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In a strong sign the Biden administration is serious about cracking down on poor quality and fraud, federal health officials Wednesday unveiled a pair of CMS data sets that named 3,236 (SNFs) and 348 that were sold after Jan. 1, 2016, including the buyer and seller, and whether they were organizations or individuals.

The effort, which aimed to improve public knowledge about what types of companies and individuals have control over these facilities, is an attempt to better examine how private equity take-overs in healthcare -- a rapidly expanding trend in recent years -- may result in reduced spending on quality care and on hiring of personnel needed for direct care.

An HHS accompanying the data explained the rationale. "Private equity and other private investment firms have purchased SNFs; in some cases, new owners have sold the real estate assets to another entity under their control, and then released the building back to the original facility with substantial management fees," HHS analysts wrote.

Sales May Reduce Care Resources

"Critics contend that this has forced SNFs to cut back on quality and, arguably, made them ill-equipped to respond to the COVID-19 pandemic," the analysts continued. As of Jan. 30, COVID-19 had taken the lives of more than 200,000 residents and staff of nursing homes, according to a Kaiser Family Foundation .

The HHS analysts also observed that academic researchers have found "private equity acquisition of SNFs is associated with increases in short-term mortality and shifts in resources from patient care toward non-patient care items."

The data showed for the first time each hospital and nursing home enrolled in Medicare that had been involved in a merger, acquisition, consolidation, or had a change of ownership after 2015.

Because individual facilities found to have improper billing practices may be part of organizational patterns of improper practices, data about owner and management relationships may improve oversight and safeguard Medicare and Medicaid payments and patients, HHS analysts observed.

By tracking consolidation trends, regulators can support pro-competitive policies that reduce health care costs. "Information on ownership changes will now be much more easily accessible by 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 South Carolina's hospitals -- 14 out 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 occurred in smaller states, too: Wyoming (23), Iowa (56), and Utah (41).

At a on nursing home care quality with state health officials in Illinois Wednesday, CMS Administrator Chiquita Brooks-LaSure praised the release of the new health facility ownership data, saying the agency is particularly interested in tracking nursing home turnover, "not just at the staffing level, but at the ownership level."

Who Is to Blame?

The administration wants more transparency on how taxpayers' dollars are spent to assure sufficient resources are dedicated to direct patient care and to know "who needs to be held responsible for issues," Brooks-LaSure emphasized. "We are seeing a tremendous amount of change in the industry."

Her agency is also working to better tie reimbursement to quality of care in nursing homes and "really making sure that the incentives with the dollars are really focused on value and quality," she said.

The data sets include sales and acquisitions of hospitals and skilled nursing facilities from 2016 to 2021 and will be updated quarterly, according to a CMS .

Ownership changes were much more frequent within the nursing home industry than among hospitals. Overall, 62.3% of SNFs 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 both types of owners.

Previous research studies have suggested that quality of care may diminish in SNFs owned by large companies. One analysis in Maryland, for example, suggested that facilities affiliated with large-for-profit and medium-for-profit chains had of family-reported experience with care.

The CMS data tables are searchable by the organizational name of the buyer or seller. For example, sorting by organizational name reveals that a company called Complete Care purchased 34 skilled nursing facilities in seven states from Connecticut to Florida over 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 in an Indiana nursing home.

One certified nurse assistant, Sharon Lake, said short-staffing is a "huge problem. We do not have enough workers to accommodate the patients, so a lot of things fall on the side, meaning that it takes longer for us to accommodate the residents need. Bathing? They may have to wait. For toileting, sometimes it takes a little longer," and unfortunately, "patients suffer because we have a lack of staff."

Brooks-LaSure frequently mentioned President Biden's pledge during his State of the Union address to improve the safety and quality of care in the nation's nursing homes.

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