Office of Rural Health and Primary Care
PO Box 64882
Saint Paul, Minnesota 55164-0882
Office: (651) 201-3838
Swing Bed Usage and Access to Post-Acute Care in Rural Minnesota
Update to 2007 Legislative Report
Executive Summary
This report provides an updated look at swing bed utilization and nursing home Medicare days,
extending the previous analysis “Swing Bed Usage and Access to Post Acute Care in Rural
Minnesota: Report to the Minnesota Legislature 2007” through the most recent available fiscal data.
The Minnesota Legislature amended statutes section 144.562 during the 2005 Minnesota
Legislative Session to allow eligible hospitals to increase the total number of days for swing bed use
per year. This amendment was made to conform to a change in federal Medicare law and
regulations. 1 The Legislature directed the Commissioner of Health to review swing bed usage and
related data to assess the impact of this change. To assess the impact of this legislation, the Office of
Rural Health and Primary Care (ORHPC) at the Minnesota Department of Health (MDH) has been
tasked with analyzing swing bed and Medicare data and to issue reports on trends in utilization.
Data gathered in this report include use of swing bed days and occupancy rates in skilled nursing
facilities within 25 miles of hospitals with swing beds.
There did not appear to be substantial change in either swing bed usage or nursing home
occupancy rates during the period assessed (Fiscal Years 2004-2012). Nursing home occupancy
remained stable, ranging from 91.76 percent to 89.12 percent, with slightly higher occupancy in the
metropolitan region compared to Greater Minnesota. It is important to note that the number of
licensed nursing home beds fell measurably in this period, continuing a long-term trend. The
number of swing bed admissions appeared to decrease slightly from FY2004 to FY2012, ranging
from 76.66 percent to 65.59 percent with the majority of admissions coming from inside the same
hospital. More than half of swing bed discharges were to home and appeared consistent across this
period.
Medicare payment for nursing home stays varied from FY2004-FY2012 but did not appear to
change substantially. While the percentage of nursing home stays paid by Medicare was higher
among nursing homes in Greater Minnesota compared to those in the metropolitan area and
Minnesota overall, the percentage of Medicare-funded stays increased from FY2008 (8.62 percent)
to FY2012 (9.20 percent). Nursing homes in the metropolitan region saw a small increase, from
8.67 percent in FY2004 to 10.69 percent in FY2012.There does not appear to be substantial change
in swing bed use, nursing home occupancy, or Medicare days.
1
Laws of Minnesota 2005, First Special Session, Chapter 4, Article 6, Section 54.
1
Background
During the 2005 Minnesota Legislature Session, Minnesota statues section 144.562 was amended to
allow eligible hospitals to increase the total number of days for swing bed use per year. This change
in swing bed regulation was implemented to better conform to 2003 changes in federal Medicare
law and regulations. 2 These amendments included:
•
•
•
•
Full swing bed conformity with federal law for Critical Access Hospitals with attached
nursing homes or nursing homes in the same municipality as the hospital.
An increase in the annual limit on swing bed days for all other hospitals from 1,460 days to
2,000 days.
Exceptions for six cases each year for hospitals subject to the 2,000 annual day limit.
A provision that a health care system may allocate its total limit of swing beds among the
hospitals within the system, if no hospital in the system without an attached nursing home
may exceed 2,000 swing bed days per year.
Swing beds are intended for hospitalized patients who are no longer in need of acute care, but still
require some level of skilled nursing care and are currently in a hospital acute care bed. 3 Swing bed
days are generally limited to 40 days per patient under state law, and patients cannot be admitted
to swing beds from the community or skilled nursing facilities unless they have spent at least three
days in an acute care hospital bed for related service needs. Swing beds are part of a continuum of
care that includes acute, post-acute and long-term care. 4
In 2007, the Office of Rural Health and Primary Care (ORHPC) at the Minnesota Department of
Health (MDH) issued “Swing Bed Usage and Access to Post Acute Care in Rural Minnesota: Report to
the Minnesota Legislature 2007.” This report responded to the Legislature’s requirement that “the
Commissioner of Health review swing bed and related data reported under Minnesota Statutes,
sections 144.562, subdivision 3, paragraph (f); 144.564 and 144.698. The commissioner shall
report and make any appropriate recommendations to the Legislature by January 31, 2007 on:
•
•
•
Use of swing bed days by all hospitals and critical access hospitals;
Occupancy rates in skilled nursing facilities within 25 miles of hospitals with swing beds;
Information by rural providers on the use of swing beds and the adequacy of services across
the continuum of care.” 5
This update extends the previous analysis of swing bed use and nursing home occupancy data
through fiscal year (FY) 2012.
See Medicare conditions of participation for swing beds under Code of Federal Regulations, Title 42, Section 482.66
“Swing Bed Usage and Access of Post Acute Care in Rural Minnesota: Report to the Minnesota Legislature 2007.”
Minnesota Department of Health, Office of Rural Health and Primary Care: January 31, 2007. Link Available Here:
http://www.health.state.mn.us/divs/orhpc/pubs/swingbed.pdf
4 “Swing Bed Usage and Access of Post Acute Care in Rural Minnesota: Report to the Minnesota Legislature 2007.”
