Under the Medicare program, rural hospitals with 100 or fewer licensed routine care beds are eligible to participate in the swing bed program, meaning that a bed can be used for either an acute care patient or a postacute patient who has been discharged from a medically necessary three-day minimum acute stay and requires skilled nursing care. Swing bed hospitals include both critical access hospitals (CAHs) and those paid under the Prospective Payment System (PPS), but the financial incentives for providing SNF care in a swing bed differ dramatically between the two types of hospitals.

This project will comprehensively address questions about how swing beds are used by hospitals; whether decision about use are driven by patient need, community resources, hospital operational concerns or some combination of these factors; the cost implications of swing bed use in critical access hospitals to the Medicare program; and whether patients served in swing beds differ in meaningful ways from those in skilled nursing facilities (SNFs). To meet these goals, the project has three components. 

Component 1 is a qualitative study consisting of semi-structured interviews with administrators of hospitals with swing beds, and of SNFs that are located in the same communities. 

Component 2 will build on information learned from the interviews to address the question of the cost to the Medicare program of swing bed use. 

Finally, component 3 will consider patient characteristics and experience, and the extent to which there are differences between those in swing beds and those in SNFs.

Publications

• Discharge to Swing Bed or Skilled Nursing Facility: Who Goes Where?
  Policy Brief
  North Carolina Rural Health Research and Policy Analysis Center
  Date: 02/2014
  This brief examines health conditions of patients discharged from rural prospective payment system (PPS) hospitals and critical access hospitals (CAHs) to swing beds and skilled nursing facilities (SNFs).
• Effect of Swing Bed Use on Medicare Average Daily Cost and Reimbursement in Critical Access Hospitals
  North Carolina Rural Health Research and Policy Analysis Center
  Date: 12/2011
  This analysis estimates the average net cost to Medicare of a SNF swing day by simulating the elimination of all Medicare SNF swing bed days in CAHs in 2009.
• Trends in Skilled Nursing Facility and Swing Bed Use in Rural Areas Following the Medicare Modernization Act of 2003 (Final Report)
  Rapid Response to Requests for Rural Data Analysis
  Date: 04/2011
  This report provides descriptive evidence on current trends in the availability and use of swing beds and skilled nursing facility services in rural areas.
• Trends in Skilled Nursing Facility and Swing Bed Use in Rural Areas Following the Medicare Modernization Act of 2003 (Findings Brief)
  North Carolina Rural Health Research and Policy Analysis Center
  Date: 08/2011
  This findings brief looks at whether the availability of post-acute skilled care stabilized and how and where is it being provided today now that the reimbursement policy changes begun in the late 1990s have been fully implemented.
• Why Use Swing Beds? Conversations With Hospital Administrators and Staff (Findings Brief)
  North Carolina Rural Health Research and Policy Analysis Center
  Date: 04/2012
  In this study, we interview hospital administrators and staff about the use of swing beds. Topics include the role of swing beds in patient care, swing bed volume and financial considerations, swing beds in the context of all community post-acute skilled care, and swing beds as a benefit for community residents.