Overview
CMS tracks the ownership status of Medicare providers that receive payments from Medicare Part A. Throughout the Marketscape platform, this encompasses hospitals, SNFs, home health agencies and hospices. This data can be found on the Analyze page for any provider of the listed type, and in the matching provider Explore page in a single column.
In this article
Background
Summary
Ownership is about who owns the selected facility or agency. This applies only to providers who receive payments from Medicare Part A: Hospitals, SNFs, home health agencies or hospices. Full stop!
This section of content is packed with lots of details. Lots, tons, (too many). If the above sentence is enough for you, jump to the next section and learn about usage. Otherwise, read on and be amazed!
Where does the data come from?
As part of CMS’ efforts to further improve provider and supplier enrollment data sharing and transparency, in 2022 and 2023, CMS released data for Hospital, SNF, HHA, and Hospice Ownership. This data for Medicare enrolled providers is a subset of information available in the Provider Enrollment, Chain, and Ownership System (PECOS) – the system of record for Medicare provider enrollment. The data contained in these files is self-reported by the provider via the CMS-855A application.
The main source of this data is the Provider Enrollment, Chain, and Ownership System, or PECOS. PECOS is an electronic Medicare enrollment system and national data repository for individual and organizational providers who have enrolled or are enrolling in Medicare. CMS’ Medicare Administrative Contractors (MACs) enroll providers using PECOS. From these enrolling providers, the MACs through PECOS collect information related to the provider’s identity, such as SSN or EIN, specialty, qualifications, practice locations, ownership, billing agency information, reassignment of benefits, and related organizations.
Which providers are required to provide ownership data?
A: Providers who are enrolled to receive payments from Medicare part A.
The data that is available in the Marketscape platform is self-reported by the facility to the Medicare Provider Enrollment, Chain and Ownership System (PECOS). Since the data is self-reported, there may be instances of inaccurate or missing data.
Lotsa Extra Details
Changes of Ownership
- When a Change of Ownership (CHOW) occurs, both the previous owner (“seller”) and the new owner (“buyer”) are required to report the transaction to CMS.
- A change of ownership (CHOW) typically occurs when a Medicare provider has been purchased (or leased) by another organization. The CHOW results in the transfer of the old owner’s Medicare Identification Number and provider agreement (including any outstanding Medicare debt of the old owner) to the new owner. The regulatory citation for CHOWs can be found at 42 CFR § 489.18. If the purchaser (or lessee) elects not to accept a transfer of the provider agreement, then the old agreement should be terminated, and the purchaser or lessee is considered a new applicant. Most changes of ownership fall into this category.
- An acquisition/merger occurs when a currently enrolled Medicare provider is purchasing or has been purchased by another enrolled provider. Only the purchaser’s Medicare Identification Number and Tax Identification Number (TIN) remain. Acquisitions/mergers are different from CHOWs. In the case of an acquisition/merger, the seller/former owner’s Medicare Identification Number dissolves, whereas in a CHOW, the seller/former owner’s provider number typically remains intact and is transferred to the new owner.
- A consolidation occurs when two or more Medicare-enrolled providers consolidate to form a new business entity. Consolidations are different from acquisitions/mergers. In an acquisition/merger, two entities combine but the Medicare Identification Number and Tax Identification Number of the purchasing entity remain intact. In a consolidation, the TINs and Medicare Identification Numbers of the consolidating entities dissolve, and a new TIN and a new Medicare Identification Number are assigned to the new, consolidated entity. Consolidations have been rare.
Data Timelines
- The current ownership status of any applicable provider will be included in the Marketscape platform.
- CMS publishes monthly updates. Trella Health will make weekly checks for new ownership information and update the Marketscape platform during the next available data update, which happens most months.
Coverage
Trella is limiting ownership to organizational owners which includes about 8,000 parent organizations. There are about 20,000 Medicare-enrolled providers that report ownership information to CMS.
Is this the same as provider roll-up data?
No, this is not the same as provider roll-up data. The information provided by CMS includes the owner(s) for agencies. The data will not show if an agency rolls-up through a health system, then to a larger owner.
Other details will be included below in the context of describing the tables and metrics below in Understanding the Metrics.
