The financial strain is attributable, in part, to health systems trying to lower the overall cost of episodes of care. “Anecdotal evidence from initial joint bundled payment episodes shows health systems are skipping discharge to skilled nursing facilities to the benefit of lower cost settings (i.e. home healthcare services),” according to Fitch.
Skipping discharge to SNFs is sometimes appropriate for joint-related bundled payments. However, Fitch expects more patients covered by the cardiac bundles to be discharged to SNFs due to the expectation that these patients will have more comorbidities and be at greater risk of readmission.
Although bundled payment initiatives are still in their early stages, healthcare real estate investment trusts are already taking action in response to these payment arrangements. Some REITs have amended lease terms and others are looking to be net sellers of SNFs, according to Fitch.
Fitch expects REITs will continue to sell SNF real estate. However, it is unclear who the incremental buyers of this real estate will be.
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