Effects of the CMS’ Public Reporting Program for Inpatient Psychiatric Facilities on Targeted and Nontargeted Safety: Differences Between For-Profits and Nonprofits

Abstract

The Centers for Medicare and Medicaid Services implemented the Inpatient Psychiatric Facility Quality Reporting Program in 2012, which publicly reports facilities’ performance on restraint and seclusion (R-S) measures. Using data from Massachusetts, we examined whether nonprofits and for-profits responded differently to the program on targeted indicators, and if the program had a differential spillover effect on nontargeted indicators of quality by ownership. Episodes of R-S (targeted), complaints (nontargeted), and discharges were obtained for 2008-2017 through public records requests to the Commonwealth of Massachusetts. Using difference-in-differences estimators, we found no differential changes in R-S between for-profits and nonprofits. However, for-profits had larger increases in overall complaints, safety-related complaints, abuse-related complaints, and R-S-related complaints compared with nonprofits. This is the first study to examine the effects of a national public reporting program among psychiatric facilities on nontargeted measures. Researchers and policymakers should further scrutinize intended and unintended consequences of performance-reporting programs.

Keywords

public reporting inpatient psychiatry restraint and seclusion safety ownership spillover

Get full access to this article

View all access options for this article.

References

Al-Maraira

O. A.

Hayajneh

F. A.

(2018). Use of restraint and seclusion in psychiatric settings: A literature review. Journal of Psychosocial Nursing and Mental Health Services, 57(4), 32-39. https://doi.org/10.3928/02793695-20181022-01

Allison

P. D.

Waterman

R. P.

(2002). Fixed-effects negative binomial regression models. Sociological Methodology, 32(1), 247-265. https://doi.org/10.1111/1467-9531.00117

Arrow

K. J.

(1984). The economics of agency. https://apps.dtic.mil/dtic/tr/fulltext/u2/a151436.pdf

Berwick

D. M.

James

Coye

M. J.

(2003). Connections between quality measurement and improvement. Medical Care, 41(1), I-30-I-38. https://doi.org/10.1097/00005650-200301001-00004

Bowers

Alexander

Bilgin

Botha

Dack

James

Jarrett

Jeffery

Nijman

Owiti

J. A.

Papadopoulas

Ross

Wright

Stewart

(2014). Safewards: The empirical basis of the model and a critical appraisal. Journal of Psychiatric and Mental Health Nursing, 21(4), 354-364. https://doi.org/10.1111/jpm.12085

Brown

O’Donnell

Casalino

L. P.

(2019). Private equity investment in behavioral health treatment centers. JAMA Psychiatry, 77(3), 229-230. https://doi.org/10.1001/jamapsychiatry.2019.3880

Busch

A. B.

Shore

M. F.

(2000). Seclusion and restraint: A review of recent literature. Harvard Review of Psychiatry, 8(5), 261-270. https://doi.org/10.3109/hrp.8.5.261

Carrillo

Nazir

Howser

Shenkman

Laxson

Scheuermann

T. S.

Richter

K. P.

(2017). Impact of the 2015 CMS inpatient psychiatric facility quality reporting rule on tobacco treatment. Nicotine & Tobacco Research, 19(8), 976-982. https://doi.org/10.1093/ntr/ntw386

Castle

N. G.

Ferguson

J. C.

(2010). What is nursing home quality and how is it measured? The Gerontologist, 50(4), 426-442. https://doi.org/10.1093/geront/gnq052

10.

CMS. (2013). Medicare program; hospital inpatient prospective payment systems for acute care hospitals and the long-term care hospital prospective payment system and Fiscal Year 2014 rates; quality reporting requirements for specific providers; hospital conditions of participation; payment policies related to patient status. Final rules. Federal Register, 78(160), 50495-51040.

11.

Contandriopoulos

Champagne

Denis

J.-L.

(2014). The multiple causal pathways between performance measures’ use and effects. Medical Care Research and Review, 71(1), 3-20. https://doi.org/10.1177/1077558713496320

12.

Cusack

F. P.

McAndrew

McKeown

Duxbury

(2018). An integrative review exploring the physical and psychological harm inherent in using restraint in mental health inpatient settings. International Journal of Mental Health Nursing, 27(3), 1162-1176. https://doi.org/10.1111/inm.12432

13.

Feng Lu

(2012). Multitasking, information disclosure, and product quality: Evidence from nursing homes. Journal of Economics & Management Strategy, 21(3), 673-705. https://doi.org/10.1111/j.1530-9134.2012.00341.x

14.

