Puzzle Healthcare
Post-Acute Performance Analytics

HCA Florida North Florida Division

A four-quarter review of FFS SNF discharge patterns, destination concentration, and FSHR performance across HCA Healthcare's 13-hospital North Florida Division — spanning North Central Florida (Gainesville, Ocala, Lake City, Palatka), the Panhandle (Pensacola, Panama City, Tallahassee, Fort Walton-Destin, Niceville), and Central Florida (Osceola, Oviedo, Poinciana).

Prepared by: Puzzle Healthcare
Date: 2026-09-04
Data Period: CMS Medicare FFS Claims: 2025 Q1 – 2025 Q4
System: HCA Florida North Florida Division (HCA Healthcare)
Confidential 13 hospitals analyzed  ·  5,866 FFS SNF patients  ·  303 SNF destinations  ·  Florida
13
HCA Florida North Florida Division Hospitals
(Active Data)
5,866
FFS SNF
Patients
303
Unique SNF
Destinations
140
Cross-System
SNFs (2+ Hosps)
15
Priority SNF
Targets
4
Quarters
Analyzed
Section 1 — Executive Summary

FSHR Elevation, Network Fragmentation, and the Opportunity to Coordinate a System-Wide Post-Acute Network

HCA Florida North Florida Division operates the North Florida market, spanning 13 hospitals across 13 hospitals across North Central Florida, the Panhandle, and Central Florida. Its post-acute discharge picture is one of meaningful scale — 5,866 Medicare fee-for-service patients flowing across 303 SNF destinations over four quarters — with limited cross-hospital coordination and no unified preferred-network infrastructure to manage FSHR performance systematically.

Over four quarters (CMS Medicare FFS Claims: 2025 Q1 – 2025 Q4), HCA Florida North Florida Division hospitals collectively discharged 5,866 fee-for-service Medicare patients to skilled nursing facilities, reaching 303 distinct SNF destinations across North Florida. HCA Florida North Florida Hospital leads the system in post-acute volume with 1,442 patients across 80 SNF destinations — the single largest HCA North Florida Division post-acute relationship set in the analysis. HCA Florida Ocala Hospital is the second-highest volume hospital in the system, contributing 1,261 FFS SNF patients.

Florida state SNF utilization average is 16.5% (FFS). What the data reveals is a system-wide FSHR elevation and destination fragmentation story: across 13 active hospitals, 5,866 patients are distributed to 303 SNFs, most operating without a structured performance framework or preferred-network accountability from HCA Florida North Florida Division care teams.

Within HCA Florida North Florida Division’s existing discharge patterns is a structural starting point for coordination: 140 SNFs already serve two or more HCA Florida North Florida Division hospitals simultaneously. These shared facilities are the organic preferred network — facilities that HCA Florida North Florida Division hospitals have collectively chosen through discharge patterns without any formal coordination. Puzzle Healthcare’s role is to formalize that organic network, extend its reach, and make FSHR performance systematically measurable and accountable.

The 15 priority SNF targets identified in this analysis — facilities with elevated FSHR rates appearing across multiple HCA Florida North Florida Division hospitals — represent the highest-impact starting cohort for an embedded clinical program. Together they account for significant patient volume and carry FSHR rates meaningfully above the system-wide average of 42.3%.

01
System-wide FSHR of 42.3%: elevated above Florida state average with limited coordination infrastructure
Across 13 HCA Florida North Florida Division hospitals, the weighted FSHR stands at 42.3% — indicating that nearly half of all SNF patients are returning to the hospital within the skilled stay. Individual hospital FSHR rates range from 32.0% to 57.4% (West Marion), a spread that underscores the heterogeneity of the post-acute challenge across HCA Florida North Florida Division’s geographically dispersed network.
02
15 priority SNF targets with elevated FSHR appearing across multiple HCA Florida North Florida Division hospitals
The priority target analysis surfaces 15 SNFs with FSHR rates significantly above the system average and appearing in two or more hospital discharge networks. These facilities represent the highest-risk, highest-leverage intervention points — natural candidates for an embedded clinical presence and preferred-network performance standards across the HCA Florida North Florida Division system.
03
140 SNFs already serve multiple HCA Florida North Florida Division hospitals — a natural preferred-network foundation
Of the 303 SNF destinations across the HCA Florida North Florida Division network, 140 are shared across two or more HCA Florida North Florida Division hospitals. These shared facilities represent existing trust relationships that can be formalized into a coordinated preferred network without requiring new partnerships to be built from scratch. The 31 SNFs serving three or more HCA Florida North Florida Division hospitals are the natural anchor points for initial engagement.
Section 2 — HCA Florida North Florida Division System-Level Overview

13 Hospitals, One Shared Post-Acute Challenge

HCA Florida North Florida Division operates 13 acute-care hospitals across the North Florida market — a dense, single-state community hospital network spanning nine counties. Each hospital draws from a distinct patient population and sends patients to a partially overlapping, partially distinct set of SNF partners across the state.

