Demand for skilled nursing occupancy flattened in April after months of increases, according to the latest Skilled Nursing Monthly Report released by the National Investment Center for Seniors Housing & Care. 

“After increasing in February and March, occupancy was flat in April. Labor is still a serious challenge within the industry and some operators are still unable to admit new patients due to staffing shortages,” NIC Senior Principal Bill Kauffman wrote in a blog post Thursday. 

Skilled nursing property occupancy totaled 77.3%, according to NIC MAP data prepared and released by NIC MAP Vision. Occupancy has risen 524 basis points since the low of 72.1% in January 2021 and remains at the highest occupancy level since the pandemic began. It is still down 8.9 percentage points compared with February 2020, before the beginning of the pandemic in the United States, however.

“There are some positive signs given the increases in occupancy since the low, but many challenges remain including labor shortages, operating expense pressure, and the proposal to claw back Medicare reimbursement as it relates to the Patient Driven Payment Model,” Kauffman wrote.

Medicare revenue mix

Medicare revenue mix declined in the month of April, for the second consecutive month. Medicare revenue mix declined 72 basis points to end April at 20.6%, which is where it was in December, before month-over-month increases earlier in 2022. The high of 24.6% was set in February.

“The increase to start 2022 was likely due to the elevated number of COVID-19 cases in January and suggests there was a significant uptick in the utilization of the 3-Day Rule waiver as COVID-19 cases increased,” Kauffman wrote.

Managed Medicare revenue per patient day decreased from $456 to $454 in April and is down 2.1% from April 2021. Overall, RPPD has fallen $111 (19.6%) from January 2012.

“The persistent decline in managed Medicare revenue per patient day continued to result in an expanded reimbursement differential between Medicare fee-for-service and managed Medicare, which accelerated during the pandemic until January 2022,” he wrote.

Medicaid patient day mix

Medicaid patient day mix, on the other hand, increased for the second month in a row. It rose by 79 basis points in April to end the month at 66%. Meanwhile, according to the report, Medicaid RPPD increased from March to end April at $247. It is up 3.3% from the pre-pandemic period (February 2020) as many states embraced measures to increase reimbursement related to the number of COVID-19 cases to support skilled nursing properties, in addition to fiscal year increases.