlscott<https://na01.safelinks.protection.outlook.com/?url=https%3A%2F%2Fwww.twitter.com%2Fdylanlscott&data=04%7C01%7C%7C7e89f9c0c80649edbae508d8df27f813%7C84df9e7fe9f640afb435aaaaaaaaaaaa%7C1%7C0%7C637504710039419674%7CUnknown%7CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D%7C1000&sdata=g%2F%2BOYjaxiAgyuOG2Dg8Tf29GWTRp61%2BCLCHsHfnAvRA%3D&reserved=0>dylan.scott@xxxxxxx<mailto:dylan.scott@xxxxxxx>
Feb 22, 2021
When private equity
firms<https://na01.safelinks.protection.outlook.com/?url=https%3A%2F%2Fwww.vox.com%2Fthe-goods%2F2020%2F1%2F6%2F21024740%2Fprivate-equity-taylor-swift-toys-r-us-elizabeth-warren&data=04%7C01%7C%7C7e89f9c0c80649edbae508d8df27f813%7C84df9e7fe9f640afb435aaaaaaaaaaaa%7C1%7C0%7C637504710039429667%7CUnknown%7CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D%7C1000&sdata=joTI341bYwNFNvx8WmlehDtnIcO2lUXlJiC%2FCBVmKAA%3D&reserved=0>
acquire nursing homes, patients start to die more often, according to a new
working
paper<https://na01.safelinks.protection.outlook.com/?url=https%3A%2F%2Fwww.nber.org%2Fsystem%2Ffiles%2Fworking_papers%2Fw28474%2Fw28474.pdf&data=04%7C01%7C%7C7e89f9c0c80649edbae508d8df27f813%7C84df9e7fe9f640afb435aaaaaaaaaaaa%7C1%7C0%7C637504710039429667%7CUnknown%7CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D%7C1000&sdata=RtxHcg%2FfKfTgEBY9X6enkjLN124rlmWTxYe6scxeyxg%3D&reserved=0>
published by the National Bureau of Economic Research.
Private equity acquisitions of nursing homes is a pressing topic: Total private
equity investment in nursing homes exploded, going from $5 billion in 2000 to
more than $100 billion in 2018. Many nursing homes have long been run on a
for-profit basis. But private equity firms, which generally take on debt to buy
a company and then put that debt on the newly acquired company’s books, have
purchased a mix of large chains and independent facilities — making it easier
to isolate the specific effect of private equity acquisitions, rather than just
a profit motive, on patient welfare.
Researchers from Penn, NYU, and the University of Chicago studied Medicare data
that covers more than 18,000 nursing home facilities, about 1,700 of which were
bought by private equity from 2000 to 2017.
Their findings are sobering.
The researchers studied patients who stayed at a skilled nursing facility after
an acute episode at a hospital, looking at deaths that fell within the 90-day
period after they left the nursing home. They found that going to a private
equity-owned nursing home increased mortality for patients by 10 percent
against the overall average.
Or to put it another way: “This estimate implies about 20,150 Medicare lives
lost due to [private equity] ownership of nursing homes during our sample
period” of 12 years, the authors — Atul Gupta, Sabrina Howell, Constantine
Yannelis, and Abhinav Gupta — wrote. That’s more than 1,000 deaths every year,
on average.
What accounts for such a significant loss of life when private equity takes
over a nursing home? The researchers advance a few possible explanations.
For one, they note, the increased mortality is concentrated among patients who
are relatively healthier. As counterintuitive as that may sound, there may be a
good reason for it: Sicker patients have more regimented treatment that will be
adhered to no matter who owns the facility, whereas healthier people may be
more susceptible by the changes made under private equity ownership.
Those changes include a reduction in staffing, which prior research has found
is the most important factor in quality of care. Overall staffing shrinks by
1.4 percent, the study found, but more directly, private equity acquisitions
lead to cuts in the number of hours that front-line nurses spend per day
providing basic services to patients. Those services, such as bed turning or
infection prevention, aren’t medically intensive, but they can be critical to
health outcomes.
“The loss of front-line staff is most problematic for older but relatively less
sick patients, who drive the mortality result,” the authors wrote.
