Baucus, Grassley and Stark want more transparency from nursing home owners

Leading lawmakers in the health policy world want nursing homes to be more open about who's running them.  

Sens. Max Baucus (D-Mont.), Chuck Grassley (R-Iowa) and Rep. Pete Stark (D-Calif.) said Wednesday that tangled layers of ownership information — complicated by buy-ups from private investment firms — make it almost impossible for consumers or government regulators to determine who's operating many facilities and who should be responsible if problems arise.

"Nursing home residents and their families deserve to know the full story about who is ultimately responsible for their care,” Baucus, chairman of the Finance Committee, said in a statement. “Federal health care officials need full and detailed information so they can properly oversee these nursing homes and hold the correct parties accountable for keeping patients safe and well-cared for."

The concerns are in response to a new report from the Government Accountability Office (GAO), released Wednesday, which found that private investment firms have snatched up more than 1,800 nursing homes since 1998, but current reporting requirements make it difficult to track those ownership changes. Ten large firms accounted for 89 percent of those purchases, GAO found. 

Under current rules, nursing homes wishing to participate in Medicare and Medicaid must disclose ownership information to the Centers for Medicare and Medicaid Services (CMS). The agency keeps a database — the Provider Enrollment, Chain, and Ownership System (PECOS) — that's supposed to track that data, but GAO found PECOS paints "a confusing picture of the complex ownership structures and chain affiliations."

"PECOS chain information was not straightforward and was sometimes incomplete, making it difficult to link all the homes in a chain," GAO said. "Compounding these shortcomings, CMS’s ability to determine the accuracy and completeness of the reported ownership data is limited."

Grassley said the findings provide "further evidence of what we already knew: That the federal government needs to do a better job giving nursing home residents — including Medicare beneficiaries — complete, accurate and timely information so they can make the right choices when choosing a nursing home."

The new health reform law addresses the ownership issue head on, requiring skilled nursing facilities (under Medicare) and nursing facilities (under Medicaid) — at the request of state and federal regulators — to provide ownership information, "including a description of the governing body and organizational structure of the facility and information regarding additional disclosable parties," according to one summary of the law.

Those changes, Stark said, "will shed light on who owns nursing homes, who is making care decisions and how these facilities are being run."

The lawmakers have already asked GAO to conduct another report examining the relationship between ownership structures of nursing homes and the quality of care they provide.