FONTEUM · USE CASE · M&A DILIGENCE
SNF owners
Federal facility data for healthcare M&A.
Ownership, staffing, and deficiency history joined from CMS primary sources, with field-level provenance.
Request access →Ownership · staffing · deficiency history
- rows · 14,425 facilities
CMS SNF All Owners
Ownership chain
ownership rows across 14,425 facilities — managing organization, operating organization, and individual owner records with percentage interests and role types. PECOS-derived under ACA §6101 / 42 CFR §424.516. A Health Affairs 2024 analysis found of top-10-chain rows carry a missing ownership_percentage in the source file.
- records/qtr · 14,537 facilities
CMS PBJ Daily Nurse Staffing
Staffing risk signal
daily records per quarter across 14,537 facilities (CY2025Q2) — RN, LPN, and CNA payroll hours from CMS Payroll-Based Journal. With the federal 3.48 HPRD minimum staffing rule rescinded Dec 3, 2025 (effective Feb 2, 2026), per-facility staffing transparency is the remaining accountability mechanism.
- citations · facilities
CMS Care Compare NH Deficiencies
Regulatory risk history
citation records across nursing home facilities. Deficiency tag, harm scope, G+ harm flags, survey event IDs. Three-year rolling dataset — the federal audit trail for facility quality.
The federal record acquirers need for regulatory risk
Ownership transparency from the federal PECOS record
across 14,425 facilities — is derived from PECOS under ACA §6101 / 42 CFR §424.516, the same federal authority CMS uses to validate Medicare participation. It includes managing organization, operating organization, and individual owner records with percentage interests and role types. This is the federal ownership record, not a commercially assembled database. The caveat acquirers must price in surfaces in the file itself: a Health Affairs 2024 analysis found of top-10-chain rows carry a missing ownership_percentage, which Fonteum flags as a documented field limitation rather than imputing.
Staffing trend as an operating signal
CMS Payroll-Based Journal (PBJ) data is a quarterly facility-level staffing submission required for Medicare participation — daily records across 14,537 facilities in CY2025Q2. Fonteum surfaces daily RN, LPN, and CNA payroll hours. With the federal 3.48 HPRD minimum staffing rule rescinded December 3, 2025 (effective February 2, 2026), there is no national floor to underwrite against — making per-facility staffing transparency the remaining accountability mechanism. A facility drifting toward contract-heavy staffing or sustained low RN hours shows in the federal payroll record before a Five-Star rating change.
Deficiency history: the G+ flag is the risk floor
CMS Care Compare NH deficiency data contains citation records across facilities, of which 5.59% reach scope/severity G or above — actual harm to a resident — the floor for regulatory risk in an acquisition. Fonteum's study at /research/nursing-home-deficiency-harm-rate-2026 shows IL at 4.57 G+ citations per facility vs NH at 0.31 — a 14.7× disparity that does not appear in aggregate star ratings. Each G+ citation carries its survey event ID and CMS source citation.
From CMS portal to scoped diligence dataset
Ingest
Fonteum pulls directly from the CMS portals on each source's native cadence — SNF All Owners ( rows across 14,425 facilities), PBJ Daily Nurse Staffing ( records per quarter across 14,537 facilities), and Care Compare NH Deficiencies ( citations across facilities). No commercial aggregator sits between the diligence model and the federal record, so a target's ownership, staffing, and enforcement history reflect the current government file.
Provenance
Every field is written with its source name, last-checked date, and documented limitation through the provider_field_provenance layer — including material gaps such as the of top-10-chain rows that carry a missing ownership_percentage in the federal file. The result is an auditable chain from each value in a diligence dataset back to the exact CMS file it came from, which is what an acquirer's counsel needs to underwrite enforcement exposure.
Deliver
Facility data is free as public research at /research, /ownership, /staffing, and /deficiencies, through the FHIR R4 US Core 6.1.0 API with SMART Backend Services auth, and via HL7 bulk $export. Scoped pilot exports — ownership chain, PBJ staffing trend, and G+ deficiency history joined and keyed to a target portfolio — start at $2,500/mo with the federal provenance chain preserved.
Common questions
- What facility-level data does Fonteum provide for healthcare M&A due diligence?
- Fonteum provides three federal data layers directly relevant to skilled nursing and post-acute facility acquisitions, drawn from a graph of 22 federal source families. The first is CMS SNF All Owners — 280,207 PECOS-derived ownership rows across 14,425 facilities, capturing managing organization, operating organization, and individual owner percentage interests under ACA §6101 / 42 CFR §424.516. The second is CMS PBJ Daily Nurse Staffing — 1.3M+ daily records per quarter across 14,537 facilities (CY2025Q2), reporting RN, LPN, and CNA payroll hours. The third is CMS Care Compare NH Deficiencies — 418,148 citation records across 14,635 facilities, carrying deficiency tag, harm scope, survey event ID, and the G or above harm flag. All three carry explicit federal source citations and last-checked dates through the provider_field_provenance layer, so an acquirer can trace any value in a diligence model back to the originating CMS file rather than to a commercial interpretation of it.
