Hospital Ownership: Medicare Sources of Information (CRS Report for Congress)
| Release Date |
Dec. 12, 2024 |
| Report Number |
IF12848 |
| Report Type |
In Focus |
| Authors |
Marco A. Villagrana |
| Source Agency |
Congressional Research Service |
Summary:
Congress’s understanding of hospital ownership is crucial
in exercising its legislative and oversight role with respect
to health care costs, quality, and access. The Centers for
Medicare & Medicaid Services (CMS)—the agency that
administers the Medicare program—collects ownership
information from Medicare health care providers and
suppliers, including hospitals. This data collection focuses
primarily on program integrity, such as ensuring accurate
and proper Medicare, and fraud, waste, and abuse
prevention and detection. This specific focus can make it
difficult to use CMS data to determine ownership’s effect
on health care cost, quality, and access.
Although CMS’s data collection may satisfy reporting
requirements for the purposes noted above, the Government
Accountability Office (GAO) and the Medicare Payment
Advisory Commission (MedPAC) have determined the
Medicare ownership data are not sufficiently detailed,
complete, or accurate to capture the complex business,
organizational, and corporate structures in the health care
sector. The data do not permit systematic analyses of the
effects of ownership type on health care cost, quality, and
access; this type of analysis is essential for Congress to
develop informed policies and conduct effective oversight.
This In Focus addresses two Medicare sources of hospital
ownership information—the Provider Enrollment, Chain,
and Ownership System (PECOS) and the Cost Report eFiling (MCReF) system. Content in these systems is
organized by the event or activity that triggers reporting by
a hospital—initial enrollment and revalidation of
enrollment in Medicare; a change of ownership (CHOW),
merger, acquisition, or consolidation; and the annual cost
report submission required by some hospitals and other
health care providers, though not all. Limitations of these
data sources are also discussed, focusing on limitations for
purposes of robust congressional oversight of hospital
ownership.
PECOS and MCReF data generally are available free of
charge. There are also nongovernment sources of ownership
information that require paid subscriptions; these data
sources are outside the scope of this In Focus.
