Megdalynn Fisher, PhD

Megdalynn Fisher, PhD

she/her

Assistant Professor

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Pages

Posts

Future Blog Post

less than 1 minute read

Published:

This post will show up by default. To disable scheduling of future posts, edit config.yml and set future: false.

Blog Post number 4

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This is a sample blog post. Lorem ipsum I can’t remember the rest of lorem ipsum and don’t have an internet connection right now. Testing testing testing this blog post. Blog posts are cool.

Blog Post number 3

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Blog Post number 2

less than 1 minute read

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This is a sample blog post. Lorem ipsum I can’t remember the rest of lorem ipsum and don’t have an internet connection right now. Testing testing testing this blog post. Blog posts are cool.

Blog Post number 1

less than 1 minute read

Published:

This is a sample blog post. Lorem ipsum I can’t remember the rest of lorem ipsum and don’t have an internet connection right now. Testing testing testing this blog post. Blog posts are cool.

portfolio

Workshop Preview

Adobe-based newsletter created to promote the Health Policy Workshop’s Spring semester

publications

The Hope of Mankind

Published in The Journal of Student Leadership, 2017

In the inaugural edition of the Journal of Student Leadership we pause to ponder what student leadership is and what students can contribute toward the future of leadership and leadership studies.

Recommended citation: Fisher, Megdalynn. (2017). "The Hope of Mankind." The Journal of Student Leadership. 1(1).
Download Paper

Racial, Demographic and Health Sorting Among Nursing Home Residents

Published in Journal of Aging & Social Policy, forthcoming, 2025

We contribute to the literature measuring segregation in the health care setting by constructing dissimilarity indices (DI) for nursing homes and counties to examine relationships with income inequality, reliance on Medicaid, urbanicity, and quality.

Recommended citation: Fisher, Megdalynn, Madeline Mustaine, Kosali Simon, John R. Bowblis. "Racial, Demographic and Health Sorting Among Nursing Home Residents" Journal of Aging & Social Policy, forthcoming.

talks

The Hope of Mankind

Published:

Fisher, Megdalynn. “The Hope of Mankind,” Oral recitation at the celebration of the inaugural edition of The Journal of Student Leadership, Orem, Utah, April 20, 2017.

An Advocacy Coalition Framework Approach to Section 340B

Published:

The Section 340B Drug Pricing program is often criticized and defended by various stakeholders. As a program with a nuanced history, growing footprint, poor targeting, and unintended consequences, I explore the program’s development, implementation, and evaluation using an Advocacy Coalition Framework to conceptualize the public policy process.

Tribal Self-Governance and COVID-19 Outcomes

Published:

Does tribal self governance improve COVID-19 outcomes among Native American and Indigenous American populations? I present early findings on collaborative work with Patrick Carlin.

Hospital Competition, Quality, and Municipal Debt: Do Non-Profit Hospitals Utilize Municipal Market Credit Access to Fund Competition on Quality

Published:

Using the variation of municipal governments’ credit ratings, I examine associations between Hospital Compare quality ratings, market concentration, and nonprofit hospital municipal market bond issuance to identify the effects of hospital quality measures on bond issuance. Findings include higher bond issuance in counties with lower reported hospital quality.

Public Reporting of Nursing Home Antipsychotic Use: Changes in the Reporting of Exclusionary Diagnoses?

Published:

Following the public reporting of Antipsychotic Medication (APM) use in nursing homes, we document an increase in prevalence of schizophrenia diagnos, a diagnosis which excludes facilities from the public reporting requirement for these residents. Public reporting is designed to reduce off-label use of APMs, increases in schizophrenia diagnosis are an unintended consequence of the policy that may be attributed to either more accurate diagnosis or upcoding.

