Hospital Swing Bed Services: Overview and FAQ

Hospital swing-bed service is a type of post-acute care (PAC) that can be offered by a qualifying hospital to patients who are transitioning between acute care and the next phase of recovery. Recipients of swing-bed care remain in the hospital, with a changed reimbursement status. They no longer need inpatient-level care, but they’re not yet ready to go home.

You may be wondering: What is a hospital swing-bed program, and how could it benefit my facility and the patients we see? Swing-bed programs have been used for decades, specifically by rural hospitals seeking to meet the post-acute care needs of patients and maintain financial viability. In this guide we’ll go over swing-bed services in more detail and answer frequently asked questions about the topic.

The History of Hospital Swing-Bed Programs

Federal swing-bed regulations were developed in 1980 to address two challenges faced by rural hospitals: low inpatient census and a lack of long-term care placement options for patients (which often resulted in extended acute care stays or unsafe discharge). At that time, hospitals could only qualify to offer swing-beds if they had fewer than 50 beds.

Changes in hospital reimbursement structures throughout the 80s dampened enthusiasm for the model. The Medicare Rural Hospital Flexibility Program (“Flex Program”), part of the Balanced Budget Act of 1997, built upon the existing foundation of swing-bed regulations. The Flex Program’s designation of Critical Access Hospitals (CAH) broadened the scope of facilities that could offer swing beds, sparking renewed interest.

Purpose of Swing-Bed Services

Today, hospital swing-bed services continue to be used to address the original challenges that policymakers were attempting to meet. The programs are often utilized by elderly patients in rural areas with limited (or an absence of) skilled nursing facilities (SNF).

In some cases, swing-bed programs contribute to financial viability for rural hospitals. For example, in a study conducted on rural Illinois CAHs, 9 participating facilities reported that swing beds accounted for more than 30% of total inpatient revenue.

Frequently Asked Questions About Swing-Bed Services

As a facility leader, you’re aware of the many challenges involved in discharging patients safely, providing cost-effective care, and managing the complexities of reimbursement rates. When a patient needs to bridge the gap between an intense hospital stay and their next phase of care, whether at home or at a SNF, a swing-bed program may provide a much-needed solution.

If you’re considering implementing this type of program at your facility, or simply researching the topic out of curiosity, the following questions and answers are a great place to start.

What is a swing bed in a hospital?

In healthcare the term swing bed refers to a stage of medical care in which a patient is transitioning from acute to post-acute care without leaving the hospital. This represents a change in reimbursement status of the patient.

How can a healthcare facility qualify to offer swing-bed services?

Healthcare facilities need to apply for approval before offering swing-bed services. Both CAHs and non-CAHs can participate in the Medicare swing-bed program. To qualify as a swing-bed hospital, a facility must:

• Have a Medicare hospital provider agreement in place.
• Be in a rural location, according to U.S. Census Bureau data.
• Have fewer than 100 beds (excluding beds in ICUs and for newborns).

Maintaining compliance with Medicare swing-bed rules is crucial to a successful transitional care program. Detailed eligibility information can be found in the CMS State Operations Manual.

What makes a patient eligible for swing-bed care?

To be considered eligible for Medicare swing-bed hospital services, patients must:

• Have received acute hospital care for a minimum of 3 consecutive days.
• Be medically stable.
• Require daily skilled medical care or rehabilitation exercises at least 5 days a week.
• Participate in Medicare Part A or another insurance plan that will cover the costs of the services.

Private insurance companies have varying hospital swing-bed requirements for patients, and case managers are often valuable resources for determining if a patient’s plan is a good fit for this program.

How long can a patient stay in a swing-bed hospital program?

Hospital swing-bed services offer a temporary solution for patients, often in rural settings, who no longer need acute care but are not yet ready to return home. Facility policies may limit the number of days that a patient can spend in a swing-bed. A typical stay lasts 1 to 2 weeks, and hospitals may limit the duration of stay to 40 days. Medicare coverage may change after the first 20 days, and could extend up to 100 days.

How do swing-bed programs impact revenue for healthcare facilities?

Swing-bed programs can be used to generate additional income when qualifying hospitals convert underutilized beds to swing beds. This use of beds that would otherwise go empty can contribute to a more stable patient census. In addition, swing-bed programs may benefit a facility’s reputation and standing within a community by meeting the needs of post-op or medically vulnerable patients who would otherwise be underserved.

Healthcare facilities should consider the potential financial downsides of implementing a swing-bed program, such as instability of the reimbursement rates for patients receiving swing-bed care. While current CMS rules and swing-bed billing guidelines support strong reimbursement rates, this may change in the future due to federal-level input.

What is a swing-bed hospital unit vs. an acute rehab unit?

Swing-bed programs and acute rehab units (ARUs) are both designed to provide multidisciplinary support for patients transitioning away from acute care and potentially returning to baseline levels of health. Patients in both settings can benefit from:

• Skilled nursing care
• Occupational therapy
• Speech therapy
• Physical therapy
• Wound care
• Monitoring
• Nutrition management
• Medication management
• Assistance with activities of daily living (ADLs)

However, swing-bed units differ from acute rehab units in several key ways.

• Location: Swing-bed care patients often stay in the same location, such as a med-surg unit, while ARU patients are moved to a new location.
• Intensity: Swing-bed patients receive skilled care, but it may be less intensive and focused than the rehabilitation services provided in an ARU.
• Duration: In general, patients utilize swing-bed programs for longer stays than the patients in ARUs.

Learn More About Flexible Patient Care Options for Your Facility

When it comes to optimizing your healthcare organization with strategies like hospital swing-bed programs, staying informed about compliance issues can be a challenge. Our expert-written healthcare facility guides and resources help you stay ahead of the curve.