- Can I access ownership chain data for skilled nursing facilities?
- Yes. The CMS SNF All Owners dataset is published at /ownership. It contains PECOS-derived ownership rows spanning 14,425 facilities — managing organization, operating organization, and individual owners with percentage interest and role type. The data is collected under the Affordable Care Act §6101 and 42 CFR §424.516, the same federal authority CMS uses to validate Medicare enrollment. An important diligence caveat surfaces directly in the file: a Health Affairs 2024 analysis, reproducible from the public CMS data, found that of top-10-chain rows carry a missing ownership_percentage. Fonteum surfaces that gap as a documented limitation on the field rather than silently imputing a value, because for an acquirer the absence of a percentage is itself material. For bulk ownership-chain exports scoped to a target portfolio, request scoping via press@fonteum.com.
- How does Fonteum's deficiency data compare to commercial healthcare intelligence platforms?
- Commercial platforms typically surface CMS Care Compare data as a derived metric or a rolled-up star rating, with no path back to the underlying citation. Fonteum publishes the underlying CMS Care Compare citation record itself — deficiency tag, harm scope, survey event ID, and the G or above harm flag — alongside the CMS source citation and methodology version. The full dataset of citations across facilities is freely downloadable at /research/nursing-home-deficiency-harm-rate-2026. The study shows that 5.59% of all citations reach scope/severity G or above — actual harm to a resident — and that the rate varies sharply by state: Illinois averages 4.57 G+ citations per facility against New Hampshire's 0.31, a 14.7× disparity invisible in aggregate star ratings. For regulatory-risk diligence, the federal citation record, not a vendor's interpretation, is the artifact an acquirer's counsel needs to underwrite enforcement exposure.
- Is Fonteum's healthcare facility data downloadable in bulk?
- Yes. The Care Compare NH deficiency dataset ( citations across facilities), the PBJ staffing study ( daily records per quarter across 14,537 facilities for CY2025Q2), the SNF All Owners surface ( ownership rows across 14,425 facilities), and the other CMS datasets are downloadable as CSV and JSON from /research, each with its methodology notes and field-level provenance. For programmatic access, Fonteum exposes an HL7 FHIR R4 US Core 6.1.0 API with SMART Backend Services auth and an HL7 bulk $export operation returning NDJSON. For M&A diligence work that needs facility-level exports scoped to a target portfolio — ownership chain, staffing trend, and deficiency history joined in one dataset and keyed to the facilities under evaluation — the pilot tier provides custom scoping starting at $2,500/mo, with the federal provenance chain preserved on every field.
- Why does the PBJ staffing layer matter more after the 2025 staffing-rule rescission?
- CMS Payroll-Based Journal data is a quarterly, facility-level staffing submission required for Medicare participation, reporting actual RN, LPN, and CNA payroll hours — daily records per quarter across 14,537 facilities in CY2025Q2. In 2024 CMS finalized a federal minimum staffing standard of 3.48 total nurse hours per resident day, but that rule was rescinded on December 3, 2025, effective February 2, 2026. With no federal staffing floor in force, there is no single regulatory threshold an acquirer can underwrite against — which makes per-facility staffing transparency the remaining accountability mechanism. For diligence, the PBJ trend becomes the leading operating signal: a facility drifting toward contract-heavy staffing or sustained low RN hours shows stress in the federal payroll record well before it surfaces in a Five-Star rating change or a survey deficiency. Fonteum surfaces those daily hours with source citation and last-checked date intact.
- What is the G+ harm flag and why is it the regulatory-risk floor?
- CMS assigns every nursing-home survey deficiency a scope-and-severity letter from A through L. Citations at scope/severity G or above — the G+ band — denote actual harm to a resident rather than potential for harm, and they carry the heaviest enforcement consequences, including Civil Monetary Penalties and, in escalated cases, denial of payment for new admissions. In Fonteum's dataset of citations across facilities, 5.59% fall at G or above. Because a G+ citation marks realized resident harm with documented federal enforcement exposure, it functions as the regulatory-risk floor in a SNF acquisition: a target's G+ history is the minimum any diligence model must price in. The state-level spread underscores why the raw citation matters — Illinois at 4.57 G+ per facility versus New Hampshire at 0.31 is a 14.7× difference that aggregate ratings smooth over. Fonteum exposes each G+ citation with its survey event ID and CMS source citation.
Request a facility-diligence pilot.
Ownership chain + staffing trend + deficiency history in one scoped export. Free public data at /ownership, /staffing, and /deficiencies. Pilot tier from $2,500/mo.
- /ownership → CMS SNF All Owners — ownership chain surface.
- /staffing → CMS PBJ Daily Nurse Staffing — facility-level staffing hours.
- /deficiencies → CMS Care Compare NH Deficiencies — citations.
- /compare/definitive-healthcare-alternative → Fonteum vs Definitive Healthcare.