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Competitive Spillovers and Regulatory Exploitation by Skilled Nursing Facilities

Listed author(s):
  • Bowblis John R.

    ()

    (Department of Economics, Miami University, 800. E. High Street, Oxford, OH 45056, USA)

  • Brunt Christopher S.

    (Department of Finance & Economics, Georgia Southern University, PO Box 8152, Statesboro, GA 30460, USA)

  • Grabowski David C.

    (Department of Health Care Policy, Harvard Medical School, 180 Longwood Avenue, Boston, MA 02115, USA)

Registered author(s):

    Typically, research on the effect of ownership has considered health care providers in isolation of competitive interaction from other firms. This analysis considers how the selection of Medicare reimbursement codes for skilled nursing facilities varies by ownership and is influenced by the competitive spillovers from market dominance of for-profit institutions. We find evidence that not-for-profits are less likely to code patients into the highest reimbursement categories. Further, as the market becomes dominated by for-profits, both for-profit and not-for-profits increase the share of patients in these high reimbursement categories.

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    File URL: https://www.degruyter.com/view/j/fhep.2016.19.issue-1/fhep-2014-0006/fhep-2014-0006.xml?format=INT
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    Article provided by De Gruyter in its journal Forum for Health Economics & Policy.

    Volume (Year): 19 (2016)
    Issue (Month): 1 (June)
    Pages: 45-70

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    Handle: RePEc:bpj:fhecpo:v:19:y:2016:i:1:p:45-70:n:1
    Contact details of provider: Web page: https://www.degruyter.com

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    References listed on IDEAS
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    1. Chalkley, Martin & Malcomson, James M., 1998. "Contracting for health services when patient demand does not reflect quality," Journal of Health Economics, Elsevier, vol. 17(1), pages 1-19, January.
    2. Leemore Dafny & David Dranove, 2009. "Regulatory Exploitation and Management Changes: Upcoding in the Hospital Industry," Journal of Law and Economics, University of Chicago Press, vol. 52(2), pages 223-250, 05.
    3. Horwitz, Jill R. & Nichols, Austin, 2009. "Hospital ownership and medical services: Market mix, spillover effects, and nonprofit objectives," Journal of Health Economics, Elsevier, vol. 28(5), pages 924-937, September.
    4. Glaeser, Edward L. & Shleifer, Andrei, 2001. "Not-for-profit entrepreneurs," Journal of Public Economics, Elsevier, vol. 81(1), pages 99-115, July.
    5. John R. Bowblis & Christopher S. Brunt, 2014. "Medicare Skilled Nursing Facility Reimbursement And Upcoding," Health Economics, John Wiley & Sons, Ltd., vol. 23(7), pages 821-840, 07.
    6. Christopher S. Brunt, 2011. "CPT fee differentials and visit upcoding under Medicare Part B," Health Economics, John Wiley & Sons, Ltd., vol. 20(7), pages 831-841, July.
    7. repec:hrv:faseco:33078971 is not listed on IDEAS
    8. Sloan, Frank A. & Picone, Gabriel A. & TaylorJr., Donald H. & Chou, Shin-Yi, 2001. "Hospital ownership and cost and quality of care: is there a dime's worth of difference?," Journal of Health Economics, Elsevier, vol. 20(1), pages 1-21, January.
    9. Leemore S. Dafny, 2005. "How Do Hospitals Respond to Price Changes?," American Economic Review, American Economic Association, vol. 95(5), pages 1525-1547, December.
    10. Gowrisankaran, Gautam & Town, Robert J., 1999. "Estimating the quality of care in hospitals using instrumental variables," Journal of Health Economics, Elsevier, vol. 18(6), pages 747-767, December.
    11. John R. Bowblis, 2011. "Ownership conversion and closure in the nursing home industry," Health Economics, John Wiley & Sons, Ltd., vol. 20(6), pages 631-644, June.
    12. Nyman, John A, 1994. "The Effects of Market Concentration and Excess Demand on the Price of Nursing Home Care," Journal of Industrial Economics, Wiley Blackwell, vol. 42(2), pages 193-204, June.
    13. Silverman, Elaine & Skinner, Jonathan, 2004. "Medicare upcoding and hospital ownership," Journal of Health Economics, Elsevier, vol. 23(2), pages 369-389, March.
    14. Hirth, Richard A., 1999. "Consumer information and competition between nonprofit and for-profit nursing homes," Journal of Health Economics, Elsevier, vol. 18(2), pages 219-240, April.
    15. Jill R. Horwitz & Austin Nichols, 2011. "Rural Hospital Ownership: Medical Service Provision, Market Mix, and Spillover Effects," NBER Working Papers 16926, National Bureau of Economic Research, Inc.
    16. Grabowski, David C. & Feng, Zhanlian & Hirth, Richard & Rahman, Momotazur & Mor, Vincent, 2013. "Effect of nursing home ownership on the quality of post-acute care: An instrumental variables approach," Journal of Health Economics, Elsevier, vol. 32(1), pages 12-21.
    17. Grabowski, David C. & Hirth, Richard A., 2003. "Competitive spillovers across non-profit and for-profit nursing homes," Journal of Health Economics, Elsevier, vol. 22(1), pages 1-22, January.
    18. Grabowski, David C. & Afendulis, Christopher C. & McGuire, Thomas G., 2011. "Medicare prospective payment and the volume and intensity of skilled nursing facility services," Journal of Health Economics, Elsevier, vol. 30(4), pages 675-684, July.
    19. Joseph P. Newhouse, 1996. "Reimbursing Health Plans and Health Providers: Efficiency in Production versus Selection," Journal of Economic Literature, American Economic Association, vol. 34(3), pages 1236-1263, September.
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