ProviderPlots market brief
Barnstable County, MA
Healthcare market case study · hospitals and health systems, ownership, federal budget exposure, population and payer mix · data as of 2026-10-27
Executive summary
Hospitals. Barnstable County, MA has 4 hospitals with 416 beds and 3 hospital outpatient sites. Cape Cod Healthcare is the largest system, with 82% of hospital beds, followed by MGB (14%). Alongside them are 10 urgent care centers and 14 nursing homes.
Ownership. Of the 26 facilities with a confirmed public owner, 21 are run by operators headquartered in Massachusetts and 5 by out-of-state or national groups. National operators bring scale and capital; local ownership keeps decisions, and exposure to state Medicaid policy, close to the market.
Federal budget exposure. No hospital here reports a high Medicaid share of patient days, so hospital exposure to the 2025 Medicaid changes runs mainly through uninsured growth and state budget responses. The 14 nursing homes are exposed regardless: Medicaid is the main payer for most long-stay residents nationally, and state rate setting follows federal funding.
Population. Barnstable County, MA has 231,668 residents. 33.1% are 65 or older, against 17.9% in Massachusetts and 17.2% nationally: a senior index of 1.93 (93% older). Median household income is $95,241 (U.S. $80,734) and 7.7% live below the poverty line (U.S. 12.5%).
Payer mix. Commercial coverage (employer and individual) covers 45.6% of residents (U.S. 51.9%), Medicare alone 9.0% (U.S. 6.4%), Medicaid alone 11.1% (U.S. 15.0%) and 2.7% are uninsured (U.S. 8.4%). 24% of Medicare beneficiaries are in Medicare Advantage (U.S. 52%), so traditional Medicare rates and federal Medicare policy carry more weight here than in most markets.
Patients against providers. Primary care supply is 115 physicians per 100,000 residents against 71 nationally (index 1.62), with 148 nurse practitioners per 100,000 (U.S. 92). An older-than-average population is served by relatively fewer primary care physicians, a gap that widens as residents age.
1 · Hospitals and health systems
- Hospital
- Hospital outpatient site
- Urgent care
- Nursing home
- Size: beds
- Cape Cod Healthcare
- MGB
- Royal Health Group LLC
- Athena Healthcare Systems
- Integritus Healthcare
- Jml Care Center, Inc
- Advanced Allergy
- Cape Cod Telamedicine
- Other systems and operators
- Owner not yet confirmed
31 providers. Circles are hospitals, sized by beds; colour is the system or operator. Owners shown are those confirmed in public records.
| System or operator | Hospitals | Beds | Share of beds | Discharges |
|---|---|---|---|---|
| Cape Cod Healthcare | 2 | 340 | 82% | 21,954 |
| MGB | 1 | 60 | 14% | 1,233 |
| Owner not yet confirmed | 1 | 16 | 4% | 159 |
| Hospital | System | Beds | Discharges | Operating margin | Medicare share |
|---|---|---|---|---|---|
| Cape Cod Hospital | Cape Cod Healthcare | 259 | 16,668 | 3.5% | 55% |
| Falmouth Hospital | Cape Cod Healthcare | 81 | 5,286 | 1.1% | 62% |
| Spaulding Rehabilitation Hospital - Cape Cod | MGB | 60 | 1,233 | -13.3% | 62% |
| Cape Cod & Islands Community Mental Health Center | — | 16 | 159 | — | 7% |
Hospitals and beds from CMS Provider of Services; discharges, margin and payer days from the latest Medicare cost reports (HCRIS 2025). Systems are named where public records confirm the owner.
2 · Local or national ownership
| Facilities | Local operator (in-state) | Out-of-state operator | National operator (5+ states) | Owner not yet confirmed | |
|---|---|---|---|---|---|
| Hospitals | 4 | 3 | 0 | 0 | 1 |
| Nursing homes | 14 | 10 | 4 | 0 | 0 |
| Urgent care | 10 | 8 | 1 | 0 | 1 |
Operator is the public owner of record (CMS Medicare enrollment, Nursing Home Care Compare, NPPES); headquarters from public registrations. Local means headquartered in Massachusetts.
3 · Federal budget impacts: who is exposed
What changed. The 2025 federal budget reconciliation law (Public Law 119-21) reduces projected federal Medicaid spending by roughly $1 trillion over ten years (CBO), mainly through work and eligibility requirements for expansion adults from 2027, more frequent eligibility checks, a phase-down of state provider taxes and limits on state-directed payments from 2028. States absorb the difference through enrollment losses, rate cuts or both.
