Continued Skilled Nursing Staffing Challenges Slow Occupancy Gains

Despite slower than recent monthly gains, skilled nursing occupancy still increased in August for the seventh consecutive month, according to the most recent NIC MAP® Data, released by NIC MAP Vision.

Property occupancy rose 14 basis points from July to August, sitting at 75.2% — that’s a 378 basis point gain from January, NIC MAP data authors noted.

The beginning of the year brought “cautious optimism,” the report said, but the COVID-19 delta variant coupled with stunted occupancy gains tied to staffing shortages meant operators could not regain occupancy at a faster rate.

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“The question remains as to how fast the industry can increase occupancy to a sustainable level as staffing shortages are likely to remain challenging,” NIC MAP data authors said.

August numbers are still below pre-pandemic levels; February 2020 occupancy was 85.6%.

Medicaid patient day mix by contrast is close to pre-pandemic levels, ending August at 66.1%. The statistic increased 278 basis points from the pandemic low of 63.3% in January.

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Medicaid revenue mix sat at 50.4%, a small increase from the previous month. NIC MAP Data authors said the increase was incremental due to Medicaid revenue per patient day (RPPD), which decreased less than 1%.

Medicaid RPPD was impacted by less state reimbursement support as COVID-19 cases declined. Medicare RPPD declined as well by 2.4% also due to fewer COVID cases — there was less of a need for providers to utilize the three-day stay waiver.

Managed Medicare RPPD decreased by 4.1% in August compared to the same month last year; NIC MAP Data authors pointed to an increasing differential between Medicare fee-for-service (FFS) and Managed Medicare RPPD numbers — an increasing gap between the two reimbursement models from $98 pre-pandemic to $117 in August.

“The trend will be monitored closely as operators and investors continue to adjust to the dynamics within healthcare delivery,” NIC MAP Data authors noted.

Overall Medicare mix was down in August from its pandemic high of 25% in January, currently sitting at 20.3%. Managed Medicare revenue mix declined slightly to 10.4% from the previous month, but was 211 basis points above the pandemic low of 8.3% in May 2020.

The number of states represented and contributors were unchanged from July to August, according to the report, while total skilled nursing properties participating in the survey decreased from 1,290 to 1,277.

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