Swing Bed Strategy

Implications: Some hospitals review swing bed utilization as follows: 1)Initial review within 24 hours to see if inpatient criteria are met. Criteria incorporate Severity of illness and Intensity of Service. Severity of Illness can be shortness of breath, multiple effusions or other symptoms. In other words, the patient has to be sufficiently sick to merit an acute care setting; 2)After 3 days in acute care, if stable or in need of therapy or other services, they can be moved to Swing beds. They can have IV antibiotics in Swing bed but the goal is to migrate them to taking the fluids by mouth by day 5; and, 3)The UR nurse reviews the patient’s medical chart, interviews the patient and compares the review results to the established guidelines. The UR nurse contacts the payer to justify the stay including but not limited to the medical necessity and the covered services.

Analysis:  

Admission is the time that criteria need to be met. To care for a patient without the necessary assessment, runs the risk that Medicare or another payor might recoup funds. Co-morbidities can be incorporated into the admission criteria. Insurance companies seem to deny extra days about 12 percent of the time. Denials require a return visit to the patient by the UR nurse. Appeals may or may not include the X-rays, lab results and other medical chart information. Sometimes, the physician is enlisted to help with the appeal. In rare cases, there may be a negotiation for the contested days of care.

Discharge can be to home, home with home health, Rehab facility or an LTAC unit.