HCA Florida North Florida Hospital
Gainesville, FL  ·  439 Beds  ·  Alachua County / Gainesville, FL
FFS SNF Patients1,442
SNF Destinations80
FSHR41.4%
HCA Florida Ocala Hospital
Ocala, FL  ·  306 Beds  ·  Marion County / Ocala, FL
FFS SNF Patients1,261
SNF Destinations81
FSHR39.2%
HCA Florida West Hospital
Pensacola, FL  ·  531 Beds  ·  Escambia County / Pensacola, FL
FFS SNF Patients621
SNF Destinations39
FSHR40.5%
HCA Florida Fort Walton-Destin Hospital
Fort Walton Beach, FL  ·  331 Beds  ·  Okaloosa County / Fort Walton Beach, FL
FFS SNF Patients580
SNF Destinations43
FSHR40.2%
HCA Florida Lake City Hospital
Lake City, FL  ·  91 Beds  ·  Columbia County / Lake City, FL
FFS SNF Patients499
SNF Destinations34
FSHR43.3%
HCA Florida Gulf Coast Hospital
Panama City, FL  ·  238 Beds  ·  Bay County / Panama City, FL
FFS SNF Patients377
SNF Destinations36
FSHR46.0%
HCA Florida Capital Hospital
Tallahassee, FL  ·  288 Beds  ·  Leon County / Tallahassee, FL
FFS SNF Patients347
SNF Destinations37
FSHR47.3%
HCA Florida Osceola Hospital
Kissimmee, FL  ·  407 Beds  ·  Osceola County / Kissimmee, FL
FFS SNF Patients295
SNF Destinations56
FSHR56.4%
HCA Florida Putnam Hospital
Palatka, FL  ·  99 Beds  ·  Putnam County / Palatka, FL
FFS SNF Patients194
SNF Destinations29
FSHR40.0%
HCA Florida Twin Cities Hospital
Niceville, FL  ·  65 Beds  ·  Okaloosa County / Niceville, FL
FFS SNF Patients102
SNF Destinations13
FSHR32.0%
Partners operationally with HCA Florida Fort Walton-Destin Hospital.
HCA Florida Oviedo Medical Center
Oviedo, FL  ·  64 Beds  ·  Seminole County / Oviedo, FL
FFS SNF Patients88
SNF Destinations26
FSHR51.4%
HCA Florida West Marion Hospital
Ocala, FL  ·  186 Beds  ·  Marion County / Ocala, FL
FFS SNF Patients34
SNF Destinations21
FSHR57.4%
Rehabilitation Unit subpart of Marion Community Hospital, Inc. Inpatient rehab admissions and their SNF referrals are tracked distinctly under NPI 1659017978 in CMS Medicare FFS Claims.
HCA Florida Poinciana Hospital
Kissimmee, FL  ·  94 Beds  ·  Osceola County / Kissimmee, FL
FFS SNF Patients26
SNF Destinations18
FSHR44.4%
* Data Availability Note: HCA Florida West Marion Hospital (NPI 1659017978) operates as a Rehabilitation Unit subpart under Marion Community Hospital, Inc. (CCN 100212), shared with HCA Florida Ocala Hospital (NPI 1841237930). Both render as distinct entities in this analysis because CMS Medicare FFS claims data (via NPI) returns distinct SNF referral patterns for each facility. All reported system totals (5,866 FFS patients, 303 SNF destinations) reflect only the 13 hospitals with active CMS Medicare FFS Claims data.

HCA Florida North Florida Division’s geographic span across the North Florida market represents both a strategic complexity and a significant opportunity. The system’s hospitals serve distinct regional communities — from North Florida (Gainesville) and Ocala/West Marion in North Central Florida, to Lake City and Putnam (Palatka) in the north, across the Panhandle at West (Pensacola), Gulf Coast (Panama City), Capital (Tallahassee), Fort Walton-Destin, and Twin Cities (Niceville), and down through Central Florida at Osceola, Oviedo, and Poinciana. This diversity means that post-acute discharge patterns, local SNF networks, and FSHR drivers differ meaningfully across facilities. A coordinated preferred-network framework delivers the greatest operational value precisely in this kind of heterogeneous multi-hospital system: unified performance standards, embedded clinical presence, and real-time visibility that operates consistently across all 13 hospitals regardless of geography.

Section 3 — Network Concentration & Top SNF Partners

A Long Tail: Top 5 SNFs Capture a minority share, Many More Share the Rest

HCA Florida North Florida Hospital’s 80-facility SNF destination network illustrates a pattern common to high-volume academic medical centers: a small number of facilities receive outsized volume, while the majority consist of lower-volume relationships that are difficult to manage systematically. This concentration and fragmentation dynamic — replicated across 13 hospitals and 303 SNF destinations — is the core visibility challenge at the heart of HCA Florida North Florida Division’s post-acute situation.

HCA Florida North Florida Hospital — Top SNF Partners by Volume (FSHR shown)
SNF Name
FSHR
Volume / Share
Magnolia Ridge Hrc, Llc
—
278 pts  ·  19.7% share
Oak Hammock At The University Of Florida Inc
—
148 pts  ·  10.5% share
Ayers Health & Rehabilitation Center, Llc
—
131 pts  ·  9.3% share
Palm Garden Of Gainesville
—
112 pts  ·  7.9% share
Solaris Healthcare Lake City Llc
—
83 pts  ·  5.9% share
Tri County Nursing Home
—
83 pts  ·  5.9% share
Terrace Healthcare & Rehabilitation Center Llc
—
73 pts  ·  5.2% share
The Plaza Health And Rehab Center
—
73 pts  ·  5.2% share
North Florida: top-SNF concentration not pre-computed — see individual rows above.

The concentration pattern at HCA Florida North Florida Hospital is characteristic of a large academic medical center in a geographically concentrated state. Its top SNF partners already have the volume to support an embedded clinical presence — and they clearly have established relationships with North Florida’s discharge planning teams. The coordination gap lives in the long tail: the facilities receiving smaller patient volumes with no systematic performance framework or preferred-network accountability.

Multiplied across 13 HCA Florida North Florida Division hospitals and 303 total SNF destinations system-wide, that long tail represents hundreds of downstream facilities operating beyond the horizon of HCA Florida North Florida Division’s visibility. That is precisely the structural problem a unified preferred-network framework addresses — starting with the 140 cross-system facilities that already appear in multiple HCA Florida North Florida Division discharge networks simultaneously.

Section 4 — Hospital Performance vs. Benchmarks

Reading the FSHR Signals: Performance Across 13 HCA Florida North Florida Division Hospitals

Florida state SNF utilization benchmark: 16.5% (FFS). FL 30-day readmission average: 17.2%. The system-wide FSHR of 42.3% serves as the primary internal reference point for identifying hospitals with elevated return-to-hospital rates and high-impact intervention opportunities.

HCA Florida North Florida Hospital
Gainesville, FL  ·  439 Beds  ·  Opportunity Score: 94
Immediate Priority
1,442
FFS SNF Patients
80
SNF Destinations
41.4%
FSHR (-0.9pp vs system)
42.3%
System FSHR Avg

HCA Florida North Florida Hospital discharged 1,442 FFS patients to 80 distinct SNF destinations over the analysis period. FSHR stands at 41.4%, -0.9pp vs system average. The leading post-acute destination is Magnolia Ridge Hrc, Llc (278 patients, 19.7% share). The hospital’s SNF network includes 37 facilityies with a “Very High” risk category.

