The Skilled Nursing Facilit y(SNF) Value-Based Purchasing (VBP) Program (Program) awards payments to SNFs based on their performance on the Program’s measure of readmissions. This measure is the SNF 30-Day Readmission Measure (SNFRM) (NQF #2510). For technical specifications related to this measure, click here.
SNFs will receive incentive payments, on an annual basis, at the start of each new fiscal year. The first time SNFs will receive incentive payments is on October 1, 2018, which is the start of fiscal year (FY) 2019. These incentive payment amounts are based on SNFs’ performance on the Program’s hospital readmissions measure during performance period, January 1, 2017, through December 31, 2017, and the baseline period, January 1, 2015 through December 31, 2015.
SNFs will be awarded points for achievement on a 0-100-point scale and improvement on a 0-90-point scale, based on how their performance compares to national benchmarks and thresholds. The SNF VBP performance score is equal to the higher of the achievement score and improvement score. CMS finalized a logistic exchange function to translate SNF performance scores into value-based incentive payments beginning in the FY 2019 SNF VBP Program.
CMS is required under the Protecting Access to Medicare Act of 2014 (PAMA) to issue quarterly and annual feedback reports to SNF’s and those reports are available in the QIES system. The quarterly reports show number of eligible stays, number of readmissions, risk standardized rate, and nation average readmission rate. The annual report will provide the SNF score for the baseline period, performance period, performance score, SNF rank, and the incentive payment adjustment percentage. For more information on how to access your SNF’s report, click here.
The adjusted federal per diem rate applicable to each SNF in an FY will be reduced by 2 percent to fund incentive payments for that FY. The total amount of incentive payments distributed to SNFs will be 60 percent of the total amount withheld from SNFs’ Medicare payments for that fiscal year. Facilities with SNF VBP performance scores ranked in the lowest 40 percent nationally will receive a payment rate lower than they would otherwise receive without the SNF VBP Program.
CMS adopted FY 2018 as the performance period and FY 2016 as the baseline period for the FY 2020 SNF VBP Program. The table below displays the performance and baseline periods for FY 2019 and FY 20120.
Special thanks to Tom Parker, FHCA Director of Reimbursement, for contributing to this article. For additional information related to SNF VBP contact Nathan Shaw at [email protected] or Robin Bleier at [email protected] or call 727.786.3032.