
Understanding how your healthcare tenants do business is critical to success in Healthcare Real Estate. For over 20 years, I've been a student of the healthcare services industry, and that knowledge has made me a better developer and resource for out tenants.
Take for instance, the difference between Inpatient Rehabilitation Facilities (IRFs) and Skilled Nursing Facilities (SNFs). While these two faciilty types may appear similar at first glance, their distinctions are vital. Below, we dive into their roles and key differences.
IRFs vs. SNFs: Quick Comparison
Aspect | IRF | SNF |
Therapy Intensity | 3+ hours/day | 30-60 minutes/day |
Length of Stay | 10-14 days | 20-30 days |
Patient Acuity | Higher | Lower |
Physician Involvement | Frequent | Monthly |
Facility Design | Hospital-like | Residential-like |
Inpatient Rehabilitation Facility (IRF)
IRFs are specialized hospitals focused on intensive rehabilitation for patients recovering from serious medical conditions, surgeries, or injuries.

Key Features
Treatment Focus and Conditions Treated:
Stroke, Traumatic Brain Injury (TBI), and Spinal Cord Injury (SCI).
Neurological disorders like Parkinson’s, MS, or Guillain-Barré.
Orthopedic conditions (e.g., fractures, joint replacements), amputations, burns, and cardiac/pulmonary rehabilitation.
Therapy:
Intensive multidisciplinary therapy aimed at functional recovery for activities of daily living (ADLs).
Patients must tolerate a minimum of 3 hours of therapy a day, 5 days a week.
Average length of stay is 10–14 days.
CMS 13 Conditions:
IRFs must meet CMS requirements: at least 60% of patients must fall into 13 specific conditions, such as stroke, spinal cord injury, and major multiple trauma.
Reimbursement and Staffing:
Medicare typically accounts for 60–70% of the payor mix via the IRF-PPS (Prospective Payment System).
Staffing includes rehab physicians, physical and occupational therapists, speech therapists, nurses, and case managers. Physicians visit at least 3 times a week.
Example Patient: A 72-year-old post-stroke patient with residual motor weakness, requiring intensive therapy for mobility and ADLs.
Facility Design: IRFs are commonly 48-60 beds but can be much larger. They feature therapy gyms, private or semi-private rooms, and advanced rehab equipment. Hospital infrastructure includes nurse call systems, telemetry, medical gas, food service, and administrative areas. Some providers also include limited kidney dialysis, either with dedicated treatment bays or accommodations bedside.
Prominent Providers:
Encompass Health, PAM Health, Select Medical, LifePoint/Kindred, and Ernest Health
Skilled Nursing Facility (SNF)
SNFs provide short-term skilled nursing care and rehabilitation, often as a step-down from a hospital stay. Their focus is on less-intensive therapy and nursing care in a more residential or hospitality-like setting.

Key Features
Treatment Focus and Conditions Treated:
Orthopedic recovery (e.g., joint replacements).
Cardiac and pulmonary rehab, wound care, and post-surgical recovery.
Therapy:
Moderate therapy for 30–60 minutes/day.
Patients’ average length of stay is 20–30 days for short-term rehab, with some transitioning to long-term care.
Reimbursement and Staffing:
Medicare typically accounts for 60–70% of reimbursement under the Patient Driven Payment Model (PDPM).
Staffing includes nurses, physical and occupational therapists, speech therapists, and dietitians. Physician visits are less frequent (typically monthly).
Example Patient: A 68-year-old recovering from knee replacement surgery, requiring moderate therapy and pain management.
Prominent Providers:
Genesis HealthCare, The Ensign Group, LHC Group, and ProMedica Senior Care.
Why SNFs Are Becoming More Like IRFs

SNFs have evolved, driven by CMS policies and the need for cost-effective care:
Bundled Payments and Value-Based Care: Hospitals discharge patients to SNFs to save costs within bundled payment models.
Patient-Driven Payment Model (PDPM): SNF reimbursement now focuses on patient characteristics rather than therapy minutes, encouraging care for more complex cases.
Medicare Audits: Tighter IRF admission rules redirect some patients to SNFs.
As a result, SNFs have invested in advanced therapy services and specialized equipment, offering niche services like cardiac recovery and neuro-rehab. While their therapy intensity is lower, SNFs align well with CMS goals for cost-effective care.
Challenges in the Evolving Landscape

While SNFs handle a broader spectrum of patients, challenges remain:
Patient Suitability: Admitting patients better suited for IRFs may delay recovery and impact outcomes.
Referral Pressure on IRFs: IRFs now rely more heavily on high-acuity patients due to fewer referrals for less complex cases.
Examples of IRF-Suited Patients:
Severe stroke patients needing high-intensity therapy.
Acute spinal cord injuries requiring mobility training.
Traumatic brain injuries with cognitive impairments.
Complex bilateral joint replacements.
Examples of SNF-Suited Patients:
Long-term IV antibiotics or severe wound care.
Dementia with behavioral issues.
Ventilator-dependent patients.
Post-acute but not yet rehab-ready patients.
Growth Trends
IRFs: Steady growth driven by aging demographics and demand for high-acuity rehab.
SNFs: Growth in short-term rehab, though long-term care SNFs face competition from home health and assisted living alternatives.

In Summary
Both IRFs and SNFs play vital roles in post-acute care but serve distinct patient populations. IRFs specialize in short-term, intensive rehab for high-acuity patients, while SNFs focus on moderate rehab and nursing care for lower-acuity or medically complex patients. Understanding these differences is critical for communication, credibility, and supporting your clients’ and tenants’ business.
There’s More to This Story
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