Open Door Forum: Skilled Nursing Facility Value-Based Purchasing (SNF VBP) Program Summarized
The legislative basis for SNF VBP Program exists in Section 215 of the “Protecting Access to Medicare Act of 2014” (PAMA), enacted on April 1, 2014, added subsections (g) and (h) to Section 1888 of the Social Security Act. Additionally, Section 1888(g) authorizes new quality measures for skilled nursing facilities (SNFs) based on the rate of hospital readmissions of Medicare beneficiaries discharged to a SNF and finally Section 1888(h) authorizes a VBP program in which Medicare payments to SNFs will be adjusted based on their performance scores on the quality measures established in Section 1888(g).
The legislative requirements for SNF VBP Program are to specify an all cause, all condition hospital readmission measure by 10/1/15, and an all condition risk-adjusted potentially preventable hospital readmission rate by 10/1/16; Provide confidential feedback reports to SNFs regarding their performance on these measures beginning on 10/1/16; and Publicize SNF performance on the measures on Nursing Home Compare or some other website beginning on 10/1/17. Additionally, establish performance standards on the quality measures that include both achievement and improvement; Develop a methodology for assessing performance scores and ranking SNFs based on their scores from low to high; Make value-based incentive payments to SNFs for services provided on or after 10/1/18, with the highest ranked SNFs receiving the highest payments and SNFs ranked in the lowest 40 percent receiving payments that are less than what they would otherwise receive without the program; and finally, make value-based incentive payments to SNFs that total not less than 50 percent of the amount withheld from SNF Medicare payments nor more than 70 percent of that amount.
To read a complete overview of FY 2016 SNF PPS Proposed Rule: SNF VBP Program Policies by CMS go to garnerhealth.com/wp-content/uploads/2014/02/SNF–VBP-ODF-Slides.pdf