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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
MICHAEL R. BELL & COMPANY 12 EAST ROWAN, SUITE 2 SPOKANE, WASHINGTON 99207 (509) 489-4524
HOWEVERMEDICARE SKILLED
NH CARE REIMBURSEMENT IS NOT THE ISSUE WITH
SWING BED CONVERSIONS
MICHAEL R. BELL & COMPANY 12 EAST ROWAN, SUITE 2 SPOKANE, WASHINGTON 99207 (509) 489-4524
THE ISSUE WITH SWING BED CONVERSIONS
IS CONVERTING UNREIMBURSED COST
TO REIMBURSABLE COST
MICHAEL R. BELL & COMPANY 12 EAST ROWAN, SUITE 2 SPOKANE, WASHINGTON 99207 (509) 489-4524
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
MICHAEL R. BELL & COMPANY 12 EAST ROWAN, SUITE 2 SPOKANE, WASHINGTON 99207 (509) 489-4524
SWING BEDS DO NOT HAVE TO BE USED
FOR ALL FOUR PURPOSES
ALL THE TIME
MICHAEL R. BELL & COMPANY 12 EAST ROWAN, SUITE 2 SPOKANE, WASHINGTON 99207 (509) 489-4524
CAN SWING BEDS BE USED FOR SHORT TERM CARE?
ABSOLUTELY
YOU HAVE ALL USED SWING BEDS FOR SHORT TERM CARE
MICHAEL R. BELL & COMPANY 12 EAST ROWAN, SUITE 2 SPOKANE, WASHINGTON 99207 (509) 489-4524
CAN SWING BEDS BE USED FOR LONG-TERM NH CARE?
ABSOLUTELY
MICHAEL R. BELL & COMPANY 12 EAST ROWAN, SUITE 2 SPOKANE, WASHINGTON 99207 (509) 489-4524
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
MICHAEL R. BELL & COMPANY 12 EAST ROWAN, SUITE 2 SPOKANE, WASHINGTON 99207 (509) 489-4524
WHY WOULD I WANT TO CONVERT LONG-TERM
BEDS TO SWING?
MORE MEDICARE
ACUTE CARE REIMBURSEMENT
MICHAEL R. BELL & COMPANY 12 EAST ROWAN, SUITE 2 SPOKANE, WASHINGTON 99207 (509) 489-4524
THE KEY TO SWING BED CONVERSIONS
IS MEDICARE’S HANDLING OF NON-MEDICARE SWING BED
DAYS
MICHAEL R. BELL & COMPANY 12 EAST ROWAN, SUITE 2 SPOKANE, WASHINGTON 99207 (509) 489-4524
THE FOLLOWING IS A SIMPLE EXAMPLE
MICHAEL R. BELL & COMPANY 12 EAST ROWAN, SUITE 2 SPOKANE, WASHINGTON 99207 (509) 489-4524
MICHAEL R. BELL & COMPANY 12 EAST ROWAN, SUITE 2 SPOKANE, WASHINGTON 99207 (509) 489-4524
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
MICHAEL R. BELL & COMPANY 12 EAST ROWAN, SUITE 2 SPOKANE, WASHINGTON 99207 (509) 489-4524
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
MICHAEL R. BELL & COMPANY 12 EAST ROWAN, SUITE 2 SPOKANE, WASHINGTON 99207 (509) 489-4524
HOW MANY BEDS SHOULD BE CONVERTED?
A CRITICAL ACCESS HOSPITAL IS LIMITED TO
25 ACUTE CARE AND SWING BEDS
MICHAEL R. BELL & COMPANY 12 EAST ROWAN, SUITE 2 SPOKANE, WASHINGTON 99207 (509) 489-4524
TO DETERMINE HOW MANY NH BEDS
SHOULD BE CONVERTED SEVERAL QUESTIONS MUST BE ANSWERED?
MICHAEL R. BELL & COMPANY 12 EAST ROWAN, SUITE 2 SPOKANE, WASHINGTON 99207 (509) 489-4524
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
MICHAEL R. BELL & COMPANY 12 EAST ROWAN, SUITE 2 SPOKANE, WASHINGTON 99207 (509) 489-4524
HOW MANY SWING BEDS DO YOU ALREADY HAVE?
MOST
CRITICAL ACCESS HOSPITALS ALREADY HAVE EITHER
5 OR 6 SWING BEDS
MICHAEL R. BELL & COMPANY 12 EAST ROWAN, SUITE 2 SPOKANE, WASHINGTON 99207 (509) 489-4524
THE MAXIMUM SWING BED CONVERSION
IS 25 BEDS
LESS NEEDED ACUTE CARE BEDS
LESS EXISTING SWING BEDS
MICHAEL R. BELL & COMPANY 12 EAST ROWAN, SUITE 2 SPOKANE, WASHINGTON 99207 (509) 489-4524
DO YOU WANT TO CONVERT THE
MAXIMUM?
