Clarifying the Opportunities and Challenges for Rural Hospitals with Swing Beds

Swing beds represent both a source of revenue for rural hospitals and a much-needed service for the communities they’re in. They’re a win-win, you might say. And yet, this program that allows hospitals that meet certain qualifications to “swing” their beds between acute and long-term care continues to be underutilized.

The reasons are varied. It certainly doesn’t help that the regulations have changed substantially in the past few years.   The Conditions of Participation (CoPs) changed substantially in October 2018, a new reimbursement model for PPS hospitals with a distinct part swing bed unit was released in 2019, followed by more changes in February 2020. 

Another reason for under-utilization is admitting only patients requiring physical therapy, occupational therapy or speech.  Patients that have nursing needs such as wound care, patient teaching, and management of the plan of care are often seen as not being candidates for Swing Bed, even though those are all appropriate uses according to CMS.

A third reason is discharging patients too soon.  CMS, in the program memo Jimmo v. SebeliusSettlement Agreement stated that,Medicare has long recognized that there may be situations in the SNF, home health, and outpatient therapy settings where, even though no improvement is expected, skilled nursing and/or therapy services to prevent or slow a decline in condition are necessary because of the particular patient’s special medical complications or the complexity of the needed services.”

And lastly, not having a reliable process in place to quickly accept referrals from other hospitals.  Most hospitals who are referring patients expect a quick turn-around to help them manage length of stay and reimbursement.

HealthTechS3 recognizes the importance of Swing Bed programs both to the hospitals that can implement them and the patients who can benefit from them, and so we routinely hold webinars on the topic to encourage hospital leaders to learn more about swing beds, how they work and what individual facilities need to do to maintain a successful program. The next webinar will be held Tuesday, Feb. 12, and it’s the perfect opportunity to gain both a basic understanding of the requirements of a swing bed program and the confidence needed to implement—or grow—one in your facility.

Led by St.Charles, the webinar, “Swing Into Winter: Understanding Swing Beds,” will review eligibility and admission requirements, the audit tools you’ll want to have in place for assessing your swing bed program, potential barriers for growth and tips for engaging your entire organization in these efforts. Reserve your spot today.

If you are interested in consulting services designed to help you implement or grow a swing bed program, please contact Carolyn St.Charles at