Patients discharged to post-acute care spend an average of 8.9 days in the hospital. Patients discharged home spend 3.7. That five-day gap is where throughput, readmission exposure, and value-based margin quietly disappear — and it isn’t closing on its own.
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National length of stay has come down from its 2022 peak, but it has not returned to 2019. The remaining gap sits at one point: the handoff to post-acute care.
Prospective payment, readmission penalties, bundled payments, and models like CMS TEAM have changed the math. The paper lays out the four financial levers a high-performing network moves: length of stay and throughput, readmission penalty exposure, patient experience, and value-based savings.
Discharge readiness, discharge appropriateness, and discharge preference — what each one costs you, and what a network has to do to address it. Includes 2026 national research linking constrained SNF nurse staffing to a 3.5% longer hospital stay, roughly six additional inpatient hours per episode.
Star ratings tell you how a facility performed. They don’t tell your case manager whether it can accept a patient on IV antibiotics this afternoon. Why facility-level capability data is the most underused input in network design.
Market analysis, network evaluation, network design, and partnership structure — including how to evaluate facilities you don’t currently refer to, why internal referral volume alone produces unreliable performance signals, and how to model the impact of network changes before you commit to them.
Building the network is not a one-time exercise. The paper closes with the active management framework for accountability, transparency, outcomes sharing, and ongoing adjustment once the network is live.
