reimbursement issues related to swing bed conversions michael r. bell & company 12 east rowan,...

REIMBURSEMENT ISSUES RELATED TO

SWING BED CONVERSIONS

MICHAEL R. BELL & COMPANY

12 EAST ROWAN, SUITE 2

SPOKANE, WASHINGTON 99207

(509) 489-4524

SWING BED CONVERSIONS ONLY WORK FOR CRITICAL ACCESS

HOSPITALS

MICHAEL R. BELL & COMPANY 12 EAST ROWAN, SUITE 2 SPOKANE, WASHINGTON 99207 (509) 489-4524

CAH REIMBURSEMENTSWING BED

VS SKILLED NURSING HOME

• SWING BED – MEDICARE PAYS FULL COST BASED REIMBURSEMENT

• SKILLED NURSING HOME – MEDICARE PAYS RUG BASIS OF REIMBURSEMENT


HOWEVERMEDICARE SKILLED

NH CARE REIMBURSEMENT IS NOT THE ISSUE WITH

SWING BED CONVERSIONS


THE ISSUE WITH SWING BED CONVERSIONS

IS CONVERTING UNREIMBURSED COST

TO REIMBURSABLE COST


WHAT IS A SWING BED?

A SWING BED IS A BED THAT CAN BE USED FOR:– OBSERVATION BED

– ACUTE CARE

– SKILLED NURSING HOME CARE

– INTERMEDIATE NURSING HOME CARE


SWING BEDS DO NOT HAVE TO BE USED

FOR ALL FOUR PURPOSES

ALL THE TIME


CAN SWING BEDS BE USED FOR SHORT TERM CARE?

ABSOLUTELY

YOU HAVE ALL USED SWING BEDS FOR SHORT TERM CARE


CAN SWING BEDS BE USED FOR LONG-TERM NH CARE?

ABSOLUTELY


CAN THE HOSPITAL SET ASIDE BEDS?

OBSERVATION BED YES

ACUTE CARE YES

SHORT TERM SWING BED

SKILLED NH CARE YES

SHORT TERM SWING BED

INTERMEDIATE CARE YES


WHY WOULD I WANT TO CONVERT LONG-TERM

BEDS TO SWING?

MORE MEDICARE

ACUTE CARE REIMBURSEMENT


THE KEY TO SWING BED CONVERSIONS

IS MEDICARE’S HANDLING OF NON-MEDICARE SWING BED

DAYS


THE FOLLOWING IS A SIMPLE EXAMPLE



COMBINED FACILITYCURRENT REIMBURSEMENT

NUMBER OF BEDSACUTE CARE 5 NURSING HOME 20

TOTAL 25

COSTCOST DAYS PER DAY

ACUTE CARE 500,000$ 400 1,250$

MEDICARE REIMBURSEMENT 1,250$ (MEDICARE UTILIZATION 90%)

NURSING HOME 810,000$ 6,000 135$

MEDICAID REIMBURSEMENT 115$

UNREIMBURSED MEDICAID COST 120,000$

COMBINED SWING BED FACILITYCURRENT REIMBURSEMENT

NUMBER OF BEDSACUTE CARE 5SWING BED 20

TOTAL 25

COSTCOST DAYS PER DAY

ACUTE CARE/SWING BED 1,310,000$ 6,400 SWING BED CARVEOUT -690,000 6,000 $115ACUTE CARE COST 620,000 400 1,550

SWING BED MEDICAID REIMBURSEMENT $115

MEDICARE REIMBURSEMENT $1,550PREVIOUS MEDICARE REIMBURSEMENT $1,250MEDICARE GAIN PER DAY $300MEDICARE GAIN TOTAL (MEDICARE 90% UTILIZATION) $108,000

PREVIOUS UNREIMBURSEDNURSING HOME COST $120,000


WHO QUALIFIES• DAYTON YES

• PORT ANGELES NON-CAH

• SOAP LAKE NON-CAH

• NEWPORT YES

• EPHRATA ALREADY AT MAX

• PROSSER YES

• FORKS YES

• ODESSA YES

• POMEROY YES

• TONASKET YES

• REPUBLIC YES

• QUINCY YES

• DAVENPORT YES

• GRAND COULEE YES

• RENTON NON-CAH

• MORTON YES


HOW MANY BEDS SHOULD BE CONVERTED?

A CRITICAL ACCESS HOSPITAL IS LIMITED TO

25 ACUTE CARE AND SWING BEDS


TO DETERMINE HOW MANY NH BEDS

SHOULD BE CONVERTED SEVERAL QUESTIONS MUST BE ANSWERED?


HOW MANY ACUTE CARE BEDS DO YOU NEED TO

MEET THE CURRENT DEMAND?

KEEP IN MIND THAT BEDS USED STRICTLY FOR OUTPATIENT

SERVICES DO NOT COUNT AS PART OF THE 25 BED LIMIT


HOW MANY SWING BEDS DO YOU ALREADY HAVE?