Frank

R. G.

McGuire

T. G.

(2000). Economics and mental health. In Culyer

A. J.

Newhouse

J. P.

(Eds.), Handbook of health economics (Vol. 1B, pp. 893-954). Elsevier. https://doi.org/10.1016/S1574-0064(00)80029-3

15.

Frueh

B. C.

Knapp

R. G.

Cusack

K. J.

Grubaugh

A. L.

Sauvageot

J. A.

Cousins

V. C.

Yim

Robins

C. S.

Monnier

Hiers

T. G.

(2005). Special section on seclusion and restraint: Patients’ reports of traumatic or harmful experiences within the psychiatric setting. Psychiatric Services, 56(9), 1123-1133. https://doi.org/10.1176/appi.ps.56.9.1123

16.

Gilburt

Rose

Slade

(2008). The importance of relationships in mental health care: A qualitative study of service users’ experiences of psychiatric hospital admission in the UK. BMC Health Services Research, 8(1), Article 92. https://bmchealthservres.biomedcentral.com/articles/10.1186/1472-6963-8-92

17.

Henry

Pylypchuk

Searcy

Patel

(2016). Adoption of electronic health record systems among U.S. non-federal acute care hospitals: 2008-2015 (ONC Data Brief No. 35). Office of the National Coordinator for Health Information Technology. https://dashboard.healthit.gov/evaluations/data-briefs/non-federal-acute-care-hospital-ehr-adoption-2008-2015.php

18.

Hibbard

J. H.

Stockard

Tusler

(2005). Hospital performance reports: impact on quality, market share, and reputation. Health Affairs, 24(4), 1150-1160. https://doi.org/10.1377/hlthaff.24.4.1150

19.

Holmstrom

Milgrom

(1991). Multitask principal–agent analyses: Incentive contracts, asset ownership, and job design. Journal of Law, Economics, & Organization, 7(January), 24-52. https://doi.org/10.1093/jleo/7.special_issue.24

20.

Huckshorn

K. A.

(2004). Reducing seclusion and restraint use in mental health settings: Core strategies for prevention. Journal of Psychosocial Nursing and Mental Health Services, 42(9), 22-33. https://doi.org/10.3928/02793695-20040901-05

21.

Kellis

D. S.

(2010). Healthcare reform and the hospital industry: What can we expect? Journal of Healthcare Management, 55(4), 283-297. https://doi.org/10.1097/00115514-201007000-00009

22.

Knox

D. K.

Holloman

G. H.

Jr. (2012). Use and avoidance of seclusion and restraint: Consensus statement of the American association for emergency psychiatry project Beta seclusion and restraint workgroup. Western Journal of Emergency Medicine, 13(1), 35-40.

23.

Kolstad

J. T.

(2013). Information and quality when motivation is intrinsic: Evidence from surgeon report cards. American Economic Review, 103(7), 2875-2910. https://doi.org/10.1257/aer.103.7.2875

24.

Konetzka

R. T.

Brauner

D. J.

Shega

Werner

R. M.

(2014). The effects of public reporting on physical restraints and antipsychotic use in nursing home residents with severe cognitive impairment. Journal of the American Geriatrics Society, 62(3), 454-461. https://doi.org/10.1111/jgs.12711

25.

McGregor

M. J.

Cohen

Stocks-Rankin

C.-R.

Cox

M. B.

Salomons

McGrail

K. M.

Spencer

Ronald

L. A.

Schulzer

(2011). Complaints in for-profit, non-profit and public nursing homes in two Canadian provinces. Open Medicine, 5(4), e183-e192. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3345377/

26.

Mohr

W. K.

Mahon

M. M.

Noone

M. J.

(1998). A restraint on restraints: The need to reconsider the use of restrictive interventions. Archives of Psychiatric Nursing, 12(2), 95-106. https://doi.org/10.1016/S0883-9417(98)80059-9

27.

Mohr

W. K.

Petti

T. A.

Mohr

B. D.

(2003). Adverse effects associated with physical restraint. Canadian Journal of Psychiatry, 48(5), 330-337. https://doi.org/10.1177/070674370304800509

28.

Muskett

(2014). Trauma-informed care in inpatient mental health settings: A review of the literature. International journal of Mental Health Nursing, 23(1), 51-59. https://doi.org/10.1111/inm.12012

29.

