In 2020, a large multi-hospital health system approached HDG needing assistance with developing a program for patients that were difficult to place for social or financial reasons. This issue had pre-dated the COVID-19 pandemic, but by late 2020 it was rising to the top of concerns for the health system, as they needed room for increasing numbers of COVID-19 patients.

The health system had identified a potential partner Skilled Nursing Facility (SNF) which had renovated a wing prior to the pandemic, but which now stood empty due to regionwide occupancy declines. The health system sought assistance in developing a partnership with the SNF.

Upon engagement, HDG went to work by interviewing key stakeholders within the health system, including case managers, Chief Medical Officer, finance department and program managers. There was broad agreement about the nature of challenge, and of equal importance, buyin from the health system leadership.

Working with the health system team, HDG took a deep dive into the types of patients, their average length of stay in inpatient care and then analyzed their potentially avoidable days. Many patients were awaiting a Medicaid eligibility determination, while others had a more challenging clinical or social profile. The potentially avoidable hospital days for cases ranged from several weeks to many months. The need for a more appropriate setting to meet the needs of these patients was a paramount concern.

HDG built a financial model to assess the impact on all parties of a program designed to facilitate transfer of these hard-to-place patients to the SNF. Finally, HDG carefully reviewed compliance and legal guidelines regarding arrangements between hospitals and SNFs.


Working with the client, HDG developed a bed reservation agreement between the health system and the partner SNF. The arrangement ensured appropriate safeguards about the type of patients to be referred to the program, a process to ensure a solid working relationship and to address any clinical or social issues that may arise, financial parameters and data reporting requirements.

This agreement details were worked out swiftly and the program began within weeks.

“We were able to work with the partner SNF and everybody upped their game on addressing clinical and social issues of these hard-to-place patients. In that respect, this program has been a clear step forward.”

Health System Program Manager


The reserved beds in the SNF filled up quickly as there was significant pent-up demand. During the fill-up period, teams from the health system and the SNF met frequently to address program operation and provide updates on patients at the SNF, as well as patients at the hospital who would be eligible to participate.

It became clear that some patients had medical complexities and/or social issues that required enhanced problem solving and clinical capabilities on the part of the SNF. Those issues were worked out, leading to closer hospital/post-acute integration than would otherwise normally occur. Turnover of key staff at the SNF created some challenges that needed to be overcome.

Ultimately, the health system was able to free up scarce beds for COVID-19 surges as well as for other patients requiring acute care. The program has had its ups and downs volume-wise, but overall, the savings from reduced avoidable days has been a net positive for the health system. Most of all, according to the program manager at the health system: “We were able to work with the partner SNF and everybody upped their game on addressing clinical and social issues of these hardto-place patients. In that respect, this program has been a clear step forward.”

For the SNF, they were able to partially fill up a completely unused unit and leverage their expertise in post-acute and long-term care.

Further evaluation of the program is pending.

About Health Dimensions Group

Minneapolis-based Health Dimensions Group (HDG) is a leading management and consulting firm, providing services to post-acute, longterm care, and senior living providers, as well as hospitals and health systems across the nation. HDG has been serving health care organizations for more than 20 years with a firm commitment to its values of hospitality, stewardship, integrity, respect, and humor.


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