The North Florida post-acute network illustrates the broader HCA Florida North Florida Division pattern: a small number of high-volume SNF relationships account for the top discharge share, while the remaining volume is distributed across a long tail of facilities that operate without systematic performance oversight. A preferred-network framework anchored at North Florida’s highest-volume destinations — with embedded clinical presence at the most critical facilities — would immediately extend coordinated care management across the majority of this hospital’s post-acute volume.

Top SNF Partners Pts Share FSHR Risk
Magnolia Ridge Hrc, Llc27819.7%43.4%High
Oak Hammock At The University Of Florida Inc14810.5%28.7%Elevated
Ayers Health & Rehabilitation Center, Llc1319.3%46.1%High
Palm Garden Of Gainesville1127.9%37.8%High
Solaris Healthcare Lake City Llc835.9%41.6%High
HCA Florida Ocala Hospital
Ocala, FL  ·  306 Beds  ·  Opportunity Score: 83
Immediate Priority
1,261
FFS SNF Patients
81
SNF Destinations
39.2%
FSHR (-3.0pp vs system)
42.3%
System FSHR Avg

HCA Florida Ocala Hospital discharged 1,261 FFS patients to 81 distinct SNF destinations over the analysis period. FSHR stands at 39.2%, -3.0pp vs system average. The leading post-acute destination is Bridgewater Park Health & Rehabilitation Center (278 patients, 21.4% share). The hospital’s SNF network includes 28 facilityies with a “Very High” risk category.

The Ocala post-acute network illustrates the broader HCA Florida North Florida Division pattern: a small number of high-volume SNF relationships account for the top discharge share, while the remaining volume is distributed across a long tail of facilities that operate without systematic performance oversight. A preferred-network framework anchored at Ocala’s highest-volume destinations — with embedded clinical presence at the most critical facilities — would immediately extend coordinated care management across the majority of this hospital’s post-acute volume.

Top SNF Partners Pts Share FSHR Risk
Bridgewater Park Health & Rehabilitation Center27821.4%38.7%High
Life Care Center Of Ocala14911.5%45.5%High
Timberridge Operations Llc14411.1%45.2%High
Hawthorne Ocala Operations Llc1068.2%47.4%High
Chatham Glen Healthcare And Rehabilitation Center886.8%32.2%High
HCA Florida West Hospital
Pensacola, FL  ·  531 Beds  ·  Opportunity Score: 90
Immediate Priority
621
FFS SNF Patients
39
SNF Destinations
40.5%
FSHR (-1.8pp vs system)
42.3%
System FSHR Avg

HCA Florida West Hospital discharged 621 FFS patients to 39 distinct SNF destinations over the analysis period. FSHR stands at 40.5%, -1.8pp vs system average. The leading post-acute destination is Olive Branch Operating Investments Llc (143 patients, 22.4% share). The hospital’s SNF network includes 15 facilityies with a “Very High” risk category.

The West post-acute network illustrates the broader HCA Florida North Florida Division pattern: a small number of high-volume SNF relationships account for the top discharge share, while the remaining volume is distributed across a long tail of facilities that operate without systematic performance oversight. A preferred-network framework anchored at West’s highest-volume destinations — with embedded clinical presence at the most critical facilities — would immediately extend coordinated care management across the majority of this hospital’s post-acute volume.

Top SNF Partners Pts Share FSHR Risk
Olive Branch Operating Investments Llc14322.4%36.4%High
De Luna Operating Investments Llc10316.2%45.5%High
Pruitthealth - Pensacola, Llc7411.6%49.5%Moderate
Life Care Center Of Pensacola436.8%41.5%High
Solaris Healthcare Pensacola Llc406.3%44.9%High
HCA Florida Fort Walton-Destin Hospital
Fort Walton Beach, FL  ·  331 Beds  ·  Opportunity Score: 91
Immediate Priority
580
FFS SNF Patients
43
SNF Destinations
40.2%
FSHR (-2.1pp vs system)
42.3%
System FSHR Avg

HCA Florida Fort Walton-Destin Hospital discharged 580 FFS patients to 43 distinct SNF destinations over the analysis period. FSHR stands at 40.2%, -2.1pp vs system average. The leading post-acute destination is Fort Walton Rehabilitation Center, Llc (152 patients, 25.1% share). The hospital’s SNF network includes 15 facilityies with a “Very High” risk category.

The Fort Walton-Destin post-acute network illustrates the broader HCA Florida North Florida Division pattern: a small number of high-volume SNF relationships account for the top discharge share, while the remaining volume is distributed across a long tail of facilities that operate without systematic performance oversight. A preferred-network framework anchored at Fort Walton-Destin’s highest-volume destinations — with embedded clinical presence at the most critical facilities — would immediately extend coordinated care management across the majority of this hospital’s post-acute volume.

Top SNF Partners Pts Share FSHR Risk
Fort Walton Rehabilitation Center, Llc15225.1%35.7%High
Westwood Operations, Llc13321.9%39.1%High
The Manor At Blue Water Bay13021.5%46.0%High
Destin Senior Care, Llc6711.1%34.9%High
Emerald Coast Center365.9%43.2%High
HCA Florida Lake City Hospital
Lake City, FL  ·  91 Beds  ·  Opportunity Score: 93
Immediate Priority
499
FFS SNF Patients
34
SNF Destinations
43.3%
FSHR (+1.0pp vs system)
42.3%
System FSHR Avg

HCA Florida Lake City Hospital discharged 499 FFS patients to 34 distinct SNF destinations over the analysis period. FSHR stands at 43.3%, +1.0pp vs system average. The leading post-acute destination is Solaris Healthcare Lake City Llc (134 patients, 27.4% share). The hospital’s SNF network includes 13 facilityies with a “Very High” risk category.

