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Long-term acute care hospitals (LTACs) and inpatient rehab hospitals (IRFs) have pretty much had a monopoly on the highest acuity post-acute patients, especially those requiring ventilator care. But as skilled nursing facilities continued to see their private pay census decline, combined with a stingy Medicaid reimbursement system, they began to seek out higher and higher acuity patients, sometimes competing with LTACs and IRFs. Site neutrality for patient care and reimbursement became a big topic. This, in part, has been pushing the values of some SNFs into never-seen-before territory. But SNFs have to be able to deliver on quality, and some have, while others have not.

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