SNFs Only Admit About a Third of Referrals as Denials Loom Large

Patients referred to skilled nursing facilities only become residents about 37% of the time, a new set of survey results reveals — with nearly a quarter of those lost referrals going to a direct competitor.

Of the potential residents referred to any given SNF, 44% are lost, according to data released last week by Enquire, a Denver-based provider of marketing software for senior living and care operators.

In the end, accounting for denials and other patient decisions, around 37% of referrals eventually become SNF patients.


Typically the domain of private-pay senior housing operators who can live or die by converting prospects into residents, referral rates haven’t made as much of an impact on skilled nursing providers; unlike seniors interested in assisted or independent living, people who require skilled nursing services generally have significantly less time to make a decision on where to receive care, with simple proximity to family or an acute care provider determining their final destination.

“According to industry leaders, most of these metrics have never been accurately tracked as all referrals and outcomes are typically not recorded,” Enquire noted in its results.

About 200 SNFs currently use Enquire’s software, chief revenue officer and survey author Erin Hayes told Skilled Nursing News, with data culled from providers that have fully integrated their systems with those of local referral partners — thus enabling Enquire to follow the outcome of every hospital-to-SNF referral.


Of those residents who did not end up at a given SNF, a total of 22% went to competitors, while 19% were denied. Around 7% of all referrals were denied because of concerns over nursing or behavior issues, Enquire found, while 6% were rejected because of a lack of available space — and an additional 7% did not end up in the SNF because of financial issues such as a lack of pre-authorization or other insurance problems.

Source: Enquire

While some factors in residents’ SNF choice calculus are outside of operators’ control, that nursing-denial metric could prove increasingly consequential under the new Patient-Driven Payment Model, set to take effect October 1. As Medicare reimbursement incentives shift to higher-acuity patients, many operators have been probing their denial reports to figure out why certain patients didn’t end up in their facilities — and, potentially, how they could change their operations to capture those residents in the future.

“We studied the denial database for us, and really it picked apart,” Vinnie Barry, Signature HealthCARE’s senior vice president of data informatics and management information systems, told SNN last month. “The new payment structure, the new reimbursement structure, there’s advantages for capturing those clinical diagnoses, the co-morbidities.”

Hayes agreed, noting that many of Enquire’s customers have begun drilling down on the diagnosis related group (DRG) codes associated with denials.

“Who are we denying and why, and do we need to have a special program for certain DRGs that we’re denying?” Hayes said of the mindset. “Looking at that data to be proactive, a lot of them will look at loss: ‘We’re losing this many to competitors, let’s take a look at who.'”

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