5 Laws of Minnesota 2005, First Special Session, Chapter 4, Article 6, Section 54.
2
3
2
Report Methods
MDH analyzed quantitative data on swing bed use nursing home occupancy rates and nursing home
Medicare days. Nursing home data was provided by the Nursing Home Rates and Policy Division at
the Department of Human Services (DHS), with additional data from the Health Care Information
System’s Hospital Annual Report (HCCIS) at MDH. Detailed methods information is included in the
appendix. Swing bed data were obtained from HCCIS.
Several aspects of data surrounding swing bed usage and Medicare days were broken down by
fiscal year were analyzed:
•
•
•
•
•
Nursing home occupancy rates.
Total number of swing bed days.
Swing bed admissions.
Swing bed discharges.
Number of Medicare days reported by nursing homes.
These data were also broken down and examined regionally, and according to a Greater
Minnesota/Metropolitan regional classification.
Statewide nursing home occupancy declined from 91.59 percent in FY2004 (with 12,441,365
nursing home resident days) to 89.12 percent in FY2011 (with 10,250,598 nursing home resident
days) and 89.18 percent in FY2012 (with 10,037,745 nursing home resident days) (Figure 1).
Similarly, nursing home occupancy in the metropolitan region declined from 92.29 percent in
FY2004 (with 5,154,995 nursing home resident days) to 90.76 percent in FY2011 (with 4,284,231
nursing home resident days) and 89.77 percent in FY2012 (with 4,218,437 nursing home resident
days). Among all counties outside of the metropolitan region, labeled as Greater Minnesota, nursing
home occupancy declined from 91.27 percent in FY2004 (with 7,286,370 nursing home resident
days) to 88.76 percent in FY2011 (with 5,966,367 nursing home resident days) and 88.58 percent
in FY2012 (with 5,819,308 nursing home resident days).
3
Figure 1: Nursing Home Occupancy Rates Statewide (FY2004-FY2012)
95.0
94.0
Nursing Home Occupancy Rates
93.0
92.0
91.0
90.0
92.29
91.59
91.27
92.74
91.52
91.00
93.12
91.76
91.18
93.15
91.60
90.93
92.46
91.54
91.14
89.0
91.92
90.78
90.24
91.06
90.25
89.56
88.0
90.76
89.12
88.76
89.77
89.18
88.58
87.0
86.0
85.0
FY2004
FY2005
FY2006
Metropolitan
FY2007
FY2008
Statewide
FY2009
FY2010
Greater Minnesota
FY2011
FY2012
4
Regional data are based on defined regions established by MDH Field Services Epidemiology (see
appendix). Nursing home occupancy rates have varied regionally to some extent (Figure 2).
Occupancy rates reached an all-time high in FY2004 with 93.65 percent occupancy in the Northeast
region, and were lowest in FY2010 with 86.53 percent occupancy in the West Central region. The
West Central region had the most interregional variability with 92.94 percent occupancy in FY2004
and 86.53 percent occupancy in FY2010. The Southeast region had the lowest interregional
variability with 90.58 percent occupancy in FY2009 and 88.41 percent occupancy in FY2012.
Figure 2: Variation of Nursing Home Occupancy Rates by Region
96.0
Nursing Home Occupancy Rates
94.0
92.0
90.0
88.0
86.0
84.0
82.0
FY2004
FY2005
FY2006
FY2007
FY2008
FY2009
FY2010
FY2011
FY2012
North
West
North
East
West
Central
Central
91.03
92.02
90.99
92.68
89.97
92.40
89.23
91.26
88.13
89.16
91.10
88.89
93.65
91.84
88.60
90.40
90.91
89.56
87.62
88.50
92.94
92.19
91.83
91.21
88.93
86.53
86.67
88.50
91.87
91.96
91.87
91.13
91.35
91.64
90.91
90.15
Metropoli
tan
South
West
South
Central
South
East
93.12
90.52
92.21
89.69
92.29
92.74
93.15
92.46
91.92
91.06
90.76
89.77
88.96
88.54
92.40
91.90
90.29
87.42
87.95
87.10
92.11
92.19
92.10
91.89
90.93
90.17
87.80
88.99
90.39
89.84
89.78
90.19
90.58
90.29
89.96
88.41
5
Swing Bed Utilization
During this period, swing bed days peaked in 2008 and by 2012 had returned to the levels of the
mid-2000s. HCCIS data indicate a general increase in the total number of swing bed days from
41,634 swing bed days in FY2004 to 48,107 swing bed days in FY2008 (about 15 percent increase)
(Figure 3). From FY2008 to FY2012 total swing bed days decreased from 48,107 to 43,974 (about 9
percent decrease). The highest number of swing bed days occurred in FY2008 with 48,107 total
days, and the lowest year occurred in FY2011 with 41,121 total days. Overall, there was about a 6
percent increase in the total number of swing bed days from FY2004 to FY2012.
