Are Anti-Kickback Rules Killing Your Length of Stay?

TL;DR: Skilled Nursing Facilities (SNFs) choose who to take. Some patients pay better than others. Hospitals can’t legally “pay extra” to speed things up. So beds sit open for the better payer or the easier case. NextBed fixes this by making speed and fairness visible, so facilities can compete on access, and incentives are re-aligned.

The rules that tie hospitals’ hands

The federal Anti-Kickback Statute (AKS) makes it a crime to offer or receive anything of value to induce referrals for services paid by Medicare or Medicaid. That includes “priority” or “expedite” payments to get a faster SNF admit or to reserve/hold a bed. OIG has explicitly flagged both as AKS risks. In short: hospitals cannot sweeten the deal for a quicker “yes.” 1

Hospitals also must protect patient choice and share quality/resource-use data when presenting post-acute options. 2

The market math underneath (why SNFs wait)

Medicare short stays (post-hospital) are often profitable for SNFs. MedPAC reports ~18–22% Medicare margins for freestanding SNFs in recent years. That’s a strong pull toward Medicare cases. 3
Medicaid (long-stay) often pays below cost. Federal analyses show the median facility got ~82–86¢ for every $1 of cost. That pushes facilities to be picky. 4
Most facilities are for-profit (about 70%+), so protecting margin is not optional—it’s a requirement. National SNF occupancy hovers around 80-85% and many “empty” beds aren’t staffed to save margins. 5 6

Plain English: If Case A (Medicare, routine) is likely profitable and Case B (Medicaid, complex, Friday 6pm) likely loses money, a rational SNF holds the bed for Case A. AKS means the hospital can’t make up the difference.

What this creates on the ground

"Check back on Monday": SNFs often wait for the better payer or the easier case.
Hospitals can’t pay to speed things up, they keep trying one facility at a time.
Patients & families get delays, or never get to use their SNF benefits—especially for complex needs.

This isn’t “bad actors.” It’s misaligned incentives.

So what actually helps (without breaking the law)?

Today’s flow asks families to name three facilities first, then case managers fax those three, wait, and only expand the list after each round of silence. That sequence burns days.

With NextBed, the hospital broadcasts one de-identified need to every qualified facility in the county at once. Within minutes, you have real offers (including earliest start times). Then you sit with the patient to choose from actual, available options. Patient choice is preserved—and improved—because it’s a choice among real, time-stamped offers instead of wish lists.

What NextBed tracks so LOS actually improves:

Time to first response: How fast the market answers when you alert the whole county.
Time to first accept: How quickly you get the first real “yes, we can start by X.”
Start reliability: How often the start happens when it was promised.
Weekend starts: The share of new starts that happen Friday afternoon through Monday early morning.
Complex‑case access: Acceptance rates for vents, dialysis, isolation, heavy wounds, bariatric, and behavior cases.
Fall‑throughs: How often accepted cases don’t start—and why.

Transparency shifts market behavior.

Hospitals can finally see who is fast, reliable, and fair for which cases.
Facilities see themselves vs. peers (leaderboard effect).
Patients and families get facts they can use, not just star ratings that say little about speed.

No PHI. No IT. Just data.

Visibility fixes the marketplace and shortens LOS.

Even with high Medicare margins and low Medicaid payments, providers that consistently move patients fast and take hard cases will be rewarded with more referrals. Making that visible changes the local game:

A SNF that keeps beds “dry” waiting for better payers will look slow on time to first response/accept and weak on weekend starts.
A SNF that accepts complex cases and starts on weekends will earn top badges and climb the shortlist. Case Managers and Social Workers will know exactly where every facility stands at all times.
Over time, market share follows performance, and performance follows public metrics.

What NextBed does (today)

Opens the market: We broadcast each de-identified discharge need to every qualified SNF in the county at once. No insider lists. No PHI until there’s a match.
Makes speed and fairness visible: We track time to first response, time to first accept, start reliability, weekend starts, and complex‑case access. Facilities get profile pages with county ranks, trends, and “Fast & Fair” / “Weekend‑Ready” badges.
Protects choice and compliance: Hospitals still show all options and share quality and resource-use data as required by the discharge rules. We add the access data those rules don’t show: speed and reliability. 2

No hospital paying SNFs. No kickback risk. Just the facts—so the right thing (a faster, safe discharge) becomes the easy thing.

Pilot with NextBed

We’re looking for pilot hospitals — slots are limited. See how county‑wide broadcasts, real‑time offers, and weekend starts can shave days off LOS without IT work.