Examining California nursing home profitability and related factors before and during the COVID-19 pandemic.

BACKGROUND: The financial status of nursing homes (NHs) is a policy concern, especially during a pandemic, because of the higher costs associated with infection prevention and resident care. METHODS: This exploratory study was designed to assess the impact of the federal and state COVID-19 funding support on California NHs profitability during 2020, the first year of the pandemic, compared with 2019, the last pre-pandemic year. The study examined the association of Medicare and Medicaid days, related-party transactions, as well as other facility characteristics on net income profit margins, using cross-sectional regression analysis of data from state NH cost reports and federal NH provider data for 2019 and 2020. RESULTS: California skilled NHs had average reported net income profit margins of 2.26% in 2019 and 7.0% in 2020 with wide variations (from a loss of about 48% to a gain of 74% in 2020). Regression analysis found that the number of beds, occupancy rates, high-quality rating scores, and medium and high proportions of Medicare resident days were positively associated with net income margins in 2019 and 2020. Chains in 2020 (but not 2019), related-party expenditures in 2019 and 2020, median Medicaid days (in 2019), high Medicaid resident days (71%-73% or higher) in 2019 and 2020, and medium and high managed care resident days were negatively associated with net income margins in both years. CONCLUSIONS: Although NH admissions and occupancy rates declined substantially between 2019 and 2020, some (but not all) California NHs had a substantial increase in profit margins in 2020 over 2019. More studies of nursing home financial patterns and profitability are needed to examine trends over time and variations across states.

Buprenorphine Treatment: Advanced Practice Nurses Add Capacity.

During the COVID-19 pandemic, there was slower growth in the number of new waivers authorizing clinicians to provide buprenorphine treatment for opioid use disorder. However, treatment capacity grew at a stable rate as a result of already authorized clinicians obtaining waivers for larger patient panels. Advanced practice nurses accounted for the largest portion of capacity growth during the pandemic.