Figure 3: Total Number of Swing Bed Days
50,000
49,000
48,107
48,000
46,546
47,000
46,000
Total Swing Bed Days
45,000
45,507
45,325
44,137
43,974
44,661
44,000
43,000
42,000
41,000
41,634
41,121
40,000
39,000
38,000
37,000
36,000
35,000
FY2004
FY2005
FY2006
FY2007
FY2008
FY2009
FY2010
FY2011
FY2012
6
Regionally, the Southwest had the greatest number of total swing bed days for all fiscal years, with
12,249 total swing bed days in FY2004 and 11,089 total swing bed days in FY2012. The largest
number of total swing bed days occurred in FY2009 in the Southwest region, with 13,989 total
swing bed days. The metropolitan region had the lowest number of total swing bed days for all
fiscal years, with 964 total swing bed days in FY2004 and 900 total swing bed days in FY2012. The
smallest number of total swing bed days occurred in FY2011 in the metropolitan region, with 756
total swing bed days. The Northeast region had the most interregional variation across FY2004FY2012, while the metropolitan region experienced the least interregional variation.
Total Number of Swing Bed Days
Figure 4: Total Swing Bed Days by Region (FY2004-FY2012)
16,000
14,000
12,000
10,000
8,000
6,000
4,000
2,000
Northwest
0
Northeast
West Central
Central
Metro
Southwest
South Central
Southeast
FY2004 FY2005 FY2006 FY2007 FY2008 FY2009 FY2010 FY2011 FY2012
3032
3017
2762
3610
3989
4377
4053
4026
3588
7122
7665
6649
6847
6318
6016
6130
5381
5026
6497
4226
964
12249
5901
1643
8261
4148
763
12582
5977
1724
7945
3798
998
13622
7406
2145
8326
3443
772
12614
7020
2029
9141
3885
990
13854
7891
2039
8054
3472
907
13989
7523
2208
7163
3175
979
12511
8473
3023
6081
2516
756
11548
7609
3204
8159
3534
900
11089
8057
3621
7
Swing Bed Admissions
HCCIS data show that most swing bed admissions occur within the same hospital, averaging about
68 percent of all swing bed admissions from FY2004 to FY2012 (Figure 5). Swing bed admissions
from the same hospital decreased slowly from FY2004 with 73.06 percent of total swing bed
admissions to 65.69 percent of total swing bed admissions in FY2012. Swing bed admissions
coming from the same hospital peaked in FY2005 with 76.66 percent of total admissions, and hit a
low of 62.58 percent in FY2011.
Swing bed admissions from another hospital averaged 28.69 percent of total swing bed admissions
from FY2004-FY2012, and increased from 24.65 percent in FY2004 to 32.10 percent in FY2012.
Swing bed admissions coming from another hospital peaked in FY2009 with 32.81 percent, after
declining to 21.81 percent in FY2005.
Readmission into the same hospital within a 60-day period accounted for about 3 percent of total
swing bed admissions, and generally remained constant from 2.30 percent in FY2004 to 2.21
percent in FY2012. Swing bed readmissions peaked in FY2011 with 5.45 percent of total
admissions and fell to 1.53 percent total admissions in FY2005.
Figure 5: Swing Bed Admissions (FY2004-FY2012)
85
Percent Total Swing Bed Admissions
80
75
73.06
76.66
73.50
67.27
70
65
64.49
63.16
32.43
32.81
3.08
FY2008
64.08
62.58
30.61
31.97
4.03
5.31
5.45
FY2009
FY2010
FY2011
65.69
60
55
50
45
40
35
30
25
24.65
21.81
23.93
20
15
10
5
0
2.30
1.53
2.57
FY2004
FY2005
FY2006
From This Hospital
27.86
4.86
FY2007
From Another Hospital
32.10
2.21
FY2012
Re-Admission in 60 Days
8
Regionally, the Southwest region had the highest total swing bed admissions for all fiscal years
(Figure 6). The Southeast region had the lowest number of swing bed admission in FY2004-FY2009,
followed by the metropolitan region in FY2010-FY2012. The largest number of swing bed
admissions occurred in FY2006 in the Southwest region, with 1,754 total swing bed admissions.
The lowest number of swing bed admissions occurred in FY2012 in the Metropolitan region with
126 total swing bed admissions.
Total Number of Swing Bed Admissions
Figure 6: Swing Bed Admissions by Region (FY2004-FY2012)
2000
1800
1600
1400
1200
1000
800
600
400
200
Northwest
0
Northeast
West Central
Central
Metro
Southwest
South Central
Southeast
FY2004 FY2005 FY2006 FY2007 FY2008 FY2009 FY2010 FY2011 FY2012
375
400
351
423
422
475
464
387
374
676
735
698
673
634
615
652
613
560
689
581
347
1665
893
219
847
560
302
1674
919
235
764
490
307
1754
1052
237
836
444
271
1569
1014
261
922
516
304
1656
1064
264
Table 1: Total Swing Bed Admissions (FY2004-FY2012)
Admissions
From This
Hospital
Total
451
259
1744
969
257
705
404
233
1591
1080
356
612
725
336
165
1492
976
317
399
126
1389
971
303
FY2004 FY2005 FY2006 FY2007 FY2008 FY2009 FY2010 FY2011 FY2012
3,978
4,348
4,155
3,694
3,729
3,496
3,515
3,065
3,184
125
87
145
267
178
223
291
267
107
From Another
1,342
Hospital
Re-Admission
in 60 Days
765
5,445
1,237
5,672
1,353
5,653
1,530
5,491
1,875
5,782
1,816
5,535
1,679
5,485
1,566
4,898
1,556
4,847
9
To better assess how swing bed admissions are distributed regionally, different swing bed
admission types were analyzed longitudinally according to region. Below, admissions from the
same hospital, from another hospital, and readmission within 60 days of discharge are presented
according to fiscal year and region.