The Lake City post-acute network illustrates the broader HCA Florida North Florida Division pattern: a small number of high-volume SNF relationships account for the top discharge share, while the remaining volume is distributed across a long tail of facilities that operate without systematic performance oversight. A preferred-network framework anchored at Lake City’s highest-volume destinations — with embedded clinical presence at the most critical facilities — would immediately extend coordinated care management across the majority of this hospital’s post-acute volume.

Top SNF Partners Pts Share FSHR Risk
Solaris Healthcare Lake City Llc13427.4%47.6%High
Bedrock Rehabilitation And Nursing Center At Lake City11723.9%41.1%High
Bedrock Rehabilitation And Nursing Center At Suwannee6012.3%53.7%High
Good Samaritan Center428.6%35.8%Elevated
Surrey Place Nursing Center398.0%42.2%High
HCA Florida Gulf Coast Hospital
Panama City, FL  ·  238 Beds  ·  Opportunity Score: 74
Immediate Priority
377
FFS SNF Patients
36
SNF Destinations
46.0%
FSHR (+3.7pp vs system)
42.3%
System FSHR Avg

HCA Florida Gulf Coast Hospital discharged 377 FFS patients to 36 distinct SNF destinations over the analysis period. FSHR stands at 46.0%, +3.7pp vs system average. The leading post-acute destination is Pruitthealth - Panama City (156 patients, 37.1% share). The hospital’s SNF network includes 15 facilityies with a “Very High” risk category.

The Gulf Coast post-acute network illustrates the broader HCA Florida North Florida Division pattern: a small number of high-volume SNF relationships account for the top discharge share, while the remaining volume is distributed across a long tail of facilities that operate without systematic performance oversight. A preferred-network framework anchored at Gulf Coast’s highest-volume destinations — with embedded clinical presence at the most critical facilities — would immediately extend coordinated care management across the majority of this hospital’s post-acute volume.

Top SNF Partners Pts Share FSHR Risk
Pruitthealth - Panama City15637.1%41.8%High
Community Health And Rehabilitation Center7618.1%52.3%High
Aviata At Emerald Shores4811.4%52.5%High
Panama City Fl Opco Llc4310.2%51.2%High
Bonifay Nursing & Rehab Center225.2%43.8%High
HCA Florida Capital Hospital
Tallahassee, FL  ·  288 Beds  ·  Opportunity Score: 82
Immediate Priority
347
FFS SNF Patients
37
SNF Destinations
47.3%
FSHR (+5.0pp vs system)
42.3%
System FSHR Avg

HCA Florida Capital Hospital discharged 347 FFS patients to 37 distinct SNF destinations over the analysis period. FSHR stands at 47.3%, +5.0pp vs system average. The leading post-acute destination is Centre Pointe Health And Rehab Center (71 patients, 18.2% share). The hospital’s SNF network includes 20 facilityies with a “Very High” risk category.

The Capital post-acute network illustrates the broader HCA Florida North Florida Division pattern: a small number of high-volume SNF relationships account for the top discharge share, while the remaining volume is distributed across a long tail of facilities that operate without systematic performance oversight. A preferred-network framework anchored at Capital’s highest-volume destinations — with embedded clinical presence at the most critical facilities — would immediately extend coordinated care management across the majority of this hospital’s post-acute volume.

Top SNF Partners Pts Share FSHR Risk
Centre Pointe Health And Rehab Center7118.2%48.7%High
Seven Hills Health & Rehabilitation Center6316.1%51.2%High
Pruitthealth - Southwood3910.0%57.7%High
Aviata At Tallahassee348.7%49.4%High
Riverchase Operations Llc266.7%38.3%High
HCA Florida Osceola Hospital
Kissimmee, FL  ·  407 Beds  ·  Opportunity Score: 72
Immediate Priority
295
FFS SNF Patients
56
SNF Destinations
56.4%
FSHR (+14.1pp vs system)
42.3%
System FSHR Avg

HCA Florida Osceola Hospital discharged 295 FFS patients to 56 distinct SNF destinations over the analysis period. FSHR stands at 56.4%, +14.1pp vs system average. The leading post-acute destination is The Terrace Of Kissimmee (51 patients, 15.3% share). The hospital’s SNF network includes 24 facilityies with a “Very High” risk category.

The Osceola post-acute network illustrates the broader HCA Florida North Florida Division pattern: a small number of high-volume SNF relationships account for the top discharge share, while the remaining volume is distributed across a long tail of facilities that operate without systematic performance oversight. A preferred-network framework anchored at Osceola’s highest-volume destinations — with embedded clinical presence at the most critical facilities — would immediately extend coordinated care management across the majority of this hospital’s post-acute volume.

Top SNF Partners Pts Share FSHR Risk
The Terrace Of Kissimmee5115.3%60.0%High
Solaris Healthcare Celebration4513.5%45.3%High
Solaris Healthcare Osceola3410.2%88.7%High
Hunter'S Creek Nursing & Rehab Center288.4%65.1%High
Avante At St. Cloud, Inc.288.4%58.5%High
HCA Florida Putnam Hospital
Palatka, FL  ·  99 Beds  ·  Opportunity Score: 79
Immediate Priority
194
FFS SNF Patients
29
SNF Destinations
40.0%
FSHR (-2.3pp vs system)
42.3%
System FSHR Avg

HCA Florida Putnam Hospital discharged 194 FFS patients to 29 distinct SNF destinations over the analysis period. FSHR stands at 40.0%, -2.3pp vs system average. The leading post-acute destination is Palatka Center For Rehabilitation And Healing (133 patients, 58.6% share). The hospital’s SNF network includes 10 facilityies with a “Very High” risk category.

The Putnam post-acute network illustrates the broader HCA Florida North Florida Division pattern: a small number of high-volume SNF relationships account for the top discharge share, while the remaining volume is distributed across a long tail of facilities that operate without systematic performance oversight. A preferred-network framework anchored at Putnam’s highest-volume destinations — with embedded clinical presence at the most critical facilities — would immediately extend coordinated care management across the majority of this hospital’s post-acute volume.

