The New York Times has a fascinating article on the growing profitability of nursing homes and the declining level of care by clinical staff. As the population ages, more and more business will develop methods for generating revenue off of the goods and services provided to this large population. That is just a fact of business (and a good business model).

Nursing homes have long been the target of both regulatory agencies and sue-happy lawyers. This deadly combination brought many skilled nursing facilities to the brink of bankruptcy. In the past few years, large private investment firms began acquiring these facilities and breaking up the management, leaseholder, license-holder, clinical management, vendor management and non-clinical management into differently held companies. This structure makes it nearly impossible to determine liability for "level of care" issues.

While this structure increases profitability and therefore ensures the continued operation of skilled nursing facilities, the impact on level of care in these facilities is left open to determination.

There is a thin line between increasing profitability in what essentially is a business, after all, and crossing that line into providing sub-standard care. Being in health care for many years, I have seen this line up close and personal. I used to be confident that those that crossed that line were few and far between and gave the rest of the industry a black eye. Now, I'm not so sure.

I support legislation that requires a transparency in ownership of these facilities and direct responsibility for clinical care to be tied to revenue centers in these businesses. For regulators to issue fines for violations and they have no impact on the way a business does business defeats the purpose of regulatory agencies.

Someone draft up some legislation for next session and call me in to help review and comment. I'm serious.