Swing bed admissions from the same hospital appeared to decrease slowly across all regions from
FY2004 to FY2012. The total number of swing bed admissions from this same hospital decreased
from 3,978 in FY2004 to 3,184 in FY2012. The Southwest region had the highest number of swing
bed admissions for all fiscal years, reaching a peak in FY2006 with 1,340 and reaching the lowest
number of admission in the region with 1,051 in FY2011. The southeast region had the lowest
number of swing bed admissions from the same hospital, with 150 admissions in FY2004 and 66
admissions in FY2011. The metropolitan region had the lowest number of swing bed admissions
from the same hospital in FY2012, with 126 admissions.
Figure 7: Total Number of Swing Bed Admission from This Hospital
Total Number of Swing Bed Admissions
1600
1400
1200
1000
800
600
400
200
Northwest
0
Northeast
West Central
Central
Metro
Southwest
South Central
Southeast
FY2004 FY2005 FY2006 FY2007 FY2008 FY2009 FY2010 FY2011 FY2012
301
339
275
277
257
303
324
282
253
417
507
447
432
419
450
462
383
353
505
431
327
1206
641
150
633
454
291
1263
699
162
543
340
291
1340
760
159
596
262
264
1131
585
147
627
331
289
1104
575
127
513
290
240
1086
502
112
461
266
223
1135
554
90
412
223
165
1051
483
66
450
288
126
1060
464
190
10
The number of swing bed admissions from another hospital was variable between FY2004 and
FY2012, with the largest number occurring in the Southwest region in FY2009 with 600 admissions
and the smallest number occurring in FY2011 and FY2012 in the metropolitan region with 0
admissions. The metropolitan region remained the region with the smallest number of swing bed
admissions throughout all fiscal years, with 20 in FY2004 and none in FY2011 and FY2012. The
Southwest had the largest number of swing bed admissions in FY2004 through FY2006, and in
FY2008 through FY2010. The South Central region had the largest number in FY2007 and from
FY2010 beyond, with 518, 469, and 494 admissions. In general, the number of swing bed
admissions from another hospital increased from 1,342 admissions in FY2004 to 1,556 admissions
in FY2012.
Figure 8: Total Number of Swing Bed Admission from Another Hospital
Total Number of Swing Bed Admissions
700
600
500
400
300
200
100
Northwest
0
Northeast
West Central
Central
Metro
Southwest
South Central
Southeast
FY2004 FY2005 FY2006 FY2007 FY2008 FY2009 FY2010 FY2011 FY2012
74
59
65
118
153
145
112
154
185
160
176
206
225
270
232
20
11
16
4
15
15
133
234
411
249
61
98
223
380
220
70
62
250
398
285
71
126
229
374
410
44
183
206
525
468
55
157
600
459
54
87
98
216
179
254
10
0
0
136
398
518
104
110
212
421
469
88
111
184
310
494
105
11
The number of swing bed readmissions within 60 days increased dramatically for the Southeast
region, before falling to eight readmissions in FY2012. The total number of swing bed readmissions
decreased slightly from 125 readmissions in FY2004 to 107 readmissions in FY2012. The West
Central and Southwest regions also saw large fluctuations in the number of swing bed
readmissions. The West Central region had 88 swing bed readmissions in FY2006, up from eight the
previous year. This number had decreased to two swing bed admissions by FY2008. The number of
swing bed readmissions in the Southwest region varied from 16 in FY2006, 64 in FY2007, 27 in
FY2008, and 58 admissions in FY2009 and FY2010, before falling to 20 in FY2011.
Figure 9: Total Number of Swing Bed Admission from Readmissions within 60 Days
180
Total Number of Swing Bed Admissions
160
140
120
100
80
60
40
20
Northwest
0
Northeast
West Central
Central
Metro
Southwest
South Central
Southeast
FY2004 FY2005 FY2006 FY2007 FY2008 FY2009 FY2010 FY2011 FY2012
0
2
11
28
12
27
28
18
23
5
1
12
9
11
5
18
23
24
38
0
0
17
25
48
3
8
8
31
0
3
15
88
0
16
7
7
15
56
3
64
19
70
25
2
0
27
21
82
20
4
4
58
8
91
28
2
0
58
8
162
21
3
0
20
24
163
21
0
0
19
13
8
12
Swing Bed Discharges
Most swing bed discharges are to the patient’s home, averaging about 61 percent of all swing bed
discharges (Figure 7). The percent of total swing bed discharges to home slowly increased from
FY2004 to FY2012, with the lowest year occurring in FY2004 at 57.99 percent of all discharges and
the peak occurring in FY2012 at 63.26 percent of all discharges. Swing bed discharges to nursing
homes averaged about 25 percent of all swing bed discharges. The percent of total swing bed
discharges to nursing homes remained constant from FY2004 to FY2012, with the lowest year
occurring in FY2004 with 23.35 percent of all discharges and the peak occurring in FY2012 with
25.83 percent of all discharges.
