Policy Impact

Moving Forward Nursing Home Coalition

Dr. Mark Unruh has been working to increase transparency and accountability of nursing home finances, operations, and ownership as a member of the Moving Forward Nursing Home Quality Coalition. The Coalition was formed to advance recommendations by the National Academies of Science, Engineering and Medicine to improve the quality of nursing home care in the United States. Dr. Unruh has been contributing to the Coalition’s efforts to bring together state agencies and the Centers for Medicare and Medicaid Services (CMS) to build a more integrated system of nursing home oversight. This includes creating a framework to align state and federal approaches to data collection, monitoring, and enforcement while providing sub-regulatory guidance for a new rule on disclosures of nursing home ownership being implemented by CMS.

Increasing Nursing Home Ownership Transparency

Research conducted by Drs. Tyler Braun, Lawrence Casalino, Hye-Young Jung, Mark Unruh, and colleagues on the impact of investments by private equity firms and real estate investment trusts on nursing home quality was influential in shaping a new federal rule on disclosures of nursing home ownership (1-3). This includes seminal studies (1,2) cited by The White House to support initiatives for more transparency and accountability in nursing home ownership proposed in President Biden’s 2022 State of the Union Address and a report written for the US Department of Health and Human Services Office of the Assistant Secretary for Planning and Evaluation. The federal rule includes new requirements for reporting of individuals and entities with a financial interest in nursing homes, including specific provisions for reporting of private equity and real estate investment trust ownership.

1. Braun, Robert Tyler, Hyunkyung Yun, Lawrence P. Casalino, Zachary Myslinski, Farai M. Kuwonza, Hye-Young Jung, and Mark Aaron Unruh. "Comparative performance of private equity–owned US nursing homes during the COVID-19 pandemic." JAMA Network Open 3, no. 10 (2020): e2026702-e2026702.

2. Braun, Robert Tyler, Hye-Young Jung, Lawrence P. Casalino, Zachary Myslinski, and Mark Aaron Unruh. "Association of private equity investment in US nursing homes with the quality and cost of care for long-stay residents." In JAMA Health Forum, vol. 2, no. 11, pp. e213817-e213817. American Medical Association, 2021.

3. Braun, Robert Tyler, Dunc Williams, David G. Stevenson, Lawrence P. Casalino, Hye-young Jung, Rahul Fernandez, and Mark Aaron Unruh. "The Role Of Real Estate Investment Trusts In Staffing US Nursing Homes: Study examines the role of real estate investment trusts in staff levels at US nursing homes." Health Affairs 42, no. 2 (2023): 207-216.

CMS Merit-based Incentive Payment System (MIPS)
Photo of doctor with patient

Transforming Kidney Care: A New MIPS Value Pathway (MVP) 

Nephrologist and health services researcher Dr. Sri Lekha Tummalapalli played an instrumental role in the development of the Optimal Care for Kidney Health MIPS Value Pathway (MVP), having identified gaps in the CMS MIPS program for nephrology care. This collaborative effort, driven by policymakers, researchers, and nephrology clinicians, aims to redefine nephrology care standards and improve outcomes by implementing patient-centered quality measures and integrating evidence-based guidelines. The MVP enables early treatment of high-risk patients and ensures compliance with MIPS requirements while emphasizing high-quality care, continuous improvement, and cost-efficient care. The implementation of MVP holds significant implications for patients, healthcare professionals, and the healthcare system at large, offering a framework for providers navigating the evolving reimbursement landscape. Looking ahead, the MVP signifies a shift in kidney care delivery towards using quality and cost measures that are more meaningful for advancing kidney health and fostering a healthcare system that intervenes early for chronic diseases.

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