Top SNF Partners Pts Share FSHR Risk
Palatka Center For Rehabilitation And Healing13358.6%39.9%High
Radiant Nursing And Rehab At Palatka4419.4%50.5%High
The Pavilion At Crescent Lake177.5%13.3%High
Moultrie Creek Nursing & Rehab Center<11——High
Saint Augustine Health & Rehabilitation Center<11——Elevated
HCA Florida Twin Cities Hospital
Niceville, FL  ·  65 Beds  ·  Opportunity Score: 56
Immediate Priority
102
FFS SNF Patients
13
SNF Destinations
32.0%
FSHR (-10.3pp vs system)
42.3%
System FSHR Avg

HCA Florida Twin Cities Hospital discharged 102 FFS patients to 13 distinct SNF destinations over the analysis period. FSHR stands at 32.0%, -10.3pp vs system average. The leading post-acute destination is The Manor At Blue Water Bay (102 patients, 71.8% share). The hospital’s SNF network includes 7 facilityies with a “Very High” risk category.

The Twin Cities post-acute network illustrates the broader HCA Florida North Florida Division pattern: a small number of high-volume SNF relationships account for the top discharge share, while the remaining volume is distributed across a long tail of facilities that operate without systematic performance oversight. A preferred-network framework anchored at Twin Cities’s highest-volume destinations — with embedded clinical presence at the most critical facilities — would immediately extend coordinated care management across the majority of this hospital’s post-acute volume.

Top SNF Partners Pts Share FSHR Risk
The Manor At Blue Water Bay10271.8%32.0%High
Westwood Operations, Llc<11——High
Destin Senior Care, Llc<11——High
Fort Walton Rehabilitation Center, Llc<11——High
Crestview Rehabilitation Center, Llc<11——High
HCA Florida Oviedo Medical Center
Oviedo, FL  ·  64 Beds  ·  Opportunity Score: 55
Immediate Priority
88
FFS SNF Patients
26
SNF Destinations
51.4%
FSHR (+9.1pp vs system)
42.3%
System FSHR Avg

HCA Florida Oviedo Medical Center discharged 88 FFS patients to 26 distinct SNF destinations over the analysis period. FSHR stands at 51.4%, +9.1pp vs system average. The leading post-acute destination is Ccrc Development Corporation (52 patients, 42.6% share). The hospital’s SNF network includes 11 facilityies with a “Very High” risk category.

The Oviedo post-acute network illustrates the broader HCA Florida North Florida Division pattern: a small number of high-volume SNF relationships account for the top discharge share, while the remaining volume is distributed across a long tail of facilities that operate without systematic performance oversight. A preferred-network framework anchored at Oviedo’s highest-volume destinations — with embedded clinical presence at the most critical facilities — would immediately extend coordinated care management across the majority of this hospital’s post-acute volume.

Top SNF Partners Pts Share FSHR Risk
Ccrc Development Corporation5242.6%45.6%High
Tuskawilla Nursing & Rehab Center3629.5%59.8%High
Palm Garden Of Orlando<11——High
Village On The Green<11——High
Presbyterian Retirement Communities Inc<11——High
HCA Florida West Marion Hospital
Ocala, FL  ·  186 Beds  ·  Opportunity Score: 35
Near-Term Priority
34
FFS SNF Patients
21
SNF Destinations
57.4%
FSHR (+15.1pp vs system)
42.3%
System FSHR Avg

HCA Florida West Marion Hospital discharged 34 FFS patients to 21 distinct SNF destinations over the analysis period. FSHR stands at 57.4%, +15.1pp vs system average. The leading post-acute destination is Bridgewater Park Health & Rehabilitation Center (21 patients, 28.4% share). The hospital’s SNF network includes 10 facilityies with a “Very High” risk category.

The West Marion post-acute network illustrates the broader HCA Florida North Florida Division pattern: a small number of high-volume SNF relationships account for the top discharge share, while the remaining volume is distributed across a long tail of facilities that operate without systematic performance oversight. A preferred-network framework anchored at West Marion’s highest-volume destinations — with embedded clinical presence at the most critical facilities — would immediately extend coordinated care management across the majority of this hospital’s post-acute volume.

Top SNF Partners Pts Share FSHR Risk
Bridgewater Park Health & Rehabilitation Center2128.4%57.4%High
Life Care Center Of Ocala1317.6%—Elevated
Timberridge Operations Llc<11——High
Hawthorne Ocala Operations Llc<11——Moderate
Chatham Glen Healthcare And Rehabilitation Center<11——High
HCA Florida Poinciana Hospital
Kissimmee, FL  ·  94 Beds  ·  Opportunity Score: 37
Near-Term Priority
26
FFS SNF Patients
18
SNF Destinations
44.4%
FSHR (+2.1pp vs system)
42.3%
System FSHR Avg

HCA Florida Poinciana Hospital discharged 26 FFS patients to 18 distinct SNF destinations over the analysis period. FSHR stands at 44.4%, +2.1pp vs system average. The leading post-acute destination is Solaris Healthcare Celebration (26 patients, 44.1% share). The hospital’s SNF network includes 7 facilityies with a “Very High” risk category.

The Poinciana post-acute network illustrates the broader HCA Florida North Florida Division pattern: a small number of high-volume SNF relationships account for the top discharge share, while the remaining volume is distributed across a long tail of facilities that operate without systematic performance oversight. A preferred-network framework anchored at Poinciana’s highest-volume destinations — with embedded clinical presence at the most critical facilities — would immediately extend coordinated care management across the majority of this hospital’s post-acute volume.

