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City report: most skilled nursing transfers remain in San Francisco; subacute data are limited
Summary
A DPH report required by local ordinance found most San Francisco residents discharged to skilled nursing facilities were placed in-city and that Medicare is the most common payer; officials cautioned the subacute dataset is inconsistent across hospitals and recommended data and EHR coding improvements.
San Francisco Department of Public Health staff presented the 2023 Skilled Nursing and Subacute Transfer report to the Health Commission, saying the data show most residents who require skilled nursing were placed in San Francisco facilities but flagged significant limitations for subacute reporting.
"Most hospital encounters who were transferred to a skilled nursing facility... were adults over the age of 65," Claire Altman, senior health program planner, told the commission, and added that Medicare is the most common payer among these transfers.
Key findings: The department reported that, across most hospitals (excluding Kaiser and Kentfield patterns), a majority of San Francisco residents discharged to skilled nursing facilities were placed in San Francisco. When residents went out of county, DPH estimated about 43% of placements were within 15 miles and 77% within 30 miles of the reporting hospital address; San Mateo County accounted for more than 60% of out-of-county transfers.
Data limits: Altman emphasized the ordinance's intent but warned the numbers come with caveats: subacute is not a standard discharge code in many electronic health records, some hospitals must manually chart-review to identify subacute cases, and more than 41% of subacute discharges lacked address information. She cautioned that comparing hospitals or combining subacute figures across systems would be misleading without standardization.
Requests and next steps: Commissioners suggested pursuing standardized EHR coding for subacute care. Commissioner Dorado suggested approaching Epic about adding a universal subacute skilled nursing discharge code to improve data collection; Altman agreed to take that suggestion back. The commission also asked for additional context on total in-city skilled nursing bed counts and constraints hospitals face when placing patients.
Public and facility updates: Kelly Hiramoto reported Chinese Hospital applied to CMS for Medicare billing and received a $5 million state award to renovate a second unit to add beds and pursue subacute certification; DPH paused parallel discussions with a rehabilitation partner while awaiting CMS site survey.
The commission received the report and asked staff to return with follow-up materials on bed counts, coding options and outreach strategies.
