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On April 20th, 2022, the U.S. Department of Health and Human Services (HHS) announced new changes to promote competition and transparency in the health care system with the aim of improving the safety and quality of nursing homes and hospitals.
For the first time, the Centers for Medicare & Medicaid Services (CMS) is releasing data publicly on mergers, acquisitions, consolidations, and changes in ownership for hospitals and nursing homes enrolled in Medicare from 2016 to 2022. The tool is designed to help individuals evaluate hospitals and nursing home facilities for signs of poor care and histories of bad behavior.
HHS and CMS release this data in the hopes that it will be a “powerful new tool for researchers, state and federal enforcement agencies, and the public to better understand the impacts of consolidation on health care prices and quality of care.”
This announcement comes after the Biden Administration’s goal of improving transparency around nursing facility ownership and enhancing nursing home safety and quality, as outlined in the State of the Union Action Plan for Protecting Seniors by Improving Safety and Quality of Care in the Nation’s Nursing Homes.
Highlighted in the Biden Administration’s fact sheet, recent research has found that outcomes for residents of skilled nursing and long-term care facilities are significantly worse at private equity-owned facilities. Residents in nursing homes owned by private equity firms were 11% more likely to have a preventable emergency department visit and 8.7% more likely to experience preventable hospitalizations when compared to other for-profit nursing homes.
Other research found that private equity ownership increased excess mortality for residents by 10% and increased prescriptions of antipsychotic drugs for residents by 50%, while decreasing the number of hours of frontline nursing staff by 3% and increasing taxpayer spending per resident by 11%. Further research has found that during the COVID-19 pandemic, private equity-owned nursing homes had COVID-19 infection and death rates 30% and 40% above statewide averages, respectively.
The goals set forth by the Biden Administration are to:
- Establish a minimum nursing home staffing requirement,
- Reduce resident room crowding,
- Strengthen the Skilled Nursing Facility Value-Based Purchasing Program,
- Reinforce safeguards against unnecessary medications and treatments,
- Adequately fund inspections and inspection activities,
- Increase scrutiny among the poorest performers,
- Expand financial penalties and other enforcement sanctions,
- Increase accountability for owners of chain facilities,
- Provide technical assistance to struggling nursing homes,
- Create a database of nursing home owners and operators,
- Improve the transparency of facility ownership and finances,
- Enhance Nursing Home Care Compare, and
- Examine the role of private equity ownership in nursing homes.
What Has the Data Found?
A recent report by HHS’s Office of the Assistant Secretary for Planning and Evaluation (ASPE) found that there were 348 changes in ownership among hospitals and more than 3,000 among skilled nursing facilities between 2016 and 2021, with wide variation across states. Ownership changes were more common in long-term care hospitals.
This data has the potential to make it easier for individuals and families to discover if the facility that their loved one resides in is suspected of or has a history of nursing home abuse or nursing home neglect.
It’s not uncommon for nursing facilities to change ownership in an attempt to rebrand or hide a problematic history of violations, abuse, or neglect. A 2016 Harvard study found that a frequent change in ownership can indicate a lower quality of care.
How to Use the Data
CMS has published data on changes in ownership, including information and details on mergers, acquisitions, and consolidations, available on data.cms.gov. CMS has plans to update the change of ownership data quarterly.
The Skilled Nursing Facility (SNF) Change of Ownership (CHOW) provides information on the SNF ownership changes that occurred on or after January 1, 2016, through 2021 (as of writing). The data includes information on the buyer and seller organization’s legal business name, provider type, change of ownership type (whether it was a change of ownership, an acquisition, merger, or consolidation), and the date of the change.
The dataset website includes an easy-to-use map of skilled nursing facilities that have changed ownership. The map tool allows you to search by city, state, and/or ZIP Code. When you hover over a data point, the tool tells you the name of the facility, the CHOW type, the effective date, and the name of the seller.
Using a combination of these tools and the accompanying data dictionary, you can now see each self-reported instance of skilled nursing and long-term care facilities and their change of ownership.
To get a fuller picture of the dataset and match the change of ownership information with the names of individual skilled nursing facilities and nursing homes, CMS recommends using the Skilled Nursing Facility Change of Ownership – Owner Information dataset.
Using these datasets together allows you to identify the individual and organizational ownership interest and managerial control associated with the buyer and seller organizations of these long-term care and skilled nursing facilities. Using the facility identifier variable, you can now see who is buying or selling the facility where your loved one resides.
There are some limitations to be aware of when using this dataset to investigate ownership and change in ownership of nursing homes and skilled nursing facilities:
- The data does not tell you whether the previous, current, or future owner of the facility has a poor track record — it will be up to you to do that research.
- The data relies on self-reporting of the CHOW. Some facilities may not be included in this dataset due to lags or omissions in self-reporting.
- As this is a federal dataset, only facilities that bill Medicare are included. There may be some instances where a change in ownership occurred but is omitted due to a lack of Medicare eligibility.
What Does This Mean for You?
So, what does this mean for your and your loved ones?
The publicly available data tracks changes in ownership of skilled nursing and long-term care facilities, allowing you to look up the current and previous owners of individual facilities. You can then compare that information with existing resources on nursing home neglect and nursing home abuse to see if the nursing home your loved one or family member is in has a poor track record.
Reach out to attorneys at Solomon & Relihan if you suspect nursing home abuse or nursing home neglect and have a loved one at a facility with questionable ownership.
Martin J. Solomon is a principal at Solomon & Relihan PC and has been licensed to practice law in Arizona since 1970. He practices exclusively in the area of personal injury litigation, with an emphasis on nursing home abuse and neglect. Martin is a graduate of the University of Arizona College of Law, a past president of the Arizona Trial Lawyers Association, and has served as a member of the Board of Directors for the Arizona Center for Disability Law and the Arizona Center for Law in the Public Interest. He is a member of the Nursing Home Litigation Group in the American Association for Justice (formerly the American Trial Lawyers Association), the National Citizens’ Coalition for Nursing Home Reform and the Maricopa Elder Abuse Prevent Prevention Alliance.