Top SNF Partners Pts Share FSHR Risk
Solaris Healthcare Celebration2644.1%44.4%High
Good Samaritan Society - Kissimmee Village<11——Elevated
Astoria Health And Rehabilitation Center<11——Elevated
Hunter'S Creek Nursing & Rehab Center<11——High
Spring Lake Rehabilitation Center<11——High
Benchmark Note: FL state SNF utilization avg 16.5% and 30-day readmission avg 17.2% from CMS Medicare FFS data. System FSHR avg 42.3% used as internal reference. 30-day readmission rates are computed from weighted SNF-level data, FFS CMS Medicare FFS Claims: 2025 Q1 – 2025 Q4. Risk scores derived from facility risk category: Very Low=1.0, Low=2.0, Medium=3.0, High=4.0, Very High=5.0. FSHR = facility-specific hospitalization rate (proportion of SNF patients returning to any hospital during the skilled nursing stay).
Section 5 — Shared SNF Network: Cross-System Analysis

140 SNFs Already Serve Multiple HCA Florida North Florida Division Hospitals — Without Coordination

Of the 303 SNF destinations across the HCA Florida North Florida Division network, 140 already serve two or more HCA Florida North Florida Division hospitals simultaneously. These shared facilities are the structural backbone of any preferred-network strategy — existing relationships that can be elevated and formalized without requiring new partnerships to be built from scratch.

Top 12 of 140 Cross-System SNFs — Serving Multiple HCA Florida North Florida Division Hospitals (FSHR shown)
SNF Name
FSHR
Hospitals Served
Olive Branch Operating Investments Llc
36.4%
5 hospitals  ·  143 pts · North Florida Hospital, West Hospital, Fort Walton-Destin Hospital, Gulf Coast Hospital +1
Magnolia Ridge Hrc, Llc
43.4%
4 hospitals  ·  278 pts · North Florida Hospital, Ocala Hospital, Lake City Hospital, Putnam Hospital
Palatka Center For Rehabilitation And Healing
40.6%
4 hospitals  ·  161 pts · North Florida Hospital, Ocala Hospital, Lake City Hospital, Putnam Hospital
Oak Hammock At The University Of Florida Inc
28.7%
4 hospitals  ·  148 pts · North Florida Hospital, Ocala Hospital, Lake City Hospital, West Marion Hospital
Timberridge Operations Llc
45.2%
4 hospitals  ·  144 pts · North Florida Hospital, Ocala Hospital, Lake City Hospital, West Marion Hospital
Ayers Health & Rehabilitation Center, Llc
46.1%
4 hospitals  ·  131 pts · North Florida Hospital, Ocala Hospital, Lake City Hospital, Putnam Hospital
Hawthorne Ocala Operations Llc
47.4%
4 hospitals  ·  106 pts · North Florida Hospital, Ocala Hospital, Putnam Hospital, West Marion Hospital
Bedrock Rehabilitation And Nursing Center At Suwannee
52.6%
4 hospitals  ·  93 pts · North Florida Hospital, Ocala Hospital, Lake City Hospital, Capital Hospital
Chatham Glen Healthcare And Rehabilitation Center
32.2%
4 hospitals  ·  88 pts · North Florida Hospital, Ocala Hospital, Putnam Hospital, West Marion Hospital
Destin Senior Care, Llc
34.9%
4 hospitals  ·  67 pts · North Florida Hospital, Fort Walton-Destin Hospital, Gulf Coast Hospital, Twin Cities Hospital
Seven Hills Health & Rehabilitation Center
51.2%
4 hospitals  ·  63 pts · North Florida Hospital, Fort Walton-Destin Hospital, Gulf Coast Hospital, Capital Hospital
Ocala Oaks Rehabilitation Center
34.6%
4 hospitals  ·  37 pts · North Florida Hospital, Ocala Hospital, Putnam Hospital, West Marion Hospital

Olive Branch Operating Investments Llc is among the most connected SNFs in the HCA Florida North Florida Division network — serving 5 hospitals with 143 total patients. The other high-volume cross-system facilities represent the tier of shared relationships where a coordinated embedded clinical presence delivers immediate and demonstrable impact across multiple HCA Florida North Florida Division hospitals simultaneously.

Of particular note are cross-system facilities with elevated FSHR: SNFs that already appear in multiple HCA Florida North Florida Division discharge patterns are precisely the facilities where an embedded clinical presence and preferred-network performance standards create the accountability needed to drive measurable FSHR improvement across the system’s post-acute continuum.

The 140 cross-system facilities represent the natural starting cohort for a coordinated HCA Florida North Florida Division preferred network. A structured engagement beginning with these shared partners would immediately extend coverage across the broadest reach of HCA Florida North Florida Division hospitals and create the governance layer for performance tracking across the most consequential downstream relationships in the system.

Section 5b — Priority Intervention Targets

15 High-Impact SNF Facilities for Immediate Engagement

The priority target analysis identifies SNFs with elevated FSHR rates, meaningful patient volume, and cross-hospital presence across the HCA Florida North Florida Division system. These facilities represent the intersection of high clinical risk and strategic leverage: where an embedded Puzzle clinical presence would deliver immediate impact across multiple HCA Florida North Florida Division hospitals simultaneously.

Priority SNF Targets — Ranked by Priority Score (FSHR shown)
SNF Name
FSHR
Volume · Hospitals
1. Solaris Healthcare Osceola
88.7%
34 pts · 1 hosp · Osceola Hospital
2. Bedrock Rehabilitation And Nursing Center At Suwannee
52.6%
93 pts · 4 hosps · North Florida Hospital, Ocala Hospital, Lake City Hospital +1
3. The Terrace Of Kissimmee
60.0%
51 pts · 2 hosps · Osceola Hospital, Poinciana Hospital
4. Community Health And Rehabilitation Center
52.3%
76 pts · 2 hosps · Fort Walton-Destin Hospital, Gulf Coast Hospital
5. Solaris Healthcare Lake City Llc
45.3%
217 pts · 3 hosps · North Florida Hospital, Ocala Hospital, Lake City Hospital
6. Hunter'S Creek Nursing & Rehab Center
65.1%
28 pts · 2 hosps · Osceola Hospital, Poinciana Hospital
7. Tuskawilla Nursing & Rehab Center
59.8%
36 pts · 2 hosps · Ocala Hospital, Oviedo
8. Pruitthealth - Southwood
57.7%
39 pts · 1 hosp · Capital Hospital
9. Gainesville Fl Opco Llc
92.3%
12 pts · 3 hosps · North Florida Hospital, Ocala Hospital, West Marion Hospital
10. Seven Hills Health & Rehabilitation Center
51.2%
63 pts · 4 hosps · North Florida Hospital, Fort Walton-Destin Hospital, Gulf Coast Hospital +1
11. Hawthorne Ocala Operations Llc
47.4%
106 pts · 4 hosps · North Florida Hospital, Ocala Hospital, Putnam Hospital +1
12. Pruitthealth - Pensacola, Llc
49.5%
74 pts · 3 hosps · West Hospital, Fort Walton-Destin Hospital, Capital Hospital
13. Life Care Center Of Ocala
45.5%
162 pts · 3 hosps · North Florida Hospital, Ocala Hospital, West Marion Hospital
14. Aviata At North Florida
61.1%
27 pts · 3 hosps · North Florida Hospital, Ocala Hospital, Putnam Hospital
15. Ayers Health & Rehabilitation Center, Llc
46.1%
131 pts · 4 hosps · North Florida Hospital, Ocala Hospital, Lake City Hospital +1

