Introduction
Critical Access Hospitals (CAHs) provide essential post-acute care for rural communities, but historically, they have lacked the ability to measure and benchmark their swing bed program quality and patient outcomes. Unlike skilled nursing facilities (SNFs), CAHs are not required to report Minimum Data Set (MDS) quality metrics, making it difficult to compare outcomes, track improvements, or market their services effectively.
Recognizing this gap, Stroudwater Associates developed the Swing Bed Quality Reporting Program—the first and only benchmarking tool designed specifically for CAHs. This tool allows hospitals to measure key swing bed outcomes, track trends, and compare their performance to SNFs and other CAHs, enabling data-driven program improvements.
Cox Barton County Hospital and Cox Monett Hospital—both part of the CoxHealth system—leveraged the Stroudwater Swing Bed Quality Reporting Program to strengthen their swing bed programs, improve patient outcomes, and drive system-wide success. Their experience underscores the power of data and improving rural care delivery.
The Challenge: A Need for Standardized Swing Bed Data
Cox Barton and Cox Monett, the only CAHs within the CoxHealth system, serve rural communities in southwest Missouri. Like many CAHs, they faced some significant hurdles in optimizing their swing bed program:
- Limited awareness of swing bed services among providers, staff, and the local community
- Misalignment across the system, with varying policies and processes between facilities
- Uncertainty about the program’s value, which made it challenging to secure resources within the broader CoxHealth system
- A lack of quality benchmarking to assess performance against SNFs or peer CAHs
Heidi Clark, Administrative Director of Nursing at Cox Monett, explains, “Without comparison data, we didn’t have a way to market our program or demonstrate its quality. The Swing Bed Quality Reporting Program changed that.”
The Solution: Implementing the Swing Bed Quality Reporting Program
Establishing a Collaborative Framework
To streamline strategies across both CAHs and maximize the impact of the reporting program, Cox Barton and Cox Monett established a Swing Bed Optimization Committee. This multidisciplinary team consisted of CAH case managers, nurse managers, utilization review, therapy services, discharge planners and system-wide case managers. Initially meeting biweekly, the committee focused on the following:
- Standardizing swing bed policies across both CAHs
- Tracking referrals, denials, and patient days using the reporting program
- Educating providers and the community on the benefits of swing bed services
“Between Barton and Monett, we conducted a thorough review of every policy, going line by line to ensure alignment between the two hospitals. Our case manager led the effort, and we met frequently to refine our approach,” Clark explained. “Each meeting, team members also came prepared with data—utilization review and case managers reported on referrals, denials, and the reasons behind them, as well as swing bed patient days. By systematically entering and comparing this data across both hospitals, and against other hospitals, we were able to identify gaps, streamline processes, and optimize our swing bed programs.”
Leveraging Data for Growth
By incorporating Stroudwater’s Swing Bed Quality Reporting Program, the CAHs gained valuable insights into their swing bed operations. By having improved optics into their swing bed program performance, the CAHs were able to
- boost swing bed admissions at Cox Monett by 71.8 percent in 2024, with patient days increasing by 30.3 percent;
- secure a dedicated Swing Bed Coordinator position at both CAHs, ensuring long-term program sustainability;
- utilize benchmarking data to highlight financial benefits and garner system-wide support; and
- increase average monthly swing bed admissions at Cox Monett from 4 in 2023 to 20 in 2024, with a record month of 26 admissions.
“Having access to data allowed us to prove that swing bed services aren’t just about filling beds—they prevent readmissions, improve community care, and contributes to the hospital’s financial sustainability,” said Rosie Hubbard, Administrative Director of Nursing at Cox Barton.
The Results: Strengthening the System Through Individual Hospital Success
The measurable improvements at Cox Barton and Cox Monett had a positive ripple effect across the entire CoxHealth system, showcasing the value of swing bed programs in enhancing patient care and financial outcomes.
Key Outcomes
- Increased Reimbursement: Over 12 months, Cox Barton boosted its swing bed reimbursement by $120,000, while Cox Monett increased reimbursement for its program by $200,000.
- Referral Optimization: The CAHs collaborated with CoxHealth’s largest facility in Springfield to establish a streamlined referral process, addressing bed capacity issues in Springfield and maximizing the use of swing beds.
- Reduction of Unplanned Rehospitalization: Cox Barton reduced their unplanned return to acute care by 100% and Cox Monett by 60 percent—both significant improvements where lower rates indicate improved and supportive patient care while in the swing bed program.
- Improvement in Patient Mobility: Rehabilitation initiatives were a key focus for both hospitals, resulting in a remarkable 242 percent improvement in patient mobility at Cox Barton and a 108 percent improvement at Cox Monett. By emphasizing patient mobility goals and fostering interdisciplinary collaboration, both hospitals enabled patients regain independence more quickly, reducing the need for long-term care and enhancing overall recovery outcomes.
- Community & Provider Education: The CAHs worked with the medical executive committees, governing boards, and community groups (like the Lions Club) to raise awareness about the benefits of swing bed services.
- Creation of New Dedicated Roles: The data-driven results supported the establishment of Swing Bed Coordinator positions at both CAHs, ensuring long-term sustainability and growth of the program.
Looking Ahead: A Model for Other CAHs
The success of Cox Barton and Cox Monett demonstrates how data transparency and strategic decision-making can transform swing bed programs. With dedicated resources, ongoing quality benchmarking, and active community involvement, these hospitals are positioned for continued success.
“Our next step is using this data to market our swing bed program effectively to referring providers and patients,” said Hubbard. “When people recognize the quality of care we provide, they prefer staying at their community hospital rather than going to a SNF.”
With over 200 CAHs using the Swing Bed Quality Reporting Program, Stroudwater continues to set the standard for swing bed benchmarking and performance improvement. By leveraging data-driven insights, CAHs like Cox Barton and Cox Monett are proving that they can not only match but surpass SNF performance—and keep high-quality care close to home.
To learn more about how Stroudwater’s approach to swing bed quality improvement, click here.
