Looking for a Trella Health Alternative?
Fonteum publishes post-acute provider data sourced directly from CMS federal records — not derived from Medicare claims. CMS Care Compare quality ratings, PBJ Daily Nurse Staffing ( daily records across facilities), PECOS SNF All Owners ownership disclosure ( rows), and NH Health Deficiency Citations ( records, at the actual-harm threshold). Every field carries the CMS dataset citation, snapshot date, and known limitations.
Fonteum vs Trella Health
| Trella Health | Fonteum | |
|---|---|---|
| Post-acute data model | Claims-based post-acute market intelligence — utilization patterns, referral relationships, and PAC performance from Medicare claims | Direct CMS facility records: Care Compare (NH/HH/Hospice quality ratings), PBJ Daily Nurse Staffing (facility-level RN/LPN/CNA hours), PECOS SNF All Owners (ownership disclosure) — facility identity from the source |
| Nursing home coverage | Medicare claims-derived nursing home utilization and referral patterns | CMS Care Compare NH module — star ratings, health inspection history, staffing ratings; CMS PBJ Daily Nurse Staffing — daily RN/LPN/CNA hours per facility; CMS NH Health Deficiency Citations — per-citation scope/severity records |
| SNF ownership data | Ownership data derived from claims billing and NPI records | PECOS SNF All Owners — direct ACA § 6101 ownership disclosure: owner PAC ID, percentage ownership, entity type flags (for-profit/non-profit, holding company, investment firm) |
| Provenance transparency | Derived from claims data; source lineage proprietary | Source name + last-checked date + limitation on every field: CMS dataset ID + snapshot date + Fonteum methodology version |
| Pricing model | Enterprise license for PAC market intelligence; typical five-to-six-figure annual contracts | Free public access to all PAC research + datasets; pilot tier from $2,500/mo for custom exports and API access |
| FHIR R4 API | Proprietary API; FHIR conformance not a primary product surface | FHIR R4 US Core 6.1.0 — 5 USCDI v3 resources: Practitioner, Organization, Location, PractitionerRole, HealthcareService |
Facility identity from the source, not inferred from claims
PBJ Daily Nurse Staffing — the payroll record, not a survey estimate
The CMS Payroll-Based Journal (PBJ) captures actual daily staffing hours from facility payroll systems — RN Director of Nursing, RN Administrative, RN Direct Care, LPN, CNA, Medication Aide. This is the federal compliance record that CMS uses to calculate staffing star ratings. Fonteum ingests the quarterly PBJ PUF directly — 1.3M+ daily records across 14,537 facilities for CY2025Q2: one row per facility per day, with employee vs contractor breakout. It matters more since the federal 3.48-HPRD staffing minimum was rescinded (Dec 3, 2025, effective Feb 2, 2026), leaving per-facility transparency as the accountability mechanism. The aggregate surface is at /staffing.
SNF ownership disclosure under ACA § 6101
PECOS SNF All Owners captures what facilities are required to disclose under ACA Section 6101 — 280,207 ownership rows across 14,425 facilities: owner name, owner PAC ID, percentage ownership (25.0 = 25%), entity type (for-profit/non-profit, holding company, investment firm, medical staffing company), and affiliation entity ID for chain analysis. This is the statutory disclosure record — not derived from NPI billing or corporate filings. Fonteum flags the documented gap (82.4% of top-10 chains have missing ownership_percentage in the source file, per a Health Affairs 2024 analysis) rather than imputing it.
Deficiency citations: scope, severity, and F-tag, per survey
CMS NH Health Deficiency Citations is the per-citation record for every health inspection finding — 418,148 records across 14,635 facilities: B–L scope/severity code, F-tag taxonomy, survey date, and whether the citation is under IDR. Across the dataset, 5.59% of citations sit at scope/severity G or above (actual harm). Fonteum's research study found a 14.7× disparity in harm-rate citations between Illinois (4.57 G+/facility) and New Hampshire (0.31/facility) — a state-survey-intensity story documented with methodology at /research/nursing-home-deficiency-correction-time.
