'A good step down' – CAH swing beds bridge gap
Rural hospitals put patients close to home
Legislation enacted a decade ago to strengthen rural health care by encouraging states to take steps to bolster rural health networks resulted in adding another tool to the discharge planning toolbox – the critical access hospital (CAH).
The Rural Hospital Flexibility Program, or "flex program," was created by the Balanced Budget Act of 1997 to preserve access in rural areas to primary care and emergency health care services, provide health services that meet a community's needs, and to ensure the financial health of the programs through a special set of reimbursement and operating rules.
Under the flex program, a state can seek grants once it has established a rural health plan and met Centers for Medicare & Medicaid Services (CMS) requirements for the CAH program – that encourage the development of and improvement to rural health networks and rural emergency medical services.
Though initially required to maintain a ratio of 15 acute care beds and 10 swing beds, CAHs now have the freedom to maintain 25 total beds in whatever configuration their patients' needs demand.
Discharge to a CAH
A patient in an acute care hospital who's been in the hospital for at least three consecutive days and no longer requires acute care is eligible for discharge from acute care. However, discharge to home isn't appropriate yet; and the patient is resistant to the idea of a skilled nursing facility, even on a temporary basis. If the patient's home is in a rural community, nursing home options might be limited.
A swing bed at a hospital like Candler County Hospital in Metter, GA, can be a lifesaver – particularly if it allows a patient to return to his or her home community but in a safer environment than home would be.
"It's a popular [discharge] option, especially since a lot of people don't want to go into a nursing home," according to Kym Bowman, RN, discharge planner and swing bed coordinator at Candler County Hospital. "Patients are discharged to a swing bed if they need skilled care, a lot of times if they need continued IV therapy or wound care, as opposed to short-term skilled nursing facilities."
Patients needing respiratory therapy or mobility/strengthening therapy are also good candidates for swing bed transfers, Bowman adds.
"It's a good stepdown," she says. "They're in a hospital setting, but we try to not make them feel like they're hospital patients."
Medicare certifies swing bed care for 14 days, but many patients stay far shorter periods, Bowman explains. A multidisciplinary team reviews transfer requests to make sure patients discharged from acute care to the CAH setting meets swing bed criteria.
"Some patients need all 14 days, but some may only need three or four days," she continues. "You have to justify the length of stay, so the therapists document the times they work with patients."
Basic criteria for admission to a swing bed are:
- Three days in acute care;
- A qualified skilled need (i.e., debilitated weakness with a need for physical therapy, IV or wound care, post-operative care).
Unlike for acute care hospitals, Medicare reimburses CAHs for most inpatient and outpatient services to Medicare beneficiaries on the basis of 101% of their "allowable and reasonable" costs. CAHs aren't subject to the Inpatient Prospective Payment System (IPPS) and Hospital Outpatient Prospective Payment System (OPPS) that acute care hospitals are. The cost-based reimbursement system helps guarantee that CAHs have adequate revenue to succeed.
CMS recently issued a factsheet on CAHs, which is available online at www.cms.hhs.gov/MLNProducts/downloads/CritAccessHospfctsht.pdf. Additional information on CAHs is available at the CMS Web site, www.cms.hhs.gov/center/cah.asp.
Sources
For more information, contact:
- Kym Bowman, RN, Discharge Planner, Swing Bed Coordinator, Candler County Hospital, Metter, GA. Phone: (912) 685-5741.
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