MOST

CRITICAL ACCESS HOSPITALS ALREADY HAVE EITHER

5 OR 6 SWING BEDS


THE MAXIMUM SWING BED CONVERSION

IS 25 BEDS

LESS NEEDED ACUTE CARE BEDS

LESS EXISTING SWING BEDS


DO YOU WANT TO CONVERT THE

MAXIMUM?

LARGE NURSING HOMES YES

SMALL NURSING HOMES ?


FOR FACILITIES WITH SMALL NURSING HOMES A PARTIAL CONVERSION IS

RECOMMENDED

CONVERT ALL NURSING HOME BEDS AND

PRO SHARE ELIGIBILITY MAY BE ELIMINATED


SMALL NURSING HOMES PARTIAL CONVERSION

WEIGH GAIN FROM CONVERSION OF SOME NURSING HOME BEDS

WITH

AFFECT ON FUTURE

PRO SHARE FUNDING


PRO SHARE RELATED QUESTIONS FOR SMALL NH

IS PRO SHARE GOING TO CINTINUE?

NO - CONVERT ALL BEDS

YES – ADDITIONAL INFORMATION

NEEDED


PRO SHARE WILL CONTINUE ADDITIONAL QUESTIONS

FOR SMALL NH

• HOW MUCH WILL PRO SHARE BE?• HOW WILL MY SHARE OF PRO

SHARE BE DETERMINED• EQUAL DISTRIBUTION TO ALL• DISTRIBUTION BASED ON MEDICAID NH

DAYS• DISTRIBUTION BASED ON MEDICAID LOSS• OTHER METHOD


PRO SHARE WILL CONTINUE DISTRIBUTION EQUAL

SMALL NH SHOULD HAVE AT LEAST ONE BED


PRO SHARE WILL CONTINUE DISTRIBUTION BASED ON

MEDICAID DAYS

KEEP NH BEDS NEEDED

TO ACCOMPDATE

MEDICAID NH PATIENTS

CONVERT THE REST TO SWING


PRO SHARE WILL CONTINUE DISTRIBUTION BASED ON

MEDICAID LOSS

KEEP NH BEDS NEEDED

TO ACCOMPDATE

MEDICAID NH PATIENTS

CONVERT THE REST TO SWING


PRO SHARE WILL CONTINUE

PUT PRIVATE PAY AND MEDICARE PATIENTS IN SWING

BEDS

KEEP MEDICAID PATIENTS IN NURSING HOME


WHEN PRO SHARE CHANGES

REEVALUATE

OPTIONS


CAPITAL PROJECTS

WHAT HAPPENS WHEN YOU CONVERT NH BEDS TO SWING BEDS?

BEFORE CONVERSION MEDICARE AND MEDICAID PAY FOR THEIR SHARE OF HOSPITAL CAPITAL COST

BEFORE CONVERSION VERY LITTLE HELP RECEIVED FROM NH SIDE


CAPITAL PROJECTS

WHAT HAPPENS WHEN YOU CONVERT NH BEDS TO SWING BEDS?

AFTER CONVERSION MEDICARE AND MEDICAID PAY FOR THEIR SHARE OF HOSPITAL CAPITAL COST WHICH INCLUDE SWING BED COSTS


CAPITAL PROJECTS

BEFORE CONVERSION

MEDICARE AND MEDICAID PAY FOR 35% OF CAPTIAL PROJECT

AFTER CONVERSION

MEDICARE AND MEDICAID PAY FOR 55% OF CAPTIAL PROJECT


RECOMMENDATIONS

• DAYTON NO DATA PROVIDED• PORT ANGELES NON-CAH• SOAP LAKE NON-CAH• NEWPORT PARTIAL CONVERSION – NO AFFECT ON PRO SHARE• EPHRATA ALREADY AT MAX• PROSSER LIMITED CONVERSION – MAXIMIZE PROSHARE• FORKS NO DATA PROVIDED (CONVERSION IN PROCESS)• ODESSA NO DATA PROVIDED• POMEROY PARTIAL CONVERSION – NO AFFECT ON PRO SHARE• TONASKET PARTIAL CONVERSION – NO AFFECT ON PRO

SHARE• REPUBLIC LIMITED CONVERSION – MAXIMIZE PROSHARE• QUINCY LIMITED CONVERSION – MAXIMIZE PROSHARE• DAVENPORT NO DATA PROVIDED • GRAND COULEE LIMITED CONVERSION – MAXIMIZE PROSHARE• RENTON NON-CAH• MORTON LIMITED CONVERSION – MAXIMIZE PROSHARE


MICHAEL R. BELL & COMPANYCERTIFIED PUBLIC ACCOUNTANTS & CONSULTANTS

12 E. ROWAN STE. 2

SPOKANE, WA 99207

(509)489-4524

EMAIL:[email protected]

ANY QUESTIONS?

reimbursement issues related to swing bed conversions michael r. bell & company 12 east rowan,...

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