Q: A new Avalere study found that hospital discharges to home health have rebounded faster than those to skilled nursing. This is a hit to skilled nursing facilities, right?

A: It’s definitely a hit. These are Medicare fee-for-service Part A patients. This is [SNFs’] lifeblood. They depend on that business to cross-subsidize Medicaid business, which is by far the largest part of their business. They typically run at some loss, in some states worse than others. [They] count on the short-stay [business] to offset those losses.

Q: Is there any sign of a recovery over the next few months? 

A:There’s a challenge ahead. It’s our expectation that these volumes start to return but not any time soon. For some of those facilities for whom the relief funds are running out, they are going to have a cash crunch, no doubt about it. 

Q: What other trends do you see?

A: I think it’s interesting that the Centers for Medicare & Medicaid Services took $2 billion and tied it to pay-for-performance for nursing homes. I think that’s a harbinger of things to come, in terms of connecting payment to facilities to performance. You can see this under either administration: an effort to tie payment to facilities demonstrating … that they are effectively managing COVID and keeping the case volume and mortality down.