Solaris Healthcare Osceola leads the priority target list with a priority score of 15.8 — an FSHR of 88.7% across 1 HCA Florida North Florida Division hospital and 34 patients. The FSHR elevation at this facility — 46.4% above the system average — represents the type of high-volume, high-FSHR, multi-hospital relationship where an embedded Puzzle clinical presence delivers immediate and measurable return.

Together, the 15 priority targets cover relationships across the majority of HCA Florida North Florida Division’s active hospital portfolio. A coordinated engagement beginning with these facilities would immediately extend Puzzle’s embedded presence into the highest-risk corner of HCA Florida North Florida Division’s post-acute network — without requiring a facility-by-facility cold-call campaign. HCA Florida North Florida Division’s endorsement opens those doors, and Puzzle’s embedded clinical model provides the sustained presence to drive FSHR improvement over time.

Section 6 — Opportunity Index: All HCA Florida North Florida Division Hospitals

Where to Focus First

Every active HCA Florida North Florida Division hospital is scored on a composite of discharge volume, destination breadth, FSHR elevation, and destination-level facility risk. The index surfaces relative priority — not a critique of any individual hospital’s care quality, but a guide to where systematic post-acute infrastructure delivers the greatest immediate return. FL state SNF utilization benchmark: 16.5% (FFS).

All HCA Florida North Florida Division Hospitals — Ranked by Opportunity Score
Hospital Beds SNF Pts Dests FSHR % Score Priority
HCA Florida North Florida Hospital4391,4428041.4%94Immediate
HCA Florida Lake City Hospital914993443.3%93Immediate
HCA Florida Fort Walton-Destin Hospital3315804340.2%91Immediate
HCA Florida West Hospital5316213940.5%90Immediate
HCA Florida Ocala Hospital3061,2618139.2%83Immediate
HCA Florida Capital Hospital2883473747.3%82Immediate
HCA Florida Putnam Hospital991942940.0%79Immediate
HCA Florida Gulf Coast Hospital2383773646.0%74Immediate
HCA Florida Osceola Hospital4072955656.4%72Immediate
HCA Florida Twin Cities Hospital651021332.0%56Immediate
HCA Florida Oviedo Medical Center64882651.4%55Immediate
HCA Florida Poinciana Hospital94261844.4%37Near-Term
HCA Florida West Marion Hospital186342157.4%35Near-Term
Opportunity Score: composite 0–100 (Volume 25 pts · Utilization vs. FL state avg 16.5% 20 pts · FSHR elevation 40 pts · Destination fragmentation 15 pts). Hospitals with no CMS Medicare FFS Claims data score —.

HCA Florida North Florida Hospital leads the opportunity ranking with a score of 94 — driven primarily by its FSHR elevation and the breadth of its SNF destination network. A high-volume hospital with elevated FSHR and a large, largely unmanaged SNF network is precisely where a preferred-network infrastructure delivers maximum return on clinical investment.

HCA Florida Lake City Hospital (93 score, Immediate) and other Near-Term hospitals represent the tier where FSHR elevation merits structured attention. Their geographic position across the HCA Florida North Florida Division system means that a preferred-network framework anchored at the top hospitals naturally extends coverage to the Near-Term tier.

Section 7 — How Puzzle Works: Methodology & Approach

The OSF HealthCare Analogy: Introductions That Build a Network

Puzzle Healthcare’s engagement model is built around one core insight: the most effective way to improve post-acute outcomes at a health system is to establish an embedded presence inside the SNF network itself. That requires the health system’s endorsement to open the door. When OSF HealthCare did exactly that, it changed the economics of the entire engagement.

The OSF Precedent: When OSF HealthCare partnered with Puzzle Healthcare, the system introduced Puzzle to approximately 60 nursing homes across their post-acute network. That single act of introduction — OSF telling its downstream SNF partners that Puzzle had the health system’s trust and support — opened relationships that would have taken years to build through conventional vendor outreach. The embedded clinical presence that followed enabled real-time visibility, coordinated care management, and measurable FSHR improvement across all 60 facilities simultaneously.

HCA Florida North Florida Division has 303 unique SNF destinations — a network of meaningful scale across North Florida. HCA Florida North Florida Division’s 140 cross-system shared facilities represent the natural introductions cohort: SNFs that already know and trust multiple HCA Florida North Florida Division hospitals, and where a coordinated Puzzle presence would have an immediate and demonstrable impact on FSHR performance. That is 140 introductions — many times the minimum needed to make the engagement economics work — before Puzzle has made a single cold call.

01
Preferred Network Design
Jointly identify the SNF partners — starting with the 140 cross-system facilities and 15 priority targets — that meet quality thresholds and are willing to formalize a partnership with HCA Florida North Florida Division. Puzzle manages the relationship, tracks FSHR performance, and provides regular scorecards to HCA Florida North Florida Division care management and population health teams across North Florida.
02
Embedded Clinical Presence
Puzzle places nurse practitioners and care managers inside preferred SNFs — not as outside consultants, but as embedded partners who round on HCA Florida North Florida Division patients, flag early deterioration, and communicate directly with hospital care teams. This is the mechanism that drives FSHR improvement without requiring the SNF to restructure its own staffing model.
03
Real-Time Visibility Dashboard
HCA Florida North Florida Division care management teams gain a unified view of post-acute performance across all 13 hospitals — FSHR rates by facility, length-of-stay trends, and destination-level risk scores — updated continuously. Florida CMS benchmarks (SNF utilization 16.5%) are embedded as the reference standard throughout the analysis and dashboard.
04
Systematic Outcome Improvement
The combination of preferred-network accountability, embedded presence, and real-time visibility drives measurable improvement in FSHR and average SNF length of stay. These outcomes are reportable to payers, CMS, and HCA Florida North Florida Division leadership — and they compound over time as the preferred network matures across North Florida.

