Factors Predicting Swing Bed Versus Skilled Nursing Facility Use
In the brief, Factors Predicting Swing Bed Versus Skilled Nursing Facility Use, the NC Rural Health Research Program, examines differences between patients discharged to swing beds versus SNFs, stratifying by admitting hospital type (i.e., rural CAH versus rural PPS hospital). Identification of key differences between patients discharged to swing beds versus SNFs can help inform further discourse on this financially and clinically important topic.
- Using data from the 2019 Healthcare Cost and Utilization Project (HCUP) State Inpatient Databases (SID), we found that 4.0% of discharges from rural Critical Access Hospitals (CAHs) were discharged to swing beds, and 9.1% of rural CAH discharges were discharged to skilled nursing facilities (SNFs). In contrast, 0.2% of discharges from rural Prospective Payment System (PPS) hospitals were discharged to swing beds, and 10.7% of rural PPS hospital discharges were discharged to SNFs.
- Compared to those discharged to SNFs and adjusting for discharging hospital type (rural CAH versus rural PPS hospital), individuals discharged to swing beds were generally younger, more likely to be White, more likely to live in a rural ZIP code, more likely to be primarily insured via Medicare, and less likely to be primarily insured via private insurance. Individuals discharged to swing beds also had a lower average number of comorbidities.
- Compared to discharges to SNFs and adjusting for discharging hospital type, discharges to swing beds were more likely to be classified as surgery-related visits during acute care.
We found that discharges to swing beds exhibited several statistically significant differences from discharges to SNFs, both in terms of demographic characteristics (e.g., age, race/ethnicity, location of residence) and clinical characteristics (insurance status, length of acute care stay, number of comorbidities, service line, major diagnostic category, principal diagnosis, primary procedure classification). These results collectively suggest that swing bed versus SNF use for post-acute care is at least partially dependent on patient-level characteristics.