NIC Notes

Insights in Seniors Housing & Care


By: Bill Kauffman  |  February 02, 2023

Skilled Nursing Occupancy Declined Slightly in November

Market Trends  |  NIC MAP Vision  |  Skilled Nursing  |  medicaid  |  medicare

NIC MAP Vision released its latest Skilled Nursing Monthly Report on February 2, 2023. The report includes key monthly data points from January 2012 through November 2022.

Here are some key takeaways from the report:

Skilled nursing occupancy decreased slightly in November. It declined 12 basis points from October to end the month at 79.4%. There was positive momentum in occupancy throughout 2022 and it is up 593 basis points since the low (73.5%) point reached in January 2021. However, COVID-19 cases created additional challenges in 2021, which slowed some of the initial momentum, and occupancy has been flat from August to November 2022. The staffing crisis in the sector is still a significant burden on skilled nursing operators. 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.
SNF Blog Slides Nov 2022_FINAL_Page_15
Medicare revenue mix increased but the Medicare revenue per patient day decreased in November. Both are down from earlier in the year (January/February) when 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. Medicare revenue mix ended November at 21.9% but is down from its pandemic high of 24.8% set in February 2022. Medicare RPPD is down 1.3% from its pandemic peak of $594 in June 2020. Meanwhile, Managed Medicare revenue mix was down 31 basis points to 10.2% in November. However, this is 194 basis points above the pandemic low of 8.3% set in May 2020.

Medicaid patient day mix increased for a fourth month in a row. It increased 7 basis points ending November at 64.7%. In addition, it has increased 269 basis points from the pandemic low of 62.0% set in February 2022. Meanwhile, Medicaid revenue mix also increased from the prior month, ending November at 50.8%. One element of the Medicaid revenue share of a property’s revenue is RPPD and that increased 0.55% from October. It up 0.9% since last year in November 2021. 

Managed Medicare revenue per patient day (RPPD) increased slightly in November but is down 1.1% from last year in November 2021. Skilled nursing property operating models can differ, and some may experience the decline in managed Medicare revenue per patient day poses 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 November 2022 at $587 and managed Medicare ended at $472, representing a $115 differential. In November of 2020, the differential was $96.

To get more trends from the latest data, download 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.

About Bill Kauffman

Senior Principal Bill Kauffman works with the research team in providing research and analysis in various areas including sales transactions and skilled nursing. He has lead roles in creating new and enhanced products and implementation of new processes. Prior to joining NIC he worked at Shelter Development in investing/acquiring, financing, and asset management for over $1 billion in assets. He also had key roles in the value creation and strategic planning and analysis for over 65 entities. He received his Master of Science in Finance from Loyola University Maryland and holds the Chartered Financial Analyst Designation (CFA).

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