“Occupancy has increased throughout 2022, which suggests demand for skilled nursing is growing. However, retaining adequate staff is still challenging and limits the ability to increase patient admissions.”
-Bill Kauffman
NIC MAP Vision released its latest Skilled Nursing Monthly Report on November 3, 2022. The report includes key monthly data points from January 2012 through August 2022.
Here are some key takeaways from the report:
Skilled nursing occupancy continued to increase in August, rising 48 basis points from July to end the month at 78.8%. This is the highest occupancy rate since April 2020. There has been positive occupancy momentum throughout 2022 and it is up 580 basis points since the low point reached in January 2021 (73.0%). However, COVID-19 cases created additional challenges last year (2021), which slowed some of the initial momentum and the staffing crisis in the sector is still a significant burden on skilled nursing operators. Occupancy remains 8.4 percentage points below the pre-pandemic February 2020 level of 87.2%. As staffing, wage growth, and general inflation pressures persist, operations for many operators will be under pressure but the long-term demand for skilled nursing services is expected to grow over time.
While Medicare revenue mix and the revenue per patient day both increased in August, they are down from earlier in the year. In January and February of 2022, increased cases of COVID-19 resulted in additional need for utilizing the 3-Day rule waiver and per day reimbursement for COVD-19 positive patients. Indeed, Medicare revenue mix ended August at 22.0% but is down from its pandemic high of 24.9% set in February 2022. Medicare RPPD is down 2.9% from its pandemic peak of $590 in June 2020. Meanwhile, Managed Medicare revenue mix was down 15 basis points to 10.4% in August. However, this is 229 basis points above the pandemic low of 8.1% set in May 2020. 
Managed Medicare revenue per patient day (RPPD) decreased in August and is down 1.2%% from year-earlier levels. Depending on an operator’s business model, the continued decline in managed Medicare revenue per patient day can pose a challenge as the reimbursement differential between Medicare fee-for-service and managed Medicare has increased during the past two years. However, some operators see opportunity to capture patient volume with the growth of managed care. Medicare fee-for-service RPPD ended August 2022 at $573 and managed Medicare ended at $453, representing a $120 differential. In August of 2020, the differential was $105.
After decreasing slightly in the month of July, Medicaid patient day mix increased 23 basis points ending August at 64.9%. However, it has increased 252 basis points from the pandemic low of 62.4% set in February 2022. Meanwhile, Medicaid revenue mix declined 25 basis points from the prior month, ending August at 50.8%. One element of the Medicaid revenue share of a property’s revenue is RPPD and that declined 0.33% from July. However, it up 0.8% since last year in August 2021.
Get more trends from the latest data by downloading the Skilled Nursing Monthly Report. There is no charge for this report.
The report provides aggregate data at the national level from a sampling of skilled nursing operators with multiple properties in the United States. NIC continues to grow its database of participating operators to provide data at localized levels in the future. Operators who are interested in participating can complete a participation form on our website . NIC maintains strict confidentiality of all data it receives.