Swing beds are a practical solution for rural hospitals with fewer than 100 beds.
By John Zelem, MD, FACS
Unless you have been exposed to daily life at rural hospitals, you may not be familiar with the term “swing bed.” What exactly is a swing bed? It is a simple and effective solution for rural hospitals with fewer than 100 beds, including critical access hospitals (CAH), with a Medicare agreement allowing them to use their beds for acute or skilled services.
According to the 2020 Centers for Medicare & Medicaid Services (CMS) interpretive guidelines for swing beds in CAHs, use of such beds marks “ a change in reimbursement status.” Essentially, a CAH can use its beds interchangeably for either acute care or post-acute care. The reimbursement “swings” from billing for acute-care services to billing for post-acute skilled nursing services, even though the patient usually stays in the same bed, in the same physical location.
Benefits to rural hospitals are many, including allowing them to continue to serve their communities and often contributing to positive operating margins, especially in today’s atmosphere of rural hospitals’ financial challenges. The swing-bed program as a reimbursement mechanism was part of the 1980 Omnibus Budget Reconciliation Project.
Swing-bed programs also directly impact local rural residents. Since it is a patient-centric, post-acute care solution, these patients may find themselves too well to stay in the urban hospital, but too sick to go back to their own homes. Few models exist that serve the patient, hospital, and community as well as the swing-bed program does. In addition, having such a program keeps the post-acute care local: a benefit not just for patients, but their families and their communities, since rural hospitals maybe 30-50 miles away from larger acute-care facilities. Since it is the same bed in the same location and the same staff who provided their acute care, that same staff may very well have expertise often not found in alternative post-acute settings, like nursing homes.
In addition, certain things sometimes aren’t done in a nursing home setting, either because it’s a high-cost item or involves processes done in such small numbers that the staff may not have the needed proficiency (for example, infusions). Because the swing bed is located within the hospital, patients will have nurses who perform infusions all the time. It’s second nature to them. Therefore, the swing bed provides service levels that might otherwise not be found in the community. If the program were not there, patients would have to relocate from their local community to get those services.
Understanding swing-bed reimbursement is key to understanding the program’s benefits. If a hospital has additional patients in the swing-bed program, that reduces the cost of care on the acute-care side, too. Finally, the goal of the swing-bed program is to establish a relationship with other hospitals so that they are the first hospital considered when swing-bed services are needed.
It’s a great concept, and just one more reason we need to ensure the survival of rural hospitals.