Usage
The information in the Analyze page tables and in the column in the Explore page table identifies the owner of the selected or listed provider. You can use this information as part of your competitive analysis. Ownership affiliation will help to identify whether you should, or can, compete with specific agencies in your Market. You might discover that another agency is owned by the same organization that owns your company - suddenly they are not a competitor.
Understanding the metrics
In this section, we will show you the metrics using images from Marketscape Insights for Home Health and showing metrics for a home health agency. Since the ownership information is the same for any provider, you can easily transfer the details to another provider type. We show examples from each Marketscape Insights line of business at the bottom of this article.
Explore Page - One Column
Ownership information on the Explore page is limited to a single column under the header "Highest Affiliation Owner."
Definition
Keep it simple: By looking at the image above, we can identify that "Sta-Home" is the direct-owner of Accentcare with the highest percentage of ownership of Accentcare.
For those of you familiar with Marketscape Insights and the use of the term "affiliation," the header of this column is a little misleading. The identified owner organization (Sta-Home) is not the organization, of many, that has the highest affiliation with the listed provider. Rather, it is the organization with the highest percentage of ownership of the listed provider. To be more accurate, think of this column under the header, Highest Percentage Owner.
So, now -
Definition
With that in mind, the entry in this column is the direct-owner organization with the highest percentage of ownership of the provider listed in the row.
Some organizations listed in this column will have a suffix to the name in parentheses that identifies the direct-owner organization as:
- (JV) - the organization is part of a joint venture
- (NP) - the organization is a non-profit
If you click on the name for the (owned) provider at the left of the row, you will navigate to the Analyze page for that provider. Click on the "Ownership" tab and you will be able to examine more ownership details.
Analyze Page - Two Tables
On the Analyze page for any owned provider, you will find ownership information in two tables. In short, we distinguish between "direct" owners and "indirect" owners.
Details
There are several dimensions to the ownership of a provider. The owner can be one or more individuals or can be one or more entities (each defined by its Tax Identification Number). When the direct owner is an organization, it too can have one or more owners, which are labeled “indirect owners.” In principle, there can be several layers of owners, with the owner at the top of the organization chart being labeled in federal statute as the “ultimate parent.” Any entities below the ultimate parent which are not identified in the data are its subsidiaries. Ownership is defined broadly to include individuals and firms that have operational or managerial control.
As mentioned above, we are only including organizational owners.
Direct Owners
Direct ownership interest means the possession of equity in the capital, the stock, or the profits of the "owned" agency.
From the image below, we can see that "Sta-Home" holds equity in the capital, the stock, or the profits of Accentcare Home Health. Sta-Home is the direct owner.
Indirect Owners
Indirect ownership interest means any ownership interest in an entity that has an ownership interest in the "owned" agency. Many organizations that directly own a provider are themselves wholly or partly owned by other organizations (or even individuals). This is often the result of the use of holding companies and parent/subsidiary relationships. Such organizations and individuals are considered to be “indirect” owners of the provider.
From the image below, we can see that a list of organizations own the direct owner of Accentcare, which is identified as "Sta-Home" in the Direct Owners table.
Definitions
For simplicity sake, we will combine the definitions for the columns in both tables in the content below. Since all metrics but two appear in both tables, we will identify the unique columns
| Metric Name | Details |
| Name | The name of the owner as available from PECOS. |
| Organization ID | This is the number assigned by PECOS to the organizational provider named in the row. |
| Address/City/State | Mailing address information for the owner listed in the row |
| Ownership Percentage (Direct Owners only) | The percentage of direct ownership for the organization listed in the Direct Owners table. |
| Profit Type | Profit or not for profit status of the listed owner - see below for definition of not-for-profit. |
| Joint Venture (Direct Owners only) | The yes or no answer to the question, "Is this ownership a joint venture?" - see below. |
Joint Venture
Trella Health will identify an organization in the table as a joint venture if we find two or more current direct owners for a provider in the data. The joint venture owners will have different PECOS PAC IDs listed in the original data.
Joint ventures will not include indirect owners. For example, if a provider is owned by Corporation A, a direct owner, but Corporation A is owned by Corporation B and Corporation C (indirect owners of the provider), this would not be considered a joint venture.
Not-for-Profit
A not-for-profit is a group organized and operated for a collective, public, or social benefit and in which no part of the organization's income is distributed to its members, directors, or officers.
