The Medicare payment system for SNFs has become increasingly broken, a report states.

The percentage of hospitals with shared ownership or investor links to a post-acute care provider jumped from 25% in 2005 to nearly 50% in 2015, a new Health Affairs study shows. That sharp increase could have policy- and care-related implications, according to the study’s authors.

The Harvard University-based research team used data from the Centers for Medicare & Medicaid Services’ Provider Enrollment, Chain and Ownership System to determine how investor links between hospitals and the post-acute care sector have evolved over time.

Healthcare ownership had previously focused on single operating organizations, like chains, but an increasing number of corporate investors now have stakes in multiple providers and sectors, the authors said.

Their findings, published Tuesday, showed that hospitals with investor links to skilled nursing facilities increased from 10.7% in 2005 to 17.5% in 2015. The study’s results also found 61.8% of skilled nursing facilities had some sort of corporate investor in 2015 compared to 36% in 2005. In 2005 nearly 28% of skilled nursing facilities had a health company investor; that increased to 48.4% in 2015.

The study also found that 48% of the country’s skilled nursing providers had a chain affiliation in 2015, compared to 21% in 2005.

The main scenarios behind the investor link increase have been a post-acute care based investor acquiring a stake in a hospital or vice versa, study co-author David Grabowski, Ph.D., told McKnight’s Long-Term Care News. An independent third entity acquiring stake occurred “relatively infrequently.”

Grabowski predicted the increases could continue over time — a trend that has both pros and cons for the long-term care sector. The study’s authors offered up the example of hospitals referring their most profitable patients to skilled nursing facilities they have a stake in.

“Some might argue there’s a potential for improved care coordination or integration, and I think that’s a fair point,” Grabowski said. “But along with that we also want to be on the lookout for increased consolidation in market power with lower quality and higher prices.”

Grabowski also noted that the data could be used to monitor fraud and abuse within the common investor ownerships.

“We’ve seen this when industries are tied together. There’s always the potential for kickbacks or other nefarious behaviors,” Grabowski said.

The research team said that information on acute and post-acute providers’ investor links should be made available on Nursing Home Compare and similar federal websites for consumers to consider as they choose a care provider.