Secondary Logo

Institutional members access full text with Ovid®

Share this article on:

Malpractice paid losses and financial performance of nursing homes

Zhao, Mei; Haley, D. Rob; Oetjen, Reid M.; Carretta, Henry J.

doi: 10.1097/HMR.0b013e3181e62c36

Background: Florida's nursing home industry has experienced significant financial pressure over the past decade. One of the primary reasons is the dramatic increase in litigation activity for nursing home providers claiming negligent care and abuse. Although anecdotal reports indicate a higher cost because of malpractice in nursing facilities, few studies have examined the extent of malpractice paid losses and their effect on the financial performance of nursing homes.

Purpose: The purpose of this study was to examine the impact of malpractice paid losses on the financial performance of nursing homes.

Methodology/Approach: Medicare Cost Report data and Online Survey, Certification, and Reporting data for Florida skilled nursing facilities over the 6-year period from 2001 to 2006 were used to calculate the malpractice paid losses and the financial performance indicators as well as the nursing home organizational and market factors. Descriptive analysis and multivariate regression analysis were used to examine the effect of paid loss on financial performance.

Findings: The paid loss for malpractice claims was strongly associated with financial performance. Nursing facilities with malpractice paid losses had consistently lower total margins over the study period. The threat of nursing home litigation may create an incentive for nursing homes to improve quality of care; however, large paid claims can also force nursing homes into a financial situation where the organization no longer has the resources to improve quality.

Practice Implications: Nursing home managers must assess their malpractice litigation risk and identify tactics to mitigate these risks to better provide a safe and secure environment for the older persons. In addition, this research offers support for local, state, and federal policymakers to revisit the issue of malpractice litigation and the nursing home industry through its insight on the relationship of nursing home margins and litigation.

Mei Zhao, PhD, is Associate Professor, Health Administration Programs, College of Health, University of North Florida, Jacksonville. E-mail:

D. Rob Haley, PhD, MBA, MHS, is Assistant Professor, Public Health Department, University of North Florida, Jacksonville. E-mail:

Reid M. Oetjen, PhD, is Assistant Professor, Health Services Administration Programs, Department of Health Management and Informatics, College of Health and Public Affairs, University of Central Florida, Orlando. E-mail:

Henry J. Carretta, PhD, MPH, is Adjunct Professor, Virginia Commonwealth University, PO Box 980566, Richmond. E-mail:

This research was supported in part by a grant from the University of North Florida Foundation/Brooks Health Foundation Dean's Professorship.

© 2011 Lippincott Williams & Wilkins, Inc.