Who feels it first. Providers with a high Medicaid share of patients and thin margins: safety-net hospitals, rural hospitals and nursing homes, where Medicaid is the main payer for most long-stay residents nationally. Hospitals with a high Medicare share are exposed instead to Medicare payment policy (sequestration, site-neutral payment).
| Provider | Type | Owner | Medicaid share | Medicare share | Operating margin | Medicaid rate pressure |
|---|---|---|---|---|---|---|
| Cape Cod & Islands Community Mental Health Center | Hospital | — | 19% | 7% | — | Moderate |
| Cape Cod Hospital | Hospital | Cape Cod Healthcare | 9% | 55% | 3.5% | Lower |
| Falmouth Hospital | Hospital | Cape Cod Healthcare | 6% | 62% | 1.1% | Lower |
| Spaulding Rehabilitation Hospital - Cape Cod | Hospital | MGB | 2% | 62% | -13.3% | Lower |
Shares are of inpatient days from each provider's latest Medicare cost report (HCRIS 2025); margin is net patient revenue less operating expense. High pressure: Medicaid at 25% of days or more, or 15% or more on a margin under 2%. 14 nursing homes are in the market; cost-report payer data is shown where filed.
4 · Population and demographics
| Barnstable County, MA | Massachusetts | United States | Index to U.S. | |
|---|---|---|---|---|
| Residents | 231,668 | 7,044,056 | — | |
| Aged 65 and older | 33.1% | 17.9% | 17.2% | 1.93 |
| Under 18 | 14.1% | 19.4% | 22.0% | 0.64 |
| Median household income | $95,241 | $103,960 | $80,734 | 1.18 |
| Below the poverty line | 7.7% | 10.0% | 12.5% | 0.62 |
| Medicare beneficiaries | 88,444 | 1,519,172 | — | |
| In Medicare Advantage | 24.4% | 35.6% | 51.6% | 0.47 |
An index above 1.00 means the market has more of that group than the nation. Census ACS 2024 5-year estimates; CMS Medicare enrollment 2026-07-31.
5 · Payer mix against the nation
| Coverage (one type only) | Barnstable County, MA | United States | Index | |
|---|---|---|---|---|
| Employer coverage | 37.7% | 45.6% | 0.83 | |
| Individual market | 7.9% | 6.4% | 1.24 | |
| Medicare | 9.0% | 6.4% | 1.41 | |
| Medicaid | 11.1% | 15.0% | 0.74 | |
| TRICARE or VA | 0.8% | 1.1% | 0.70 | |
| Two or more types | 30.8% | 17.1% | 1.80 | |
| Uninsured | 2.7% | 8.4% | 0.32 | |
| Commercial (employer + individual) | 45.6% | 51.9% | 0.88 |
Share of the civilian non-institutional population by health coverage (Census ACS). The tick on each bar marks the national share. People with more than one type are counted once, under “two or more types”; most of them are older adults with Medicare plus supplemental or Medicaid coverage.
6 · Patients against providers
| Per 100,000 residents | Barnstable County, MA | Massachusetts | United States | Index to U.S. |
|---|---|---|---|---|
| Residents aged 65+ (share) | 33.1% | 17.9% | 17.2% | 1.93 |
| Primary care physicians | 115 | 93 | 71 | 1.62 |
| Specialist physicians | 178 | 146 | 102 | 1.75 |
| Hospital-based physicians | 105 | 87 | 61 | 1.73 |
| Psychiatrists and behavioral health clinicians | 164 | 130 | 62 | 2.66 |
| Nurse practitioners | 148 | 122 | 92 | 1.60 |
| Nurse anesthetists, midwives and clinical nurse specialists | 18 | 24 | 22 | 0.84 |
| Physician assistants | 108 | 65 | 44 | 2.46 |
Read the indexes together: a senior index above a clinician index means demand is outpacing supply. Clinicians by practice ZIP (CMS Doctors and Clinicians, NPPES).
Sources and method
U.S. Census Bureau American Community Survey; CMS Medicare enrollment, Provider of Services, Hospital Cost Reports (HCRIS), Nursing Home Care Compare and PECOS ownership; NPPES; Congressional Budget Office. Prepared by ProviderPlots from public data, 2026-10-27. Facts change: every provider page on providerplots.com carries its source and date.