Swing bed discharges to another hospital unit were also stable. The percent of total swing bed
discharges only varied from 6.90 percent in FY2012 to 12.91 percent in FY2010. The percent of
total swing bed discharges to another hospital unit did decline from 9.00 percent in FY2004 to 6.90
percent in FY2012, however. Discharge to “other” averaged about 5 percent from FY2004 to
FY2012, peaking in FY2004 with 9.66 percent but falling to about 4 percent from FY2008 to
FY2012.
Figure 10: Swing Bed Discharges (FY2004-FY2012)
70
Percent Total Swing Bed Discharges
65
60
57.99
58.46
23.35
24.52
60.75
62.10
60.73
62.28
59.34
62.14
63.26
55
50
45
40
35
30
25
20
15
10
5
0
9.00
11.69
25.13
24.73
25.08
10.15
25.22
23.68
24.35
25.83
12.91
9.29
8.17
8.48
5.32
5.96
4.69
4.04
4.44
4.07
4.21
4.01
FY2005
FY2006
FY2007
FY2008
FY2009
FY2010
FY2011
FY2012
8.05
6.90
9.66
FY2004
Another Hospital Unit
Nursing Home
Home
Other
13
Regionally, the Southwest region had the highest total swing bed discharges for all fiscal years. The
Southeast region had the lowest number of swing bed discharges in FY2004-FY2009, followed by
the Metropolitan region in FY2010-FY2012. The largest number of swing bed discharges occurred
in FY2006 in the Southwest region, with 1,709 total swing bed discharges. The lowest number of
swing bed discharges occurred in FY2012 in the Metropolitan region with 129 total swing bed
discharges.
Figure 11: Swing Bed Discharges by Region (FY2004-FY2012)
Total Number of Swing Bed Discharges
1800
1600
1400
1200
1000
800
600
400
200
Northwest
0
Northeast
West Central
Central
Metro
Southwest
South Central
Southeast
FY2004 FY2005 FY2006 FY2007 FY2008 FY2009 FY2010 FY2011 FY2012
362
391
330
404
403
457
440
355
343
652
679
684
663
614
597
635
597
540
668
574
348
1615
861
209
805
722
520
292
1640
899
222
751
408
300
1709
1000
235
421
259
1522
995
254
890
516
297
1618
1037
263
Table 2: Total Swing Bed Discharges (FY2004-FY2012)
772
443
254
1708
974
270
679
635
404
232
1570
1066
328
337
162
1468
977
311
711
396
129
1366
964
293
Discharges
FY2004 FY2005 FY2006 FY2007 FY2008 FY2009 FY2010 FY2011 FY2012
Another
Hospital Unit
Nursing
Home
511
290
321
247
228
243
218
204
190
3,067
3,185
3,273
3,272
3,424
3,410
3,177
3,009
3,000
Home
Other
Total
1,235
476
5,289
1,336
637
5,448
1,354
440
5,388
1,303
447
5,269
1,414
572
5,638
1,381
441
5,475
1,268
691
5,354
1,179
450
4,842
1,225
327
4,742
14
To better assess how swing bed discharges are distributed regionally, different swing bed
discharges types were analyzed longitudinally according to region. Below, discharges to another
hospital unit, home, nursing homes, and other are presented according to fiscal year and region.
Swing Bed discharges to another hospital unit has varied from FY2004 to FY2012, beginning with a
steep decline in the West Central region between FY2004 and FY2005. The Southwest region was
the second largest region with discharges to another hospital unit from FY2005 to FY2008, and
from FY2009 to FY2011. The South Central region also had the highest number of swing bed
discharges to another hospital unit in FY2008 and FY2012, while the remaining regions remained
relatively constant during this period. For all regions combined, the total number of swing bed
discharges to another hospital unit decreased from 511 in FY2004 to 190 in FY2012.
Figure 12: Swing Bed Discharge to Another Hospital Unit by Region
Total Number of Swing Bed Discharges
250
200
150
100
50
Northwest
0
Northeast
FY2004 FY2005 FY2006 FY2007 FY2008 FY2009 FY2010 FY2011 FY2012
83
69
56
16
13
15
13
33
12
32
35
29
43
27
31
32
33
28
21
West Central
199
Southwest
124
Central
Metro
South Central
Southeast
6
38
8
29
5
5
110
33
4
18
14
6
133
49
16
43
9
2
89
33
12
39
12
2
56
70
9
36
7
1
88
56
9
23
14
12
58
57
9
18
13
7
52
39
9
25
20
7
32
54
12
15
The number of swing bed discharges to home remained relatively constant from FY2004 to FY2012
for all regions. The Southwest region had the highest total number of swing bed discharges to home
for all fiscal years, from 949 discharges in FY2004 and 827 in FY2012. The Southeast had the lowest
number of swing bed discharges to home in FY2004 with 115 discharges, while the Metro region
had the lowest number of swing bed discharges to home in FY2012 with 173 total discharges. For
all regions, the total number of swing bed discharges to home decreased from 3,067 to 2,000.
