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 2010 Top 50

SteadyAnd Cautious


Another year of economic turmoil is over, but on the horizon are significant Medicare cuts to skilled nursing facilities: a 10-year $14.6 billion productivity adjustment to the skilled nursing facility market basket beginning in fiscal year 2012. Providers are also facing the resource utilization group (RUG) IV implementation, the impact of which is uncertain, while provisions in the new health care reform law, such as employer health care insurance man-dates, employee background check requirements, and others, will also impact long-term and post-acute care providers.

All of these issues will likely translate into a play-it-safe mentality that appears to reflect the last year as well. That said, the Top 50 Nursing Facility Companies​ made little noise in terms of mergers and acquisitions in 2009, although there were some modest fluctuations in bed counts. HCR ManorCare took the lead spot for the sixth consecutive year, while No. 8, Extendicare, reported a bed count reduction of 1,375. No. 5, Genesis HealthCare, lost 2,496 beds. Even with this loss, the company’s total bed count of 25,451 is still higher than its 2008 count of 23,195.

​​Rehab Remains Popular

Providers continue to renovate facilities and add ancillary or specialty care services, despite a reported lack of available financing. Some 27 companies plan to add rehabilitation suites or units, and seven of the top 50 will add specialty care services such as dialysis, ventilator, or bariatric care. Outpatient rehabilitation continues its rise in popularity, with 37 companies now offering it, compared with 32 last year.

Five companies are planning to add home care to their menu of services, while a total of 21 companies on the list this year already offer it, up from 19 last year.

Three companies indicated plans to add Alzheimer’s or dementia care with secured units. This figure may seem low, but 46 providers already count this type of care among their services.

Hospice care has risen moderately among the top 50, with 31 providers now offering it, compared with last year’s count of 24.

​Modest Jostling

Two companies had modest relocations in the rankings this year. Signature HealthCare slid down two slots, from No. 12 last year to No. 15 this year. Stonegate Senior Care jumped two slots, from No. 26 to 24 this year, with only 324 additional beds.

Trilogy Health Services slid from the No. 18 spot last year to No. 28 this year, with a reported bed count reduction of 2,191.

These shifts in rankings are due in part to the fact that several companies did not participate in this year’s ranking, leaving slots open for others to move into.

Among the companies that opted out of participating in the survey this year are: Encore Healthcare, ranked No. 24 last year; Avante Group, ranked No. 37 in 2009; Apple Health Care, No. 38 last year; and Prestige Care, No. 42 last year.

Culture Change Coming

A new question on the survey this year revealed a remarkable response: At least two dozen companies are planning to implement culture change initiatives at their facilities, with a majority of companies planning to create a more “homelike atmosphere.” These initiatives include removing nurses’ stations, installing “resident-centered furniture,” and implementing “I” care plans.

Many companies will add amenities like new dining and meal options, consistent assignment, and enhanced, “spa-like” bathing services.

A lesser number of companies reported plans to incorporate or build small-house models or “the neighbor-hood concept.”

On the following pages is Provider’s annual ranking of the top 50 nursing facility companies, as of Dec. 31, 2009. The data indicate the 50 leading companies’ 2009 revenue, occupancy rates, extent of regionalism, and range of services.

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