Health systems and hospitals with successful skilled nursing facility bed leasing programs have many of the same best practices: value alignment, transparency around patient selection, recurring check-ins and more.
Most hospitals and health systems left the SNF business long ago, leaders told Becker’s. However, amid higher boarding, an expanding older population and fewer overall SNF, many healthcare leaders are now leasing nursing home beds to improve throughput.
But leasing beds comes with a number of challenges, including finding a high-quality partner and finding facilities with enough beds to lease.
Here five leaders give their best practices for leasing SNF beds.
Editor’s note: Responses have been lightly edited for clarity and length.
Alex Brennsteiner. Director of Operations for the Clinically Integrated Network at Allegheny Health Network/Highmark Health (Pittsburgh): First, we have a technology component built into how our case management teams handle freedom of choice — we can flag these facilities as system partners, which equips our case managers to explain that we have a partnership with a given facility and that there’s more alignment with our continuum of care at AHN. That’s hardwired into the freedom-of-choice process.
Second, we meet with these facilities weekly. I have a nursing counterpart who reviews every readmission each week and does a root cause analysis — not always a formal RCA, sometimes just a review — and we go through that with the facility weekly to identify opportunities for clinical improvement. It’s not purely a throughput play; it’s an opportunity to work together on quality and to understand barriers we didn’t even anticipate five years ago, since the acuity of patients going to skilled nursing facilities now is so much higher than before COVID.
Third, from a pure operations standpoint, members of our team are doing what I’d call air traffic control — tracking who’s moving, when, and whether we’re above or below our lease threshold, so we can flag our case management partners to make sure we’re aligning the right patients to the right facility and not falling below our lease threshold.
Bianca Caballero. Director of Social Work, Care Management and Social Work Department, Harborview Medical Center (Seattle): The hospital system has to be really invested. Other hospitals around us have tried this kind of model and it hasn’t always been successful, because it takes a lot of resources and money to ensure you’re not just sending a patient to a nursing home and walking away — that’s probably why the nursing home didn’t want to take the patient in the first place, because there weren’t additional services available for that patient. As a system, you have to be willing to invest, just like you would in a clinic, because these patients will come back if you don’t.
Aashka Mehta. Vice President of Post-Acute Care at Cone Health (Greensboro, N.C.): Trust, transparency and connectedness. That’s the solid foundation to build on. Are you meeting with your partner facility on a regular cadence? Are you being transparent about who those patients are before they go into their facility? For example, if a patient has a felony record, are you being transparent with the nursing home about that history and who’s coming? They don’t want anything compromised in their building. Transparency is the foundation for this to work.
Ezz-Eldin Moukamal, MD. Chief Quality Officer at Allegheny Health Network/Highmark Health (Pittsburgh): What we found was: start small, and be smart about measuring your downside risk — how much financial pressure can you absorb if those beds aren’t filled? Calculate that, and work from there. Also, have a great partner. In our case, we had a great partner in Helion, with Alex Brennsteiner and his team, who already had relationships with these facilities. It wasn’t a cold call — it was leaning into existing connections with those nursing homes and working with their leaders to ensure mutual benefit for both the hospital system and the skilled nursing facility.
Part of our initial facility selection considered whether our clinicians already had a presence there, which speaks to quality. We also closely monitor readmission data, length of stay and other metrics within those facilities to make sure we’re using this optimally and that patients are getting the right care. Utilization was also a big factor — we had demand, and those facilities were able to meet it while keeping patients flowing through their recovery cycle. The main intent is to get patients to the right place, make sure they get what they need right away, and manage their length of stay appropriately.
The other thing is that being a good partner to these facilities starts with patient selection — whatever clinical criteria you’re using, you don’t want this to become a way of moving difficult-to-place patients into those beds. You want the nursing facilities to know you’re partnering in good faith on patient selection, and that you’re not sending them challenging patients that could put them in a difficult position down the road.
Mara Prandi-Abrams. Patient Flow Administrator at Denver Health: First, find a partner that’s really aligned with the population you serve. Our skilled nursing facility partner already serves a large Medicaid population, so they understand our patients well.
I’d also say a huge part is thinking about the daily cost of keeping a patient in your hospital versus discharging and paying for a leased bed, even out of pocket, which we do. What are your lost opportunity costs, plus the cost of keeping that patient in the hospital, and was it worth it to discharge them sooner?
The other thing we did well was creating internal workflows so we’re reviewing every patient. Our care management team can say, “I’d love for this patient to be able to use that leased bed,” and we have an internal workflow to review and send patients to those beds — just to reduce the risk of accidentally sending someone who may never discharge, where we’d end up paying indefinitely.