The study also detected a 50 percent increase in the use of antipsychotic drugs
for nursing home patients under private equity, which may be intended to offset
the loss in nursing hours. But that introduces its own problems for patients,
because antipsychotics are known to be associated with higher mortality in
elderly people.
The combination of fewer nurses and more antipsychotic drugs could explain a
significant portion of the disconcerting mortality effect measured by the
study. Private equity firms were also found to spend more money on things not
related to patient care in order to make money — such as monitoring fees to
medical alert companies owned by the same firm — which drains still more
resources away from patients.
“These results, along with the decline in nurse availability, suggest a
systematic shift in operating costs away from patient care,” the authors
concluded.
The researchers make a point in their opening to stipulate that private equity
may prove successful in other industries. But, they warn, it may be dangerous
in health care, where the profit motive of private firms and the welfare of
patients may not be aligned:
For example, patients cannot accurately assess provider quality, they typically
do not pay for services directly, and a web of government agencies act as both
payers and regulators. These features weaken the natural ability of a market to
align firm incentives with consumer welfare and could mean that high-powered
incentives to maximize profits have detrimental implications for consumer
welfare.
This finding is likely to draw a lot of attention, as David Grabowski, a
Harvard Medical School professor who studies long-term care, told me. (He said
he found the result to be plausible, though he would need more time to unpack
the research data in full.) Private equity has already faced
scrutiny<https://na01.safelinks.protection.outlook.com/?url=https%3A%2F%2Fwww.nytimes.com%2F2019%2F09%2F13%2Fupshot%2Fsurprise-billing-laws-ad-spending-doctor-patient-unity.html&data=04%7C01%7C%7C7e89f9c0c80649edbae508d8df27f813%7C84df9e7fe9f640afb435aaaaaaaaaaaa%7C1%7C0%7C637504710039439662%7CUnknown%7CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D%7C1000&sdata=ey7whpbGmsK%2FtOTNuSPDcsenK7SM72kBlzUAUGk10UE%3D&reserved=0>
for surprise medical billing and acquisitions of physician practices.
This study of nursing homes lays down a marker in the research literature:
private equity leads to worse care. For patients, it’s a matter of life and
death.
https://www.vox.com/policy-and-politics/22295461/nursing-home-deaths-private-equity-firms<https://na01.safelinks.protection.outlook.com/?url=https%3A%2F%2Fwww.vox.com%2Fpolicy-and-politics%2F22295461%2Fnursing-home-deaths-private-equity-firms&data=04%7C01%7C%7C7e89f9c0c80649edbae508d8df27f813%7C84df9e7fe9f640afb435aaaaaaaaaaaa%7C1%7C0%7C637504710039439662%7CUnknown%7CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D%7C1000&sdata=TP%2F45%2F8nq%2F8QY%2FzqsQQy%2BgYf6hNCc%2FNVZwhL8BI2Mow%3D&reserved=0>
_______________
Distributed by:
Kay Tillow, Coordinator
All Unions Committee for Single Payer Health
Care<https://na01.safelinks.protection.outlook.com/?url=http%3A%2F%2Funionsforsinglepayer.org%2F&data=04%7C01%7C%7C7e89f9c0c80649edbae508d8df27f813%7C84df9e7fe9f640afb435aaaaaaaaaaaa%7C1%7C0%7C637504710039449661%7CUnknown%7CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D%7C1000&sdata=V2BprVRWdrBaYg%2FoHMUUImNULXfvPKnes0q23wvYxaM%3D&reserved=0>
P. O. Box 17595
Louisville, KY 40217
(502) 636 1551
Email: <http://mce_host/roundcube/nursenpo@xxxxxxx>
nursenpo@xxxxxxx<mailto:nursenpo@xxxxxxx>
http://unionsforsinglepayer.org<https://na01.safelinks.protection.outlook.com/?url=http%3A%2F%2Funionsforsinglepayer.org%2F&data=04%7C01%7C%7C7e89f9c0c80649edbae508d8df27f813%7C84df9e7fe9f640afb435aaaaaaaaaaaa%7C1%7C0%7C637504710039449661%7CUnknown%7CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D%7C1000&sdata=V2BprVRWdrBaYg%2FoHMUUImNULXfvPKnes0q23wvYxaM%3D&reserved=0>
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March 4, 2021
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