What is a skilled-nursing facility worth? How buyers read the financials

The average skilled-nursing bed changed hands for about $83,800 in 2024, down from $97,700 the year before. That per-bed figure is where a valuation conversation starts. It is not where a defensible one ends.

Price per bed is a rule of thumb, useful for a first pass and misleading past it. Two buildings at the same per-bed number can be opposite assets: one full and Medicare-heavy, the other half-empty and backfilling with Medicaid. Value turns on what a building actually earns, how reliably it earns it, and what a buyer has to pay in rent and debt service to keep it running. The cost-report file shows what normal looks like on each of those inputs, which is the benchmark a real number gets built against.

• Price per bed — $83,800 · 2024 average, down from $97,700
• Revenue per day — $358 · Middle half $307 to $432
• EBITDAR margin — 9.2% · Middle half 1.6% to 16.4%
• Occupancy — 83.8% · The leading indicator on margin

The metrics that drive SNF value

Four numbers do most of the work.

Revenue sizes the business. The median SNF books about $10.7 million a year, with the middle half between $7.1 million and $15.3 million. Revenue per patient-day is the sharper read: the median facility runs $358, the middle half $307 to $432, and the top decile above $550. That spread is a proxy for acuity and payer mix. A facility near $432 is running more Medicare and skilled-rehab days than one at $307, and it earns a higher multiple for it.

EBITDAR is the earnings line buyers price. The median facility runs a 9.2% EBITDAR margin, with the middle half from 1.6% to 16.4%. It is a wide band, and where a target sits inside it matters more than the median does.

Occupancy is the leading indicator. Median occupancy is 83.8%, and it tracks the margin more tightly than any other operating figure. A buyer prices census risk first, because a largely fixed cost base turns every empty bed into lost margin. For the state-by-state picture, see SNF occupancy by state.

Payer mix sets the ceiling. Medicaid covers roughly 62% of the sector's days and pays below cost in many states. Medicare pays well above its own cost, in the low-to-mid twenties on a fee-for-service margin basis by MedPAC's read, and managed care lands between them. Two facilities at identical occupancy are different businesses if one runs Medicare-heavy and the other Medicaid-heavy. Revenue per day is the file's window into that difference.

Why EBITDAR, not EBITDA

Skilled nursing is valued on EBITDAR, which adds rent back to EBITDA. Most operators lease their real estate, so the rent line moves with deal structure rather than the operation. Adding rent back puts an owned building and a leased one on the same footing, so a comp set is not distorted by who happens to hold the property. For the mechanics, see what EBITDAR is and why post-acute uses it.

The catch is what EBITDAR leaves out. Capital and rent take a median 8.2% of revenue, and once they are paid the median operating margin is 0.3%. The 9% that looks like profit is mostly rent waiting to be paid. For a leveraged buyer, EBITDAR is a coverage number, not take-home: what matters is how many times it covers rent and debt service, because the line underneath has almost no cushion. It is why so many deals split the real estate from the operation, with a REIT underwriting rent coverage and the operator underwriting census.

Building a defensible comp set

A valuation is only as good as its comp set, and in skilled nursing the comp set is local and same-sector. State Medicaid rates, occupancy norms, and labor markets swing enough that a facility three points below the national median can lead its market or trail it. The national line is orientation, not a comp.

The work is to place a target against buildings in its own state, at its own scale, with a similar payer profile, then read where it falls on revenue per day, margin, and occupancy. A facility at the 40th percentile on occupancy and the 60th on margin is a specific risk profile, not a single multiple. That local comp set is what the Post-Acute tool returns, with the full percentile curves behind a plan.

What moves the multiple up or down

Once earnings are normalized, a short list of facts moves the price, and they move it the same direction every time.

Value rises with

A strong Medicare and managed-care payer mix

High and documented occupancy

A clean survey history and strong CMS Star ratings

Real estate that transfers with the deal

Value falls with

Medicaid concentration and the policy risk that carries

Low or declining occupancy backfilled with Medicaid admissions

Survey deficiencies or a Special Focus Facility flag

A short or restricted lease on the property

The per-bed dispersion around that $83,800 average is almost entirely these factors, which is why the average says so little about any one building.

Where the benchmark stops and the appraisal begins

Cost-report data is the right tool for market position and the wrong tool for a valuation opinion. It tells you where a facility sits relative to its market. It does not tell you what the facility is worth.

Use the benchmark to frame the question. Use an appraiser to answer it.

The figures are self-reported, unaudited, and lag current operations by 12 to 24 months. Read them as directional market position, not audited accounting, and remember they look backward at a sector whose payer mix is shifting toward Medicare Advantage faster than a two-year-old filing shows. Getting from "60th percentile on margin" to a number is the work of a qualified appraiser, and it turns on facility-specific facts a benchmark cannot see: the lease terms, the survey file, the local competition, the quality of the last two years of census.

To place a specific facility against the full distribution, the Post-Acute tool returns median revenue, revenue per day, margin, and occupancy for any market on the free tier. The full comp set and per-facility financials unlock on a plan. For the operators behind the beds, see the largest skilled-nursing operators.

Sources and method

• Source — CMS HCRIS provider cost reports, FY2024 and FY2025 filings
• Analysis set — 12,247 facility-level filings after dropping consolidated chain filings and margin-plausibility outliers
• Revenue per day — p10 $263, p25 $307, median $358, p75 $432, p90 $551
• Transaction pricing — Per-bed averages are Levin Associates transaction data, not cost-report figures
• Payer mix — SNF payer columns are empty in this extract; the ~62% Medicaid share is external industry context, and revenue per day is the file's proxy for mix
• Statistics — Medians and quartiles throughout; no means, since facility margins are too dispersed for a mean to carry meaning
• Known limits — Self-reported, unaudited, and lagging current operations by 12 to 24 months

Full methodology and limitations

Disclaimer

This article is a market-data benchmarking resource derived from publicly available Medicare cost reports. It does not provide, and must not be relied upon as, a fair market value determination, valuation opinion, appraisal, or legal, tax, or compliance advice. Cost-report figures are self-reported, unaudited, and subject to revision. The opinion of value for any specific arrangement remains the professional judgment of a qualified appraiser.