LARGE NURSING HOMES YES
SMALL NURSING HOMES ?
MICHAEL R. BELL & COMPANY 12 EAST ROWAN, SUITE 2 SPOKANE, WASHINGTON 99207 (509) 489-4524
FOR FACILITIES WITH SMALL NURSING HOMES A PARTIAL CONVERSION IS
RECOMMENDED
CONVERT ALL NURSING HOME BEDS AND
PRO SHARE ELIGIBILITY MAY BE ELIMINATED
MICHAEL R. BELL & COMPANY 12 EAST ROWAN, SUITE 2 SPOKANE, WASHINGTON 99207 (509) 489-4524
SMALL NURSING HOMES PARTIAL CONVERSION
WEIGH GAIN FROM CONVERSION OF SOME NURSING HOME BEDS
WITH
AFFECT ON FUTURE
PRO SHARE FUNDING
MICHAEL R. BELL & COMPANY 12 EAST ROWAN, SUITE 2 SPOKANE, WASHINGTON 99207 (509) 489-4524
PRO SHARE RELATED QUESTIONS FOR SMALL NH
IS PRO SHARE GOING TO CINTINUE?
NO - CONVERT ALL BEDS
YES – ADDITIONAL INFORMATION
NEEDED
MICHAEL R. BELL & COMPANY 12 EAST ROWAN, SUITE 2 SPOKANE, WASHINGTON 99207 (509) 489-4524
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
MICHAEL R. BELL & COMPANY 12 EAST ROWAN, SUITE 2 SPOKANE, WASHINGTON 99207 (509) 489-4524
PRO SHARE WILL CONTINUE DISTRIBUTION EQUAL
SMALL NH SHOULD HAVE AT LEAST ONE BED
MICHAEL R. BELL & COMPANY 12 EAST ROWAN, SUITE 2 SPOKANE, WASHINGTON 99207 (509) 489-4524
PRO SHARE WILL CONTINUE DISTRIBUTION BASED ON
MEDICAID DAYS
KEEP NH BEDS NEEDED
TO ACCOMPDATE
MEDICAID NH PATIENTS
CONVERT THE REST TO SWING
MICHAEL R. BELL & COMPANY 12 EAST ROWAN, SUITE 2 SPOKANE, WASHINGTON 99207 (509) 489-4524
PRO SHARE WILL CONTINUE DISTRIBUTION BASED ON
MEDICAID LOSS
KEEP NH BEDS NEEDED
TO ACCOMPDATE
MEDICAID NH PATIENTS
CONVERT THE REST TO SWING
MICHAEL R. BELL & COMPANY 12 EAST ROWAN, SUITE 2 SPOKANE, WASHINGTON 99207 (509) 489-4524
PRO SHARE WILL CONTINUE
PUT PRIVATE PAY AND MEDICARE PATIENTS IN SWING
BEDS
KEEP MEDICAID PATIENTS IN NURSING HOME
MICHAEL R. BELL & COMPANY 12 EAST ROWAN, SUITE 2 SPOKANE, WASHINGTON 99207 (509) 489-4524
WHEN PRO SHARE CHANGES
REEVALUATE
OPTIONS
MICHAEL R. BELL & COMPANY 12 EAST ROWAN, SUITE 2 SPOKANE, WASHINGTON 99207 (509) 489-4524
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
MICHAEL R. BELL & COMPANY 12 EAST ROWAN, SUITE 2 SPOKANE, WASHINGTON 99207 (509) 489-4524
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
MICHAEL R. BELL & COMPANY 12 EAST ROWAN, SUITE 2 SPOKANE, WASHINGTON 99207 (509) 489-4524
CAPITAL PROJECTS
BEFORE CONVERSION
MEDICARE AND MEDICAID PAY FOR 35% OF CAPTIAL PROJECT
AFTER CONVERSION
MEDICARE AND MEDICAID PAY FOR 55% OF CAPTIAL PROJECT
MICHAEL R. BELL & COMPANY 12 EAST ROWAN, SUITE 2 SPOKANE, WASHINGTON 99207 (509) 489-4524
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 & COMPANY 12 EAST ROWAN, SUITE 2 SPOKANE, WASHINGTON 99207 (509) 489-4524
MICHAEL R. BELL & COMPANYCERTIFIED PUBLIC ACCOUNTANTS & CONSULTANTS
12 E. ROWAN STE. 2
SPOKANE, WA 99207
(509)489-4524
EMAIL:[email protected]
ANY QUESTIONS?