Figure 13: Swing Bed Discharges to Home by Region
Total Number of Swing Bed Discharges
1200
1000
800
600
400
200
Northwest
0
Northeast
West Central
Central
Metro
Southwest
South Central
Southeast
FY2004 FY2005 FY2006 FY2007 FY2008 FY2009 FY2010 FY2011 FY2012
126
201
142
254
250
270
267
170
231
430
424
455
424
375
383
400
421
342
417
221
308
949
501
115
499
260
147
948
556
150
490
199
169
1014
646
158
535
264
132
888
615
160
619
292
147
914
672
155
580
271
134
997
636
139
518
243
137
849
633
130
465
229
73
877
670
104
533
241
62
827
591
173
16
The number of swing bed discharges to nursing homes broken down by region also remained
consistent across all fiscal years. The Southwest region had the largest number of swing bed
discharges to nursing homes from FY2004 to FY2012, with 426 discharges in FY2004 and 441
discharges in FY2012. The South Central region had the second largest number of swing bed
discharges to nursing homes, with 233 discharges in FY2004 and 242 discharges in FY2012. The
Southeast region had the lowest number of swing bed discharges to nursing homes from FY2005 to
FY2011, with 49 and 31 discharges, respectively. The Metro region had the lowest number of swing
bed discharges to nursing homes in FY2004 with 17 discharges, and again in FY2012 with 29
discharges. The total number of swing bed discharges to nursing homes decreased from 1,235 in
FY2004 to 1,225 in FY2012.
Figure 14: Swing Bed Discharges to Nursing Home by Region
Total Number of Swing Bed Discharges
600
500
400
300
200
100
Northwest
0
Northeast
West Central
Central
Metro
Southwest
South Central
Southeast
FY2004 FY2005 FY2006 FY2007 FY2008 FY2009 FY2010 FY2011 FY2012
84
99
96
109
94
118
123
114
152
146
141
121
235
218
169
218
166
186
153
125
158
17
130
113
116
127
124
128
426
233
57
108
146
416
202
49
98
150
459
229
56
115
129
434
259
16
137
495
16
98
140
89
545
27
94
92
55
546
48
72
92
106
47
29
87
469
31
129
148
441
242
58
17
The total number of swing bed discharges to other was variable across regions. Other discharges
include other hospital units, assisted living facilities, group homes or death. The largest number of
swing bed discharges to other occurred in FY2010 in the South Central region with 207 discharges,
and the lowest number occurred in the Southeast region in FY2006 with 5 discharges. The total
number of swing bed discharges to other locations decreased in FY2004 with 476 discharges to 327
discharges in FY2012.
Figure 15: Swing Bed Discharges to Other by Region
Total Number of Swing Bed Discharges
250
200
150
100
50
Northwest
0
Northeast
West Central
Central
Metro
Southwest
South Central
Southeast
FY2004 FY2005 FY2006 FY2007 FY2008 FY2009 FY2010 FY2011 FY2012
69
64
22
36
25
46
54
37
38
28
74
50
67
60
37
62
22
22
91
30
147
116
166
62
17
89
29
10
108
19
61
97
12
103
76
5
48
33
9
111
88
66
74
75
21
153
60
83
58
25
30
78
64
95
44
55
28
117
207
141
60
8
35
70
50
167
47
6
31
66
77
50
18
Swing Beds and Critical Access Hospitals by Region
Minnesota currently has 79 Critical Access Hospitals (CAHs), of which 77 are licensed swing bed
providers. In FY2012, 23 hospitals outside of the metropolitan area were not designated as Critical
Access Hospitals but were licensed as swing bed providers. The majority of swing bed days now
occur in CAHs, having risen from 73.60 percent of total swing bed days in FY2004 to 98.21 percent
of total swing bed days in FY2012.
Figure 16: Percent Swing Bed Days in CAH Hospitals
Percent Total Swing Bed Discharges
100
95
90
85
93.95
93.58
93.80
FY2006
FY2007
FY2008
95.35
96.26
FY2009
FY2010
97.55
98.21
FY2011
FY2012
86.71
80
75
70
73.60
65
60
55
50
FY2004
FY2005
Table 3: Total Swing Bed Days (FY2004-FY2012)
Swing Bed Days FY2004 FY2005 FY2006 FY2007 FY2008 FY2009 FY2010 FY2011 FY2012
Non-CAH
Hospital
CAH Hospital
10991
30643
5865
38272
2742
42583
2869
41792
2982
45125
2166
44380
1702
43805
1006
789
40115
43185
19
Medicare Days
An analysis of Medicare days reported by nursing homes provides an avenue to assess the possible
impact of changes in swing bed regulations on nursing homes. When comparing Medicare days
after changes were made in swing bed regulations, there do not seem to be substantial changes. The
percent of total nursing home stays paid by Medicare was higher among nursing homes located in
Greater Minnesota than in the metropolitan area or the state average in FY2004 and FY2005.