The engagement economics of Puzzle’s model require a minimum scale to be operationally viable: an embedded presence in a facility that receives only 8–10 patients per year cannot be sustained. HCA Florida North Florida Division’s cross-system SNF concentration solves this elegantly. The top cross-system facilities collectively receive enough volume across multiple HCA Florida North Florida Division hospitals to support a full embedded clinical program from day one — and their FSHR elevation makes the case for urgency clear.

The explicit ask mirrors the OSF model: HCA Florida North Florida Division introduces Puzzle to its downstream SNF partners — particularly the 140 cross-system facilities where the relationship already exists — so that Puzzle can establish a coordinated presence across the network. With OSF, 60 such introductions built the foundation for a system-wide preferred network. HCA Florida North Florida Division’s 140 cross-system facilities represent a comparable starting point, with a clear path to expanding across the full 303-destination network as the preferred-network framework matures.

Section 8 — Recommended Next Steps

Recommended Actions: From Analysis to Action

The following sequence is designed to move efficiently from this initial analysis to a working preferred-network engagement, with no disruption to existing care pathways during the design phase.

1
Discovery Conversation — HCA Florida North Florida Division Leadership & Puzzle Healthcare
A structured 60-minute session to walk through this analysis together, validate the data findings against HCA Florida North Florida Division’s ground-level experience, and identify which hospitals and SNF relationships are highest operational priority for HCA Florida North Florida Division care management teams. Puzzle brings familiarity with the Florida SNF market and a clear view of the preferred-network design options that make sense at HCA North Florida Division’s scale.
2
High-Volume Hospital Anchor Deep-Dives
Dedicated working sessions with the highest-volume hospitals (North Florida/Gainesville, Ocala, and West/Pensacola) around discharge planning, case management, and population health to validate the top-SNF data, surface any preferred-partner relationships already in place, and establish baseline FSHR performance metrics for a preferred-network framework. These hospitals account for the majority of HCA Florida North Florida Division’s total post-acute volume and set the architecture for the broader system strategy.
3
Cross-System SNF Preferred Network Design
Using the 140 cross-system facilities and 15 priority targets as the foundation, Puzzle and HCA Florida North Florida Division co-design the preferred network. Selection criteria include FSHR performance, geographic coverage, patient volume, and willingness to participate. Puzzle leads the SNF outreach and relationship management; HCA Florida North Florida Division provides the health-system endorsement that makes participation in the preferred network valuable to SNF operators across North Florida.
4
Formal Introduction to the HCA Florida North Florida Division SNF Network
HCA Florida North Florida Division formally introduces Puzzle to the preferred-network SNF facilities — mirroring the OSF model where the health system’s endorsement opens doors that a vendor cold-call cannot. The cross-system facilities and priority targets are the natural first cohort, with the broader 303-destination network as the longer-term expansion target. Puzzle negotiates participation agreements, establishes embedded clinical presence schedules, and onboards each facility. Target: initial cohort live within 90 days of network finalization.
5
Quarterly Performance Reviews & FSHR Benchmarking
Standing quarterly reviews with HCA Florida North Florida Division care management and population health leadership to present FSHR trends by facility and hospital, FSHR benchmarking against OH state averages and internal HCA Florida North Florida Division averages, facility-level performance scorecards, and network expansion recommendations. These sessions serve as the governance layer that keeps the preferred network accountable over time — and provide HCA Florida North Florida Division leadership with the data to demonstrate post-acute program impact to payers and internal stakeholders.
Closing Note

What HCA Florida North Florida Division Has — and What Comes Next

HCA Florida North Florida Division has built one of the North Florida region’s most expansive community hospital networks, spanning 13 hospitals across the North Florida market. 5,866 FFS patients, 303 SNF destinations, 13 active hospitals, and 140 facilities already embedded in multiple HCA Florida North Florida Division care pathways simultaneously. That is not a system with a post-acute crisis. It is a system with a post-acute opportunity that has not yet been systematically activated.

HCA Florida North Florida Division’s 13-hospital post-acute network currently operates as 13 largely independent discharge patterns, each sending patients to their own set of SNF destinations without shared FSHR standards, systematic accountability, or a unified visibility layer connecting HCA Florida North Florida Division care teams to downstream SNF performance. The 15 priority SNF targets — facilities with FSHR rates significantly above the system average of 42.3% appearing across multiple HCA Florida North Florida Division hospitals — represent the highest-urgency intervention points. But they are part of a larger structural story: 303 SNF destinations, most operating beyond the horizon of HCA Florida North Florida Division’s systematic oversight.

The 140 cross-system SNFs — facilities that already serve multiple HCA Florida North Florida Division hospitals and have demonstrated their relevance to the system’s post-acute continuum — are the proof of concept. These are not hypothetical preferred partners; they are already functioning as the de facto preferred network across North Florida. Puzzle’s role is to formalize it, extend it, and make FSHR performance systematically measurable and accountable.

The explicit ask: Introduce Puzzle to HCA Florida North Florida Division’s downstream SNF partners — beginning with the 140 cross-system facilities and 15 priority targets that already serve multiple hospitals — so that Puzzle can establish a coordinated embedded presence across the network. When OSF HealthCare made that introduction across approximately 60 nursing homes, the result was a system-wide preferred-network program built on existing trust. HCA Florida North Florida Division has the same structural foundation — at a scale that makes the opportunity commensurately significant for the North Florida market.

We look forward to the conversation — and to what HCA North Florida Division’s post-acute program looks like with the visibility, FSHR accountability, and coordination infrastructure to match the system’s clinical ambition across North Florida.