Payment reform is shaking up the health care industry and trickling down to affect owners and operators of health care facilities. This year, several of the nation’s largest health care facility owners have sold their skilled nursing facilities, or spun them off into separate companies, to exit the business. The moves are largely in reaction to the federal government’s preference to reimburse facilities that cost less than skilled nursing facilities for rehabilitating patients after hospital procedures. Kindred Healthcare Inc. of Louisville, Ky., Irvine-based Sabra Health Care REIT Inc. and giants HCP Inc. and Welltower Inc. announced their plans to leave the market earlier this year. Welltower said in its statement that lower-cost facilities – which typically aren’t skilled nursing facilities – appear to benefit more from changes in federal reimbursements. As properties come onto the market, it could present an opportunity for Westlake Village’s LTC Properties Inc., a real estate investment trust that owns and develops long-term care properties including skilled nursing facilities. During the company’s November third-quarter earnings call, Chief Executive Wendy Simpson and other managers said LTC would be less inclined now to take on new skilled nursing facilities run by operators it hasn’t worked with before, or even a current one that isn’t a strong operator, and “would need more data and appropriate history to underwrite them.” Pam Kessler, LTC’s chief financial officer, explained that’s because of its credit underwriting process. “If it’s with an existing operator we have a relationship with, it takes about 30 to 60 days,” she said. “One in which we have no relationship with is about 90 days, because that credit underwriting is very extensive.” Since the beginning of the year, LTC’s share price has gained about 4.4 percent. The stock closed Dec. 7 at $46.82 on the New York Stock Exchange. Mike Carroll, senior analyst with RBC Capital Markets in Cleveland, who follows LTC and other REITs, said LTC management on the call appeared cautious rather than opportunistic about buying skilled nursing facilities. “The reason why, is that the evolution in these new (payment) models going in is pretty complex, and it’s uncertain how this is going to impact certain operators,” he said. Kessler added that while it’s a “very opportunistic” time for acquisitions for LTC, what tends to come onto the market after these divestitures are large portfolios of nursing homes. They have a mix of good and bad facilities, so large portfolios are too risky for LTC, she said. But should LTC consider acquisitions now, it has financial flexibility because its operators have been generating better cash flows than others, Carroll said. “They have one of the stronger coverage ratios, so they are better positioned to handle changes,” he said.