Comprehensive Study of Swing Bed Use in Rural Hospitals

Lead researcher:
Project funded:
September 2010
Project completed:
February 2014
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.