Value Based Purchasing and Penalties
SNF Value-Based Purchasing – Mandated by 10/1/18: The SNF VBP was part of the Protecting Access to Medicare Act of 2014 (PAMA) which authorized establishment of the SNF VBP Program beginning with FY 2019 and established a 2 percent withhold to SNF Part A payments that can be partially earned back based on a SNF’s performance and level of improvement on metrics. PAMA requires CMS to select a risk-adjusted re-hospitalization measure and to calculate a score for each SNF, taking into account both relative performance and degree of improvement from a baseline period. CMS is also required to provide the measure and score reports to SNFs for review and to display this information on Nursing Home Compare.
The final rule adopts the SNF 30-Day All-Cause Readmission Measure, (SNFRM) (National Quality Forum/NQF #2510), as the all-cause, all-condition readmission measure that will be used in the SNF VBP Program. This measure estimates the risk-standardized rate of all-cause, unplanned, hospital readmissions for SNF Medicare beneficiaries within 30 days of their prior proximal short-stay acute hospital discharge based on claim data. CMS is required to replace this measure with an all-condition, risk-adjusted potentially preventable hospital readmission rate which will be addressed in future rulemaking.
The proposed rule also seeks comment on SNF VBP Program policies such as value-based Incentive payments; public reporting; SNF-specific performance information; and aggregate performance information which CMS will address in the FY 2017 SNF PPS proposed rule.
CMS SNF NPRM 2017 language asking for feedback about providing SNFs with their data and public reporting: Section 7
7. SNF VBP Reporting
a. Confidential Feedback Reports
Section 1888(g)(5) of the Act requires that we provide quarterly confidential feedback reports to SNFs on their performance on the measures specified under sections 1888(g)(1) and (2) of the Act. Section 1888(g)(5) of the Act also requires that we begin providing those reports on October 1, 2016. In order to meet the statutory deadline, we are developing the feedback reports, operational systems, and implementation guidance related to those reports. We intend to provide these reports to SNFs via the QIES system CASPER files currently used by SNFs to report quality performance. We welcome public comments on the appropriateness of the QIES system, and any considerations we should take into account when designing and providing these feedback reports.
b. Proposed Two-Phase SNF VBP Data Review and Correction Process
Section 1888(g)(6) of the Act requires the Secretary to establish procedures to make public performance information on the measures specified under paragraphs (1) and (2) of such section. The procedures must ensure that a SNF has the opportunity to review and submit corrections to the information that will be made public for the facility prior to its being made public. This public reporting is also required by statute to begin no later than October 1, 2017. Additionally, section 1888(h)(9) of the Act requires the Secretary to make available to the public information regarding SNFs’ performance under the SNF VBP Program, specifically including each SNF’s performance score and the ranking of SNFs for each fiscal year. Accordingly, we are proposing to adopt a two-phase review and correction process for (1) SNFs’ measure data that will be made public under section 1888(g)(6) of the Act, which will consist of each SNFs’ performance on the measures specified under sections 1888(g)(1) and (2) of the Act, and (2) SNFs’ performance information that will be made public under section 1888(h)(9).
(2) Phase One: Review and Correction of SNFs’ Quality Measure Information
We view the quarterly confidential feedback reports described above as one possible means to provide SNFs an opportunity to review and provide corrections to their performance information. However, collecting SNF measure data and calculating measure performance scores takes a number of months following the end of a measurement period. Because it is not feasible to provide SNFs with an updated measure rate for each quarterly report or engage in review and corrections on a quarterly basis, we propose to use one of the four reports each year to provide SNFs an opportunity to review their data slated for public reporting. In this specific quarterly report, we intend to provide SNFs: (1) A count of readmissions; (2) the number of eligible stays at the SNF; (3) the SNF’s risk-standardized readmissions ratio; and (4) the national SNF measure performance rate. In addition, we intend to provide the patient-level information used in calculating the measure rate. However, we seek comment on what patient-level information would be most useful to SNFs, and how we should make this information available if requested. We intend to address the topic of what specific information will be provided if requested in this specific quarterly report in future rulemaking, where we intend to propose a process for SNFs’ requests for patient-level data. We intend to notify SNFs of this report’s release via listserv email and posting on the QualityNet News portion of the Web site. Therefore, we propose to fulfill the statutory requirement that SNFs have an opportunity to review and correct information that is to be made public under section 1888(g)(6) of the Act by providing SNFs with an annual confidential feedback report that we intend to provide via the QIES system CASPER files. We further propose that SNFs must, if they believe the report’s contents to be in error, submit a correction request to SNFVBPinquiries@ cms.hhs.gov with the following information:
SNF’s CMS Certification Number (CCN).
The correction requested and the SNF’s basis for requesting the correction.
More specifically, the SNF must identify the error for which it is requesting correction, and explain its reason for requesting the correction. The SNF must also submit documentation or other evidence, if available, supporting the request. Additionally, any requests made during phase one of the proposed process will be limited to the quality measure information at issue. We further propose that SNFs must make any correction requests within 30 days of posting the feedback report via the QIES system CASPER files, not counting the posting date itself. For example, if we provide reports on October 1, 2017, SNFs must review those reports and submit any correction requests by October 31, 2017. We will not consider any requests for correction to quality measure data that are received after the close of the first phase of the proposed review and correction process. As discussed further below, any corrections sought during phase two of the proposed process will be limited to the SNF performance score calculation and the ranking. We will review all timely phase one correction requests that we receive and will provide responses to SNFs that have requested corrections as soon as practicable.