Since FY2006, the percent of nursing home stays paid by Medicare in Greater Minnesota has
decreased. The percentage of total nursing home stays funded by Medicare has varied over the
years. Among all nursing homes, the percent of nursing homes stays paid by Medicare was greatest
in FY2012 (9.20 percent) and lowest in FY2007 (8.31 percent). From FY2004 to FY2007, nursing
homes in Minnesota saw the percentage of Medicare-funded stays decrease from 9.05 percent to
8.31 percent, and then increased from FY2008 (8.62 percent) to FY2012 (9.20 percent).
Nursing homes in the metropolitan region saw a general increase in the percentage of Medicare
funded stays from FY2004 (8.67 percent) to FY2012 (10.69 percent). Nursing homes in Greater
Minnesota saw a general decline in the percentage of Medicare-funded stays from FY2004 (9.68
percent) to FY2012 (8.46 percent). Fiscal years 2010, 2011 and 2012, however, increased from 7.85
percent to 8.44 percent to 8.46 percent, respectively.
Percent of Total Nursing Home Stays Billed
Figure 17: Percent of Nursing Home Stays Billed to Medicare
11.0
10.5
10.0
Metro
MN
9.5
9.0
8.5
8.0
7.5
7.0
Greater MN
FY2004 FY2005 FY2006 FY2007 FY2008 FY2009 FY2010 FY2011 FY2012
8.67
9.05
9.68
9.32
9.30
9.61
8.80
8.47
8.57
9.26
8.31
8.03
10.06
8.62
8.08
9.99
8.65
8.12
10.19
8.66
7.85
10.55
9.16
8.44
10.69
9.20
8.46
20
The percent of nursing homes stays billed to Medicare has varied regionally (Figure 10). Medicare
funding was highest in FY2005 in the Southeast region, with 11.61 percent of all nursing home
stays funded by Medicare. Likewise, Medicare funding was lowest in FY2010 in the Northwest
region, with 5.19 percent of all nursing home stays funded by Medicare. The West Central region
had the most interregional variability, with 9.95 percent funding in FY2004 and 6.17 percent
funding in FY2009. The Northeast region had the least interregional variability, with 9.95 percent
funding in FY2005 and 8.29 percent funding in FY2008.
Figure 18: Percent of Nursing Home Stays Billed to Medicare
Percent of Nursing Home Satys Billed to Medicare
12.0
11.0
10.0
9.0
8.0
7.0
6.0
5.0
4.0
3.0
2.0
1.0
0.0
FY2004
FY2005
FY2006
FY2007
FY2008
FY2009
FY2010
FY2011
FY2012
North
West
North
East
West
Central
Central
Metro
6.38
9.17
7.43
8.63
7.35
9.32
6.98
6.50
5.99
5.49
5.44
5.19
5.37
5.20
9.41
9.95
8.79
8.29
8.55
8.50
9.50
8.87
9.95
7.86
6.68
6.29
6.17
6.43
7.32
7.09
8.92
6.57
8.67
8.80
9.26
7.01
10.06
7.39
10.55
6.93
6.97
7.63
9.99
10.19
10.69
South
West
South
Central
South
East
6.55
10.18
10.58
8.20
8.27
6.20
6.12
11.44
10.88
9.63
9.22
5.69
10.00
6.31
9.13
5.63
5.98
8.74
9.34
11.22
11.61
9.52
10.17
10.02
9.29
10.05
10.48
21
Nursing Homes within 25-Mile Radius
Spatial mapping software was used to conduct geographical analysis of nursing home Medicare
days in close proximity to swing bed hospitals. Among nursing homes that are located within a 25mile radius of swing bed providers, the percent of nursing homes stays that were billed to Medicare
ranged from 8.32 percent in FY2007 to 9.32 percent in FY2005 (Figure 11). There did not appear to
be substantial variation in the percent of nursing homes stays billed to Medicare over this period.
Figure 19: Nursing Home Medicare Stays within 25-Mile Radius of Swing Bed Provider
Percent of Nursing Homes Stays Billed to Medicare
10.0
9.5
9.0
9.32
9.17
9.07
8.90
8.5
8.47
8.0
8.63
8.66
8.68
FY2008
FY2009
FY2010
8.32
7.5
7.0
6.5
6.0
FY2004
FY2005
FY2006
FY2007
FY2011
FY2012
22
Hospital and Nursing Home Days
Swing beds comprise a relatively small proportion of care settings in comparison to nursing homes
and hospitals. Differences exist in the total number of days patients spend in swing beds compared
to days in acute care or days in a skilled nursing facility, regardless of payer. The total number of
days that patients spend in nursing homes outnumbers the total number of days spent in swing
beds, Medicare-funded nursing home days, and acute hospital days. When comparing these care
setting categories side-by-side, more days are reported in acute hospital beds and nursing home
beds than in swing beds for all fiscal years presented.