Racial and Ethnic Segregation in Nursing Homes

Published:

In this presentation, we discuss our upcoming contribution to the literature measuring and understanding drivers of racial and ethnic sorting (segregation) in the health care setting by constructing dissimilarity indices (DI) for nursing homes. The dissimilarity index, a commonly used measure in residential segregation studies, ranges from 0 to 1 and in our context describes the share of patients in a health care market who would have to switch homes in order for there to be evenness (no segregation) across the providers in that market. Prior work has computed the DI in healthcare settings but provides limited evidence on how the DI varies across geographic areas and/or is based on data more than a decade old. We combine administrative data on all certified nursing homes in the U.S. with health assessments of long-term stay patients residing in those homes for the years 2011 and 2017. Geographically, we define a nursing home market to be a county.

Racial Equity in Long-Term Care: Disentangling the Effects of Managed Long-Term Services and Supports, Medicaid Expansion, and the Balancing Incentive Program

Published:

Policies such as the Balancing Incentive Program (BIP), Managed Long-Term Services and Supports (MLTSS), and Medicaid Expansion have fundamentally reshaped the long-term care landscape in the United States. However, the effects of these policies on racial composition and segregation in nursing homes are not yet well understood. This study evaluates the individual and combined impacts of these policies on the racial demographics of long-stay nursing home residents, with a particular focus on trends in racial segregation, measured by the dissimilarity index. The dissimilarity index quantifies the extent of segregation between two groups, ranging from 0 (complete integration) to 100 (complete segregation), and represents the percentage of individuals from one group who would need to move to achieve an even distribution.

Balancing Incetive Program: Racial, Demographic and Health Sorting Among Nursing Home Residents

Published:

Policies such as the Balancing Incentive Program (BIP), Managed Long-Term Services and Supports (MLTSS), and Medicaid Expansion have fundamentally reshaped the long-term care landscape in the United States. However, the effects of these policies on racial composition and segregation in nursing homes are not yet well understood. This study evaluates the individual and combined impacts of these policies on the racial demographics of long-stay nursing home residents, with a particular focus on trends in racial segregation, measured by the dissimilarity index. The dissimilarity index quantifies the extent of segregation between two groups, ranging from 0 (complete integration) to 100 (complete segregation), and represents the percentage of individuals from one group who would need to move to achieve an even distribution.

Balancing Incentives Meets Medicaid Expansion: Reshaping Long-Term Care Populations

Published:

The Balancing Incentive Program (BIP) and Medicaid Expansion, both key components of the Affordable Care Act, have significantly reshaped access to long-term services and supports (LTSS) in the United States. Medicaid Expansion increased the number of nursing home (NH) residents \citep{ritter_younger_2022, van_houtven_association_2020}, while BIP offered financial incentives to states to enhance non-institutional LTSS, supporting the use of home and community-based services (HCBS) instead of institutional care. Despite these distinct goals, the combined and independent effects of these policies on nursing home populations remain understudied.

Local Government Nursing Homes: Incentives, Quality, and Sustainability

Published:

Medicaid supplemental payments are a vital but often opaque tool in financing long- term care, designed to stabilize providers and ensure access for low-income populations. Yet these payments also create powerful incentives that shape ownership and governance decisions. This paper examines the growing trend of nursing homes converting to local government ownership as a strategy to capture supplemental payments. Using national nursing home data linked to ownership status and quality indicators, I find evidence of a selection effect: facilities with poorer quality (measured by higher rates of on-site inspection deficiencies) are disproportionately those that transition into local government ownership.

teaching

Public Management Economics, MPA-612

Graduate Teaching Assistant, Brigham Young University, Romney Institute of Public Service and Ethics, 2018

Course support, lab direction and tutoring, assignment grading for Dr. Andrew Heiss. By the end of this course, you will (1) be literate in fundamental economic principles, (2) understand the limits of economic theory and free markets, (3) justify government and nonprofit intervention in the economy, and (4) make informed policy recommendations by analyzing and evaluating public sector policies.
MPA-612

Contemporary Economic Issues in Public Affairs, SPEA-V202

Associate Instructor (Instructor of Record), Indiana University, O'Neill School of Public and Environmental Affairs, 2021

Fall Semester (3 cr.)
This course reinforces and deepens economic skills by applying basic microeconomic concepts and models to a variety of policy areas. Using economic models, students in the course will examine the motivation for intervention in the economy, the types of intervention, and the predicted effects of policies.