Ingest → provenance → deliver
STEP 1 / INGEST
Pull post-acute records directly from CMS
Fonteum ingests the post-acute facility records straight from CMS portals on each source's native cadence: Care Compare for nursing home, home health, and hospice; PBJ Daily Nurse Staffing ( daily records, facilities, quarterly); SNF All Owners ( ownership rows); and NH Health Deficiency Citations ( records). The CMS Provider of Services file supplies the CCN identity backbone — no claims feed, no inferred facility identity.
STEP 2 / PROVENANCE
Attach source, date, and limitation to every field
Each fact is written to the provider_field_provenance layer with the CMS dataset citation, snapshot date, and any known limitation. The documented gap in SNF ownership-percentage values is flagged with a data-availability state rather than imputed; deficiency citations keep their B–L scope/severity code and survey event ID; PBJ rows keep their employee-versus-contractor breakout. The federal record is preserved as it is.
STEP 3 / DELIVER
Free surfaces, FHIR R4 API, and joined exports
The data ships three ways: free public surfaces at /ownership, /staffing, /deficiencies, and /care-compare/nursing-homes (CSV + JSON, no account), a FHIR R4 US Core 6.1.0 API with HL7 bulk $export, and scoped pilot exports from $2,500/mo — including a single facility-keyed export joining ownership, staffing, quality, and deficiencies for a target portfolio via the federal CCN.
Common questions
- How does Fonteum's post-acute data differ from Trella Health?
- Trella Health is built on Medicare claims data — it derives post-acute market intelligence from billing patterns: referral relationships, utilization rates, and PAC provider performance inferred from claims. Fonteum is built on direct CMS facility records: CMS Care Compare for nursing home, home health, and hospice quality ratings; CMS PBJ Daily Nurse Staffing for facility-level RN/LPN/CNA hours ( daily records across facilities, CY2025Q2); PECOS SNF All Owners for ACA § 6101 ownership disclosure ( ownership rows across facilities); and CMS NH Health Deficiency Citations ( records across facilities). These are the source-of-truth facility identity, ownership, staffing, and quality records — not inferences from billing. The practical difference: a claims model can estimate a facility's referral volume, but only the federal payroll record shows its actual reported nurse hours, only the PECOS disclosure shows its ownership chain, and only the survey record shows its inspection findings — each with a CMS dataset citation and snapshot date written to the provenance layer.
- Does Fonteum have nursing home deficiency and penalty data?
- Yes, sourced directly from CMS records rather than derived from claims. Fonteum ingests CMS NH Health Deficiency Citations (Provider Data Catalog r5ix-sfxw) as a per-citation record: scope/severity code on the B–L scale, F-tag taxonomy, survey event ID, and survey date. The dataset spans citation records across facilities on a three-year rolling basis, and of those citations sit at scope/severity G or above — the threshold for actual harm to a resident. The aggregate surface is at /deficiencies, and the analysis at /research/nursing-home-deficiency-correction-time documents a 14.7× disparity in harm-rate citations between Illinois (4.57 G+ per facility) and New Hampshire (0.31) — a state-survey-intensity finding that does not appear in aggregate star ratings. A separate study covering $467M in civil money penalties and 2,553 payment denials across 6,919 facilities is at /research/nursing-home-penalties-enforcement. Each citation carries its CMS source citation and methodology version.
- Does Fonteum have SNF ownership and chain data?
