In a strong sign that the Biden administration is serious about fighting poor quality and fraud, federal health officials on Wednesday unveiled a pair of CMS datasets that named 3,236 skilled nursing facilities (SNF ) and 348 hospitals that were sold after January 1, 2016. , including the buyer and seller, and whether they were organizations or individuals.
The effort, which aimed to improve public knowledge about the types of companies and individuals who control these facilities, is an attempt to better examine how private equity takeovers in health care – a trend expanding in recent years – can lead to reduced spending on quality care and on hiring the staff needed for direct care.
An HHS analysis accompanying the data explained the rationale. “Private equity firms and other private investment firms have purchased NFCs; in some cases, the new owners have sold the real estate assets to another entity under their control and then returned the building to the facility origin with substantial management fees,” the HHS analysts wrote. .
Sales can reduce healing resources
“Critics argue this forced SNFs to reduce quality and, arguably, made them ill-equipped to respond to the COVID-19 pandemic,” the analysts continued. As of January 30, COVID-19 has claimed the lives of more than 200,000 nursing home residents and staff, according to a report by the Kaiser Family Foundation.
HHS analysts also observed that academic researchers found that “private equity acquisition of SNF is associated with increases in short-term mortality and shifts of resources from patient care to health care elements.” not intended for patients”.
The data showed for the first time every Medicare-enrolled hospital and nursing home that had been involved in a merger, acquisition, consolidation or changed ownership after 2015.
Because individual facilities that have inappropriate billing practices may be part of organizational models of inappropriate practices, data on owner-management relationships can improve oversight and protect Medicare and Medicaid payments and patients, observed HHS analysts.
By following consolidation trends, regulators can support pro-competition policies that reduce health care costs. “Information about ownership changes will now be much more readily available to researchers and the general public through this CMS data release,” the analysts wrote.
The new datasets also indicated where most ownership changes occurred. For example, 19% of hospitals in South Carolina – 14 of 73 – changed hands while in most other states ownership changed in less than 4%.
SNF ownership changes occurred in every state, but most transactions occurred in Texas (471), Ohio (268), California (207), Illinois (175), Pennsylvania (148 ), Florida (144), North Carolina (103) and Virginia, (101). Sales also took place in smaller states: Wyoming (23), Iowa (56) and Utah (41).
During a roundtable on quality of care in nursing homes with Illinois state health officials on Wednesday, CMS Administrator Chiquita Brooks-LaSure welcomed the release of the new data. on healthcare facility ownership, saying the agency is particularly interested in tracking nursing home turnover, “not just at the staff level, but at the ownership level.”
Who is to blame?
The administration wants more transparency about how taxpayers’ money is spent to ensure that enough resources are spent on direct patient care and to know “who should be held accountable for issues,” Brooks-LaSure stressed. “We are seeing a huge amount of change in the industry.”
His agency is also working to better tie reimbursement to quality of care in nursing homes and “to really make sure that the incentives with the money are really about value and quality,” he said. she declared.
The datasets include sales and acquisitions of hospitals and skilled nursing facilities from 2016 to 2021 and will be updated quarterly, according to a press release from CMS.
Ownership changes were much more common in the nursing home sector than in hospitals. Overall, 62.3% of NFCs purchased from 2016 to 2021 had a single organizational owner, 6.9% had multiple organizations as owners, 18.2% had only individual owners, and 12.7% had the two types of owners.
Previous research studies have suggested that the quality of care may decline in NFCs owned by large corporations. An analysis in Maryland, for example, suggested that facilities affiliated with large and medium-sized for-profit chains had lower ratings of family-reported experience of care.
CMS data tables can be searched by buyer or seller organization name. For example, sorting by organization name reveals that a company called Complete Care purchased 34 skilled nursing facilities in seven states from Connecticut to Florida during the 6-year period.
During the Illinois roundtable, Brooks-LaSure heard from nursing home patients and caregivers, as well as the nephew of a woman who died of COVID at an Indiana nursing home.
A certified practical nurse, Sharon Lake, said the lack of staff is a “huge problem. We don’t have enough workers to accommodate patients, so a lot of things fall to the side, which means that we it takes longer to get residents in. They may have to wait. Going to the bathroom sometimes takes a little longer”, and unfortunately, “patients are suffering because we are understaffed”.
Brooks-LaSure frequently mentioned President Biden’s commitment during his State of the Union address to improving the safety and quality of care in nursing homes across the country.