• How the pandemic laid bare America’s diabetes crisis (Reuters)
• How to Avoid a Surprise Bill for Your Coronavirus Test (New York Times)
• Biden says US will require nursing homes get staff vaccinated or lose federal funds (CNN)
• Food stamps to get their biggest boost ever, with benefits rising more than 25% (CBS News)
• U.S. officials’ decision on Covid-19 booster shots baffles — and upsets — some scientists (STAT)

Research Corner: Rachel Werner, MD, PhD

This week's contributor is Rachel Werner, the executive director of the Leonard Davis Institute of Health Economics* and Robert D. Eilers Professor of Medicine and Health Care Management at the University of Pennsylvania. She is also a member of the 2021 Tradeoffs Research Council.

Private equity investment in U.S. health care has grown substantially in the past two decades. In 2018 the valuation of private equity deals in the U.S. health care sector reached $100 billion — 20 times higher than it was in 2000. Supporters say private equity firms provide needed funds and business acumen to improve efficiency, while critics say they squeeze costs to deliver short-term return for investors without regard for long-term quality consequences. These critics include some members of Congress, who have raised concerns about private equity’s growing presence in everything from physician practices to retail health and addiction treatment facilities. And in the last year, nursing homes have taken the spotlight in the debate over private equity.

The nursing home sector has long attracted profit seekers. More than two-thirds of nursing homes are for-profit, and over half are owned by large nursing home chains. Ample prior research has found both for-profit and chain nursing homes have lower quality of care compared to nonprofit facilities, and a new working paper suggests private equity investment in nursing homes lowers quality even further.

Researchers Atul Gupta, Sabrina Howell, Constantine Yannelis and Abhinav Gupta used national data from 2000 to 2017 to examine the impact of private equity investment. The high prevalence of for-profit nursing homes in the data made it possible for them to compare private equity investments directly to for-profit ownership, disentangling the effects of private equity investment from a simple profit motive. In addition, because private equity firms acquire both independent and chain-operated nursing homes, the researchers could also isolate the effect of private equity investment from the operational changes to nursing homes associated with being part of a chain.

What they found was startling. Going to a private equity-owned nursing home increased individuals’ short-term mortality by 10% during and for 90 days after the nursing home stay. These stays were also at a higher cost, with Medicare spending 11% more over that time. The authors also showed a decline in nursing home quality (measured using Medicare’s Five Star ratings) and a decline in nurse staffing levels, perhaps explaining why mortality rates rose.

The pandemic has pushed many to reconsider whether the traditional nursing home model is the best way to care for aging and frail adults, or whether more people should be cared for in home or community-based settings. But nursing homes are an integral part of any sensible long-term care system as some people are simply unable to live out their lives at home. This requires ensuring we have stable, high-quality nursing homes and private equity investment in nursing homes is unlikely to get us there. Research like this can help pave the way for true reform in nursing homes.

*The Leonard Davis Institute of Health Economics is one of Tradeoffs’ financial supporters, and their support has no influence on their inclusion in Research Corner.

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Staff Picks: Operations Assistant Jamie Song

MASK UP (AGAIN): As the delta variant continues to wreak havoc on the U.S., a recent Axios-Ipsos poll shows most of the public favors implementing mask mandates in schools, in spite of bans in a number of states. If you’re pulling your masks back out (or never put them away), here are some tips from NPR on how to best protect yourself. Be sure to watch out for counterfeits, and a quick literature review I did for an epidemiology class showed that neck gaiters may be ineffective or even counterproductive in preventing the spread of COVID. One conclusion has been supported by many studies: mask-wearing effectively prevents us from being infected and from infecting others.

AN INTRO TO PHILLY MUSIC NOBODY ASKED FOR: After living in Philadelphia for 6 years and in an adjacent suburb for 17, I can confidently say that one of our city’s greatest assets is its independent — or “DIY” — music scene. Fostered by scrappy bands in unfinished row home basements, venues with zoning violations, and even a famous church basement, the Philly DIY scene has lifted up talents who have gone on to wider popularity. It has also become a social space for young people seeking refuge, or at least a momentary break, from the commodified aesthetics of popular music. In tribute to a scene that was one of my social homes in college, as well as the artists who have struggled greatly throughout the pandemic, I made a Philly DIY 101 playlist with music from the scene’s greatest stars and some lesser known bands too. Some tracks are more accessible than others, so if something doesn’t immediately please your ears, hit the shuffle button and give it a few more chances!

WHEN LIFE GIVES YOU BLACKBERRIES: My mom has grown fruits and vegetables in our family backyard for as long as I can remember. This year, her blackberry crop was huge. As she sent me back on the train to Philly with two large containers of blackberries, I wondered what I could easily make with such a large quantity. I settled on this recipe for blackberry syrup — a wonderful addition to pancakes, waffles or another breakfast treat. It’s also great for mixing, so I’ve been using it to up the flavor (and color!) of various drinks, like an old-fashioned, a margarita and even just plain seltzer (pictured below).