Nordstrom

Berlin

J. S.

Nash

S. S.

Shah

S. B.

Schmelzer

N. A.

Worley

L. L.

(2019). Boarding of mentally ill patients in emergency departments: American Psychiatric Association resource document. Western Journal of Emergency Medicine, 20(5), 690-695. https://doi.org/10.5811/westjem.2019.6.42422

30.

Ortiz

(2014). Examining patients’ perceptions of care to identify opportunities for quality improvement in psychiatric inpatient hospitals. Patient, 7(3), 301-312. https://doi.org/10.1007/s40271-014-0052-5

31.

Pauly

M. V.

(1988). Is medical care different? Old questions, new answers. Journal of Health Politics, Policy and Law, 13(2), 227-237. https://doi.org/10.1215/03616878-13-2-227

32.

Pham

H. H.

Coughlan

O’Malley

A. S.

(2006). The impact of quality-reporting programs on hospital operations. Health Affairs, 25(5), 1412-1422. https://doi.org/10.1377/hlthaff.25.5.1412

33.

Polacek

M. J.

Allen

P. D. E.

Damin-Moss

R. S.

Schwartz

A. J. A.

Sharp

Shattell

Souther

Delaney

K. R.

(2015). Engagement as an element of safe inpatient psychiatric environments. Journal of the American Psychiatric Nurses Association, 21(3), 181-190. https://doi.org/10.1177/1078390315593107

34.

Shields

M. C.

Busch

A. B.

(2020). The effect of centers for Medicare and Medicaid’s Inpatient Psychiatric Facility Quality Reporting Program on the use of restraint and seclusion. Medical Care, 58(10), 889-894. https://doi.org/10.1097/MLR.0000000000001393

35.

Shields

M. C.

Ritter

Busch

A.B.

(2020). Electronic health information exchange at discharge from inpatient psychiatric care in acute care hospitals. Health Affairs, 39(6), 958-967. https://doi.org/10.1377/hlthaff.2019.00985

36.

Shields

M. C.

Stewart

M. T.

Delaney

K. R.

(2018). Patient safety in inpatient psychiatry: A remaining frontier for health policy. Health Affairs, 37(11), 1853-1861. https://doi.org/10.1377/hlthaff.2018.0718

37.

Slade

Domino

M. E.

(2020). Are there enough inpatient psychiatric beds? In The Palgrave handbook of American mental health policy (pp. 129-169). Palgrave Macmillan. https://doi.org/10.1007/978-3-030-11908-9_6

38.

Slymen

D. J.

Ayala

G. X.

Arredondo

E. M.

Elder

J. P.

(2006). A demonstration of modeling count data with an application to physical activity. Epidemiologic Perspectives & Innovations, 3(1), 3. https://doi.org/10.1186/1742-5573-3-3

39.

Stevenson

D. G.

(2005). Nursing home consumer complaints and their potential role in assessing quality of care. Medical Care, 43(2), 102-111. https://doi.org/10.1097/00005650-200502000-00003

40.

Stevenson

D. G.

(2006). Nursing home consumer complaints and quality of care: A national view. Medical Care Research and Review, 63(3), 347-368. https://doi.org/10.1177/1077558706287043

41.

Troyer

J. L.

Sause

(2013). Association between traditional nursing home quality measures and two sources of nursing home complaints. Health Services Research, 48(4), 1256-1278. https://doi.org/10.1111/1475-6773.12021

42.

Van Bogaert

Clarke

Willems

Mondelaers

(2013). Staff engagement as a target for managing work environments in psychiatric hospitals: Implications for workforce stability and quality of care. Journal of Clinical Nursing, 22(11-12), 1717-1728. https://doi.org/10.1111/j.1365-2702.2012.04341.x

43.

Werner

R. M.

Konetzka

R. T.

Kruse

G. B.

(2009). Impact of public reporting on unreported quality of care. Health Services Research, 44(2p1), 379-398. https://doi.org/10.1111/j.1475-6773.2008.00915.x

44.

Zinn

J. S.

Weimer

D. L.

Spector

Mukamel

D. B.

(2010). Factors influencing nursing home response to quality measure publication: A resource dependence perspective. Health Care Management Review, 35(3), 256-265. https://doi.org/10.1097/HMR.0b013e3181e23d64

Supplementary Material

Please find the following supplemental material available below.

For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.

For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.

0.00 MB

0.14 MB