(3) Phase Two: Review and Correction of SNF Performance Scores and Ranking
As required by section 1888(h)(7) of the Act, we intend to inform each SNF of its payment adjustments as a result of the SNF VBP Program not later than 60 days prior to the fiscal year involved. For the FY 2019 SNF VBP Program, we intend to notify SNFs of those payment adjustments via a SNF performance score report not later than 60 days prior to October 1, 2018. We intend to address the specific contents of that report in future rulemaking. In that report, however, we also intend to provide SNFs with their SNF performance scores and ranking. By doing so, we intend to use the performance score report’s provision to SNFs as the beginning of the second phase of the proposed review and correction process. By completing phase one, SNFs will have an opportunity to verify that their quality measure data are fully accurate and complete, and as a result, phase two will be limited only to corrections to the SNF performance score’s calculation and the SNF’s ranking. Any requests to correct quality measure data that are received during phase two will be denied. We intend to set out specific requirements for phase two of the proposed review and correction process in future rulemaking. To inform those proposals, we seek comments on what information would be most useful for us to provide to SNFs to facilitate their review of their SNF performance scores and ranking. As with the phase one process, we intend to adopt a 30-day time period for phase two review and corrections, beginning with the date on which we provide SNF performance score reports. We welcome public comments on this proposed two-phase review and correction process.
c. SNF VBP Public Reporting
Section 1888(h)(9)(A) of the Act requires that we make available to the public on the Nursing Home Compare Web site or its successor information regarding the performance of individual SNFs with respect to a FY, including the performance score for each SNF for the FY, and each SNF’s ranking, as determined under paragraph (4)(B) of such section. Additionally, section 1888(h)(9)(B) of the Act requires that we periodically post aggregate information on the SNF VBP Program on the Nursing Home Compare Web site or its successor, including the range of SNF performance scores, and the number of SNFs receiving value-based incentive payments and the range and total amount of those payments. We intend to address this topic in future rulemaking. However, we welcome public comments on the best means by which to display the SNF specific and aggregate performance information for public consumption.
d. Ranking SNF Performance
Section 1888(h)(4)(B) of the Act requires ranking the SNF performance scores determined under paragraph (A) of such section from low to high. Additionally, and as discussed in this section, we are required to publish the ranking of SNF performance scores for a FY on Nursing Home Compare or a successor Web site. To meet these requirements, we propose to order SNF performance scores from low to high and publish those rankings on both the Nursing Home Compare and QualityNet Web sites. However, because SNF performance scores will not be calculated until after the performance period concludes after CY 2017 (that is, during CY 2018), and because SNFs must be provided their value-based incentive payment adjustments not later than 60 days prior to the FY involved, we intend to publish the ranking for FY 2019 SNF VBP payment implications after August 1, 2018.We welcome public comments on the most appropriate format and Web site for the ranking’s publication.
PAMA SNF VBP Statutory Language about feedback reports and public reporting.
5) FEEDBACK REPORTS TO SKILLED NURSING FACILITIES.—Beginning October 1, 2016, and every quarter thereafter, the Secretary shall confidential feedback reports to skilled nursing facilities on the performance of such facilities with respect to a measure specified under paragraph (1) or (2).
‘‘(6) PUBLIC REPORTING OF SKILLED NURSING FACILITIES.—
‘‘(A) IN GENERAL.—Subject to subparagraphs (B) and (C), the Secretary shall establish procedures for making available to the public by posting on the Nursing Home Compare Medicare website (or a successor website) described in section 1819(i) information on the performance of skilled nursing facilities with respect to a measure specified under paragraph (1) and a measure specified under paragraph (2).
‘‘(B) OPPORTUNITY TO REVIEW.—The procedures under subparagraph (A) shall ensure that a skilled nursing facility has the opportunity to review and submit corrections to the information that is to be made public with respect to the facility prior to such information being made public.
‘‘(C) TIMING.—Such procedures shall provide that the information described in subparagraph (A) is made publicly available beginning not later than October 1, 2017.
‘‘(9) PUBLIC REPORTING.—
‘‘(A) SNF SPECIFIC INFORMATION.—The Secretary shall make available to the public, by posting on the Nursing Home Compare Medicare website (or a successor website) described in section 1819(i) in an easily understandable format, information regarding the performance of individual skilled nursing facilities under the SNF VBP Program, with respect to a fiscal 2 year, including— ‘‘(i) the SNF performance score of the skilled nursing facility for such fiscal year; and ‘‘(ii) the ranking of the skilled nursing facility under paragraph (4)(B) for the performance period for such fiscal year.
‘‘(B) AGGREGATE INFORMATION.—The Secretary shall periodically post on the Nursing Home Compare Medicare website (or a successor website) described in section 1819(i) aggregate information on the SNF VBP Program, including— ‘‘(i) the range of SNF performance scores provided under paragraph (4)(A); and ‘‘(ii) the number of skilled nursing facilities receiving value-based incentive payments under paragraph (5) and the range and total amount of such value-based incentive payments.