It’s no secret that the country’s population is aging, and many seniors will continue to require more complex healthcare services. For years, the healthcare industry has prepared to care for this aging population, but the pandemic hit providers with an exodus of exhausted workers and subsequent staffing shortages. These shortages have created a domino effect of instability, especially for skilled nursing facilities (SNFs), and has experts asking: Who will provide care for this generation?
Even before the pandemic, SNFs felt the staffing shortage squeeze largely due to insufficient reimbursement rates and competitive wages offered outside of the healthcare industry. These historic staffing shortages (exacerbated by the pandemic) have required SNFs to limit new admissions or even close their doors, which creates a bottleneck for hospital discharges. The loss of SNF beds means that facilities that survived the pandemic are often full, staffed to a reduced bed capacity, or unable to admit complex cases. And those patients who would normally be discharged from the hospital are staying put, causing a costly increased length of stay in the acute setting.
To help meet this challenge of SNF placement, rural and critical access hospitals (CAHs) have the opportunity to utilize swing beds. Reimbursed by Medicare, swing beds can be described as hospital beds used interchangeably for acute care or post-acute care, allowing the patient to stay in the same physical location. Post-acute services can include rehabilitation, IV medication therapy, respiratory support, and wound care. Medicare will reimburse for up to 100 days of swing bed care under the SNF prospective payment system.
Using swing beds can help rural hospitals and CAHs further support the local community, contribute to improved outcomes and patient satisfaction, and potentially create positive financial results by reducing or even eliminating unnecessary days in inpatient care.
Swing Bed Readiness
If your rural hospital or CAH is facing challenges with discharging qualifying Medicare patients and is interested in implementing a swing bed program, Forvis Mazars recommends the following considerations to help gain a solid financial footing:
- Assess the Market – Examine the operating climate of the SNFs in your market area. Are they operating at a reduced bed capacity? Are any for sale? Have you had the appropriate conversations with your area referral SNFs to confirm there is no better alternative to free up discharges by working together more closely to solve the problems?
- Financial Modeling – Swing beds can often contribute to a positive operating margin due to the increased reimbursement for a service that wouldn’t otherwise be covered. There also are some hospital efficiencies to providing both acute and post-acute services from the same patient bed. However, it’s important to complete this forecasting exercise and assess which additional resources (beds, staffing, leadership, services, etc.) are needed.
- Understand SNF Operations – Make sure that leadership and the interdisciplinary team comprehend the reimbursement methodology, requirements of participation, and assessment tools that are utilized by both SNFs and swing beds.
- Complete the Steps for Enrollment – Hospitals must apply and be approved by CMS to provide these post-acute/swing bed services.
- If a swing bed program is already in place, is there a need for additional beds (maximum of 25 beds) to meet post-pandemic demand and ease any inpatient bottleneck discharges?
If your hospital is experiencing discharge challenges, swing beds may be an option to help alleviate this financial and operational burden. If you would like additional guidance on incorporating swing beds into your existing services, please reach out to a professional at Forvis Mazars.