Contemporary Economic Issues in Public Affairs, SPEA-V202

Associate Instructor (Instructor of Record), Indiana University, O'Neill School of Public and Environmental Affairs, 2022

Spring Semester (3 cr.)
This course reinforces and deepens economic skills by applying basic microeconomic concepts and models to a variety of policy areas. Using economic models, students in the course will examine the motivation for intervention in the economy, the types of intervention, and the predicted effects of policies.

Quantitative Methods in Public Administration, PAD6701

Instructor, Florida International University, Steven J. Green School of International and Public Affairs, 2025

Fall Semester (3 cr.)
The purpose of this course is to help you understand statistics and develop practical skills for summarizing, describing, and analyzing the data in a public administration/policy setting. The focus is on the presentation and interpretation of quantitative data. This is a rigorous course requiring cumulative effort.

wip

Government Intervention in Nursing Homes: Assessing Ownership Dynamics and Quality of Care Under Non-State Government Owned Supplemental Payment Programs

Work in Progress: job market paper

Do subsidies through Non-State Government Owned nursing facility supplemental payment programs spur government acquisitions and do the subsidies translate to fewer deficiencies and better quality?

Recommended citation: Fisher, Megdalynn. "Government Intervention in Nursing Homes: Assessing Ownership Dynamics and Quality of Care Under Non-State Government Owned Supplemental Payment Programs" work in progress.

End of Life Inpatient Spending and Hospital Advertising

Work in Progress: under review

Does hospital advertising inform patient choice or represent ‘cheap talk’? We investigate the hospital advertising at the market level, establishing a correlation with end-of-life inpatient spending, a proxy for geographical differences in hospital spending on care with a uniform outcome.

Recommended citation: Freedman, Seth, Victoria Perez, Megdalynn Fisher. "End of Life Inpatient Spending and Hospital Advertising" under review.

Nursing Home Use of Antipsychotics: Does Public Reporting Incentivize Gaming?

Work in Progress: working paper

The number of nursing home residents with schizophrenia has increased due to their exemption from the requirement for antipsychotic medication quality reporting. Since public reporting incentivizes either more accurate diagnosis or upcoding, we examine these effects at the reporting threshold based on number of residents in the facility.

Recommended citation: Bowblis, John, Megdalynn Fisher, Kosali Simon. "Nursing Home Use of Antipsychotics: Does Public Reporting Incentivize Gaming?" work in progress.

Antipsychotic Medication Use Among Nursing Home Residents with Alzheimer’s Disease and Related Dementias: Ownership Structures

Work in Progress: working paper

Do nursing home residents with Alzheimer’s disease and related dementias (ADRD) receiving antipyschotic medications more often based on ownership structures, and do rates of diagnosis excluding public reporting requirements of antipsychotic medication use differ by these ownership structures?

Recommended citation: Bowblis, John, Megdalynn Fisher, Judith Lucas, Kosali Simon. "Antipsychotic Medication Use Among Nursing Home Residents with Alzheimer's Disease and Related Dementias: Ownership Structures and Racial Disparities." work in progress.

Medicaid Expansion and Nursing Home Outcomes

Work in Progress: working paper

Medicaid expansion has increased the number of nursing home (NH) residents (Ritter et al, Van Houtven et al) but there is a lack of research on individual level decisions and facilty level reactions. To expand this research base, we examine resident level data to determine how quickly Medicaid expansion leads to changes in the type of long-stay patients in NHs, and how that translates into changes in the characteristics of long-stay residents and NHs over time. We hypothesize that SMI populations under 65 will be the group that experiences the largest increase.

Recommended citation: Bowblis, John, Megdalynn Fisher, Madeline Mustaine, and Kosali Simon. "Medicaid Expansion and Nursing Home Outcomes" work in progress.