Promoting transparency to reduce costs and improve quality: An evaluation of information disclosure in the nursing home industry

Background: The Affordable Care Act of 2010 contains the first ever, federal nursing home ownership transparency requirements. Despite over 40-years of evidence revealing poor performance by for-profit nursing homes, the long-term care industry has remained one of the most under researched, under regulated--yet costly segments of United States healthcare. As our nation embarks on reform however, recent trends in the industry have created complicated, opaque organizations, obscuring operations, costs, and owners. Methods: To understand the culture that fostered this profitable yet poor-performing, and opaque industry, a broad systematic review of literature and information pertaining to nursing home transparency from OBRA to ACA was conducted. The review examined the social, legislative, and regulatory culture to 1.understand the context from which the ACA transparency regulations arose and 2. to determine challenges that may result from the new ownership disclosure requirements. Results: Detailed ownership transparency is essential for improving the delivery of nursing home care. Salient findings indicate that in conjunction with international organizations, the U.S. subscribes to the notion that opaque corporate structuring is indicative of questionable motives. Historically, corporate objectives have impeded the implementation of legislation that would allow examination of finances and foster ownership accountability. Conclusion Given the national imperatives to reduce costs and improve quality, the role of for-profits in long-term care must be thoroughly evaluated. Consequently, increased transparency is required to identify 1. the actual beneficiaries of federal funding, 2.the return on investment of those dollars to society, and 3. the areas where streamlining can occur.