- Yes. Fonteum ingests the PECOS-derived CMS SNF All Owners dataset (ACA Section 6101; 42 CFR § 424.516) — ownership rows across facilities. Each row carries the owner name and PAC ID, the percentage ownership where disclosed (25.0 = 25%), entity-type flags (for-profit/non-profit, holding company, investment firm, medical staffing company), and the affiliation entity ID used for chain analysis. The ownership and chain-analysis surface is at /ownership. Crucially, Fonteum surfaces a known gap rather than hiding it: of the top-10 nursing home chains have missing ownership_percentage values in the source file — a finding first documented in a Health Affairs 2024 analysis and reproducible from the public CMS file. Rather than impute a percentage, Fonteum flags the field with an explicit data-availability state, because ownership percentage is the primary signal for controlling-interest determination under OIG affiliate-exclusion doctrine, and a fabricated value would be worse than a marked silence.
- Can I access Fonteum's post-acute data without an enterprise contract?
- Yes. All post-acute research snapshots and datasets are free to access and cite at /research, /deficiencies, /staffing, and /ownership — no account and no API key for the static CSV and JSON files. This is possible because the underlying CMS records are federal public works under 17 U.S.C. § 105, so Fonteum redistributes the structured, provenance-tagged versions openly. That is a structurally different model from PAC market-intelligence platforms, which typically gate the same federally derived data behind five- or six-figure annual enterprise contracts. For production use cases — bulk exports scoped to specific facility types, geographies, or ownership chains, or a joined export linking PBJ staffing to SNF ownership and Care Compare quality for a target portfolio — the pilot tier starts at $2,500/mo and adds FHIR R4 API access, methodology-versioning commitments, and a 30-day no-penalty exit. No enterprise contract is required for public data access.
- Why does the federal payroll staffing record matter more after the staffing-minimum repeal?
- CMS Payroll-Based Journal (PBJ) data captures actual daily staffing hours from facility payroll systems — RN, LPN, CNA, and contract staff — not self-reported estimates. Fonteum ingests it directly: daily records across Medicare-certified facilities for CY2025Q2, one row per facility per day with employee-versus-contractor breakout. This record became more important, not less, after the federal minimum staffing rule (3.48 total nurse hours per resident day) was rescinded on December 3, 2025, effective February 2, 2026. With no federal floor enforceable, per-facility staffing transparency is the remaining accountability mechanism for residents, families, researchers, and acquirers. A facility trending toward contract-heavy staffing or below-threshold RN hours is a quality and regulatory signal that appears in the federal payroll record before it shows up in a Five-Star rating change. A claims-derived model does not see payroll hours at all; the PBJ record is the only source that does, and Fonteum publishes it with full provenance.
- Can I join Fonteum's post-acute datasets together for diligence?
- Yes — joining ownership, staffing, and quality is the core post-acute diligence workflow, and Fonteum's datasets share the federal facility identifier (the CMS Certification Number, or CCN) that makes the join clean. The CMS Provider of Services (POS) file serves as the CCN identity backbone, so a SNF's PECOS ownership record ( rows), its PBJ staffing history ( daily records), its Care Compare star ratings, and its deficiency citations (records) can be assembled into one facility-keyed view. The free surfaces at /ownership, /staffing, /deficiencies, and /care-compare/nursing-homes let you explore each layer; for a target portfolio, the pilot tier delivers a single scoped export joining all of them, with every field retaining its source citation, last-checked date, and any limitation. Because the join keys on the federal CCN rather than a proprietary entity ID, the result is reproducible against the public CMS files rather than locked to a vendor's data model.
Explore the post-acute data layer.
Browse free datasets at /staffing, /deficiencies, and /ownership, or request access to scope a custom PAC export.
- /staffing → PBJ Daily Nurse Staffing — facility-level RN/LPN/CNA hours from the federal payroll record.
- /deficiencies → CMS NH Health Deficiency Citations — per-citation scope/severity, F-tag, and penalties.
- /ownership → PECOS SNF All Owners — ACA § 6101 ownership disclosure and chain analysis.
- /care-compare/nursing-homes → CMS Care Compare NH module — star ratings, staffing, health inspection history.
- /sources → Full source library — 44 federal source families with tier, refresh cadence, and limitations.