Trends over Time in the Provision of Skilled Nursing Care in Critical Access Hospitals

executive summary

This study examines trends in the delivery of skilled nursing facility (SNF) services in both hospital-based units and swing beds during a period of dramatic change in Medicare payments for post-acute care, focusing on critical access hospitals (CAHs). In Prospective Payment System (PPS) hospitals swing bed skilled nursing care is now reimbursed under SNF-PPS, but CAHs continue to receive cost-based reimbursement. CAHs do not receive cost-based reimbursement for SNF services delivered in a dedicated hospital-based SNF unit; these are paid under the SNF-PPS rules for PPS and CAH facilities alike. However, the financial incentives for operating a SNF unit are very different for CAHs than they are for PPS hospitals because of the potential impact on overhead allocations.