Skilled Nursing Occupancy Growth Stalled in March

NIC MAP Vision released its latest Skilled Nursing Monthly Report on June 1, 2023. The report includes key monthly data points from January 2012 through March 2023.

Here are some key takeaways from the report:

Skilled nursing property occupancy decreased in March, after increasing for two months in a row. It declined 27 basis points from February to end the month at 81.0%. There has been positive momentum in occupancy throughout 2022 and the first couple months of 2023. It is up 6.3 percentage points since the low (74.7%) point reached in January 2021. However, staffing in the sector is still a significant burden on skilled nursing operators and is limiting additional admissions in many markets around the country. Occupancy is down 7.8 percentage points from the pre-pandemic February 2020 level of 88.9%. As staffing 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.


Both Medicare revenue mix and the revenue per patient day (RPPD) increased in March. However, both are down slightly from December 2022. Medicare revenue mix is down 251 basis points from the most recent in high in February 2022 which was a time when increased cases of COVID-19 resulted in additional need for utilizing the 3-Day rule waiver and per day reimbursement for COVID-19-positive patients. Medicare revenue mix ended March at 22.2%. Medicare RPPD ended March at $591 and is up 0.78% from one year ago. Meanwhile, Managed Medicare revenue mix was down 28 basis points to 11.4% in March. However, this is 220 basis points above the pandemic low of 9.2% set in May 2020.

Managed Medicare revenue per patient day (RPPD) increased slightly in March, but it is down 0.8% from March 2022. 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 March 2023 at $591 and managed Medicare ended at $478, representing a $113 differential. In March of 2021, the differential was $90.

After increasing slightly in the month of February, Medicaid patient day mix was flat, ending March at 64.9%. However, it has increased 188 basis points from the pandemic low of 63.1% set in February 2022. Meanwhile, Medicaid revenue mix declined 45 basis points from the prior month, ending March at 50.1%. One element of the Medicaid revenue share of a property’s revenue is RPPD and that declined 0.23% from February. However, it up 3.44% since last year in March 2022.

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 and NIC MAP Vision maintain strict confidentiality of all data received.