4 Steps for Growing Your Swing Bed Program

As of July 2018, there were nearly 1,400 Critical Access Hospitals (CAHs), and the majority of them provided swing bed services. No, the beds don’t swing physically. Rather, they can swing between—or be used interchangeably for—acute-care and post-acute care patients. The Centers for Medicare and Medicaid Services established the program nearly four decades ago with a dual aim: first, to provide a needed service in communities that are underserved by long-term care and skilled nursing facilities; and second, to offer small rural hospitals another revenue stream, minimizing their risk of closure due to low census numbers on the acute care side.

To be eligible for swing bed services, a hospital must have fewer than 100 hospital beds and be located in a rural area. Rural hospitals (not CAHs) are reimbursed for swing bed services using the SNF prospective payment system, while CAHs are currently reimbursed at a rate of 101 percent of “reasonable cost,” making swing bed services a significant revenue opportunity for CAHs. Here’s four steps to growing the swing bed program at your facility.

1. Stay on top of regulatory changes
Several key changes affecting swing bed services went into effect in the past two years. New requirements for LTC facilities went into effect in November 2017, while revisions for Swing Bed came in October 2018. New language addressed in Appendices A (for hospitals) and W (for CAHs) include:

      • Resident choice of physician and information provided to the resident on how to contact physicians
      • Timelines for reporting abuse
      • Clarification regarding dental care including timelines
      • Providing culturally-competent and trauma-informed care (see recent HealthTechS3 webinar, Swing Bed Series Part 2: Implementing Trauma-Informed Care for more on this topic)
      • Development of plan of care and who must be involved
      • Reconciliation of pre-discharge medications with post-discharge medications
      • Discharge documentation including providing information to the next provider of care
      • Notification of discharge provided to ombudsman

For more information on these changes and what they mean for hospitals and CAHs with swing bed programs, check out our past webinar, Strategies for Growing Your Swing Bed Program, which includes a roundup of the changes from Carolyn St. Charles, RN, BSN, MBA, Chief Regional Clinical Officer for HealthTechS3.

2. Know who’s eligible for swing bed services
In order to bill for swing bed services, there are several criteria that must be met for Medicare. (Our focus is on Medicare because the majority of patients are in this population, but other payers may have slightly different criteria.) Conditions include:

      • Patient has Medicare Part A with benefit days available
      • Medicare age and disability/disease eligibility requirements met
      • Clarification regarding dental care including timelines
      • Patient is admitted to swing bed within 30 days of discharge from acute care
      • Reconciliation of pre-discharge medications with post-discharge medications
      • Patient’s condition meets criteria to necessitate inpatient skilled nursing services

Teaching a patient or a caregiver how to manage treatment can also require skilled nursing staff and is included in swing bed services. Such activities can include teaching or training on self-administration of injectable medications, gait training and prosthesis care, post-op care from colostomy or ileostomy, and care and maintenance for central lines.

3. Focus on internal referrals

With a limited number of swing bed patients, CAHs need to actively pursue referrals—both internal and external. Internal referrals are those influencers inside your CAH that determine readiness to accept swing bed patients. Influencers may include utilization review, discharge planning, social work, physical therapy, nursing staff and providers.

It’s important to identify potential swing bed patients at the time of admission to acute care, and not wait until the day of discharge. Discharge planning, to be timely, must start at the time of admission.

Daily interdisciplinary rounds or care conferences are a good opportunity to discuss the potential for swing bed referral. It’s important that providers and clinical staff understand the criteria for swing bed so they know what patients may be eligible.

Providing influencers information about the advantages of swing bed services can help increase internal referrals. In addition to additional revenue for the hospital, advantages for both the patient and their support persons include:

    • Staying in the same facility;
    • Care provided by the same care team, including providers; and
    • In many instances, a shorter length of stay than in a skilled nursing facility.

4. Pursue external referral sources
External referrals mean creating relationships with case managers at urban and PPS hospitals or tertiary care centers in the community. Depending on where you are located, “community” can be a distance of 15 minutes to 3 hours. The goal is creating a relationship so that your CAH is the first location considered when swing bed services are needed.

Make no mistake, establishing a large referral network is time-consuming and complex, and relationships will not get built quickly. Identify a swing bed coordinator who can manage the process, both for internal and external referrals. This coordinator will need to be able to articulate the benefits of your swing bed program and offer a value proposition for different referral sources.

HealthTechS3 has been providing swing bed consulting services since the program began. If you’d like more information on what’s happening in this area of clinical care or want to discuss how we might support your organization, please contact Carolyn St. Charles at Carolyn.stcharles@healthtechs3.com.