San Diego-based Scripps Health has saved 14,731 bed days since January 2023 by leasing beds at skilled nursing facilities.
Many hospitals struggle with boarding patients ready to discharge because the patients do not have a place to go. Meanwhile, skilled nursing facilities across the country have been shutting down and closing beds, leaving those that remain overloaded with patients.
"By leasing beds, we ensure we always have space available, rather than relying on open availability in the system," Ghazala Sharieff, MD, Scripps Health chief medical and operations officer and corporate executive vice president, told Becker's.
Scripps started leasing beds during COVID-19.
"We found that the cost was justified, given how expensive hospital stays are," she said. "Most of our patients fall under diagnostic-related groups, meaning we're reimbursed at a fixed rate. Whether a patient stays five days or 15 days, we're paid the same amount. Keeping patients in the hospital longer becomes costly, so leasing beds is a cost-effective solution for patient flow."
The number of beds leased depends on the year and need. In 2023, the system leased about 24 beds at four facilities. As of January 2025, it had seven beds at one facility.
There is constant communication between skilled facilities with leased beds and the hospital. The hospital does regular check-ins to ensure patients aren't staying longer than necessary and maintain oversight of the patients.
Having leased beds has improved discharge for many patients. However, the system still struggles to place behavioral health patients.
"We desperately need more mental health and behavioral health facilities," she said. "These patients have both medical and behavioral health needs, but there's no comprehensive solution for them yet."
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Dr. Sharieff said that the idea of leasing beds began with conversations.
"We already know which skilled nursing facilities have great reputations and which don't," she said. "Some of our physicians work in skilled nursing facilities, so we ask for their input on which facilities would be a good fit. From there, it's a matter of reaching out to leadership on both sides and seeing if they're open to the idea. The worst they can say is no — but in our experience, many facilities have been willing to work with us."
For skilled nursing facilities, leased beds can be a win-win. It guarantees payment, a certain number of patients and helps them build reliable partnerships with a system they trust.