Figure 20: Total Days by Swing Bed Providers and Nursing Homes
14,000,000
13,000,000
12,000,000
11,000,000
Total Number of Days
10,000,000
9,000,000
8,000,000
7,000,000
6,000,000
5,000,000
4,000,000
3,000,000
2,000,000
1,000,000
0
FY2004
FY2005
FY2006
Swing Bed Days
Nursing Home Medicare Days
FY2007
FY2008
FY2009
FY2010
FY2011
FY2012
Acute Hospital Days
Nursing Home Resident Days
23
Report Methods
Nursing Home Occupancy Rates
Nursing home occupancy data was gathered and calculated by the Nursing Facility Rates and Policy
Division of the Minnesota Department of Human Services. Nursing home occupancy rates are
computed by dividing the total number of resident days for the reporting period by the maximum
number of resident days available for the reporting period. Nursing facilities that ceased operation
during a reporting period had their occupancy rate computed only for the days the nursing home
was in operation.
Occupancy Rate =
Total Resident Days Used
Maximum Number of Resident Days Possible
The Maximum number of resident days possible is calculated by taking the average number of beds
for the facility for the reporting period and multiplying that number by the number of days in the
reporting period. The average number of beds is computed by totaling the number of licensed beds
for each day in the reporting period and dividing by the total number of days in the reporting
period.
Average Number of Beds =
∑ of Beds Available for Each Day of the Reporting Period
Total Number of Days in the Reporting Period
In this report, total resident days used is computed by counting the number of days a resident is
considered a resident of the nursing home during the reporting period. If a resident was
hospitalized during the reporting period and the nursing home expected the resident to return to
the facility the hospital days are counted as nursing home resident days. If a resident was
discharged from the nursing home and was not expected to return then the count of resident days
stopped on the day the resident was discharged from the facility. If a resident was discharged from
the facility and return was expected but the resident did not return then the counting of resident
days would be stopped on the day of discharge.
Nursing Home Medicare Days
Nursing home Medicare data was also obtained from the Nursing Facility Rates and Policy Division
of the Minnesota Department of Human Services. Medicare days are reported by federal fiscal year
beginning October 1st and ending on September 30th of the following year. Medicare days
represent the number of days that Medicare Part A paid a portion of the daily cost of a nursing
home stay. Medicare days allow for a more detailed examination of nursing home stays and are
included as a supplement to the occupancy data in this report.
24
Swing Bed Data
Data on swing bed were obtained from the Health Care Information System’s Hospital Annual
Report (HCCIS) at the Division of Health Policy at the Minnesota Department of Health. HCCIS is a
source of information about the financial, utilization, and service characteristics of hospitals in
Minnesota and is reported annually to MDH.
Nursing Homes within 25-Mile Radius
Occupancy rates in skilled nursing facilities within 25 miles of a hospital with licensed swing bed
providers were also reviewed. A GIS mapping system was used to measure distance between
nursing homes and hospitals with swing beds. Hospitals and nursing homes were geocoded by city
location, and a 25-mile radius was drawn around each swing bed hospital. Nursing homes falling
within the 25-mile radius were identified and occupancy rates and Medicare days for these nursing
homes were aggregated and analyzed separately.
Occupancy Data
Swing bed HCCIS data are presented in fiscal year format, although every facility may not have the
same fiscal year end date. Nursing home occupancy and Medicare data are also presented in federal
fiscal year format and cover the following periods:
Fiscal Year 2004: October 1st, 2003 to September 30th, 2004
Fiscal Year 2005: October 1st, 2004 to September 30th, 2005
Fiscal Year 2006: October 1st, 2005 to September 30th, 2006
Fiscal Year 2007: October 1st, 2006 to September 30th, 2007
Fiscal Year 2008: October 1st, 2007 to September 30th, 2008
Fiscal Year 2009: October 1st, 2008 to September 30th, 2009
Fiscal Year 2010: October 1st, 2009 to September 30th, 2010
Fiscal Year 2011: October 1st, 2010 to September 30th, 2011
Fiscal Year 2012: October 1st, 2011 to September 30th, 2012
25
County Breakdown for Regional Analysis:
Northwest Region: Kittson, Roseau, Lake of the Woods, Marshall, Beltrami, Hubbard, Clearwater,
Pennington, Red Lake, and Polk counties.
Northeast Region: Koochiching, Saint Louis, Lake, Cook, Itasca, Aitkin, and Carlton counties.
West Central Region: Norman, Mahnomen, Clay, Becker, Wilkin, Otter Tail, Traverse, Grant, Douglas,
Pope, and Stevens counties.
Central Region: Cass, Wadena, Crow Wing, Todd, Morrison, Mille Lacs, Kanabec, Pine, Isanti, Benton,
and Stearns counties.
Metropolitan Region: Sherburne, Anoka, Chisago, Washington, Hennepin, Ramsey, Carver, Scott,
and Dakota counties.
Southwest Region: Big Stone, Swift, Kandiyohi, Lac Qui Parle, Chippewa, Yellow Medicine, Renville,
Lincoln, Lyon, Redwood, Pipestone, Murray, Cottonwood, Rock, Nobles, and Jackson counties.
South Central Region: Meeker, Wright, McLeod, Sibley, Nicollet, Le Sueur, Brown, Watonwan, Blue
Earth, Waseca, Martin, and Faribault counties.
Southeast Region: Rice, Goodhue, Steele, Dodge, Olmstead, Winona, Freeborn, Mower, Fillmore,
Houston, and Wabasha counties.
26
Appendix 1:
27