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Skilled Nursing Facilities VBP

The Skilled Nursing Facility Value-Based Purchasing Program (SNF VBP) 

What’s the Skilled Nursing Facility Value-Based Purchasing Program (SNF VBP)?

The SNF VBP Program rewards skilled nursing facilities with incentive payments for the quality of care they give to people with Medicare.

When does the SNF VBP Program start?

The SNF VBP Program starts with fiscal year 2019 payment.

Why’s the SNF VBP Program important?

The SNF VBP Program promotes better clinical outcomes for skilled nursing facility patients and makes their care experience better during skilled nursing facility stays.

How will the program work?

CMS will pay participating skilled nursing facilities for their services based on the quality of care, not just quantity of the services they provide in a given performance period.  

Section 215 of the 2014 Protecting Access to Medicare Act (PAMA) started the SNF VBP Program and gives details about:

  • The readmission measures specified for the Program
  • How facility performance will be scored
  • What the performance standards and periods are
  • How facilities can review their scores
  • How facility performance will be reported to the public

Every year, the SNF Prospective Payment System (PPS) rules outline what’s required of the SNF VBP Program for that year.

FY 2019 SNF PPS Proposed Rule

On April 27, 2018, CMS issued a proposed rule [CMS-1696-P] outlining proposed FY 2019 Medicare payment rates and proposals for the SNF VBP Program. CMS is accepting comments on these proposals through June 26, 2018. The SNF PPS proposed rule can be downloaded here.

Since October 2016, we have been providing SNFs with quarterly confidential feedback reports containing information regarding their performance on the readmission measure specified for the SNF VBP Program. These quarterly reports are disseminated to SNFs via the QIES system.

October 2017 Update: SNF VBP Baseline Performance Data Are Now Available.  

Performance data from the baseline year of the SNF VBP program are now available here. This includes SNFs’ performance on the Skilled Nursing Facility Readmission Measure (NQF# 2510) from Calendar Year (CY) 2015.

What types of SNFs are included in the SNF VBP Program?

All SNFs paid under the SNF PPS are included in the SNF VBP Program and are eligible for payment incentives based on their performance on the program’s measure.

What measures will be used in the SNF VBP Program?

Skilled Nursing Facility 30-Day All-Cause Readmission Measure

The Skilled Nursing Facility 30-Day All-Cause Readmission Measure (SNFRM) is used in the SNF VBP Program. The SNFRM estimates the risk-standardized rate of unplanned readmissions within 30 days for:

      • People with fee-for-service Medicare who were inpatients at PPS, critical access, or psychiatric hospitals.
      • Any cause or condition.

We finalized the SNFRM in the SNF PPS Final Rule for FY 2016. This fact sheet contains important information you should know about SNFRM. 

This technical report and technical report supplement provide additional detail on the SNFRM.

Additional reliability testing for the SNFRM can be found in this memo.

What are the baseline and performance periods affecting FY 2019 payment for the SNF VBP Program?

For each year that the SNF VBP Program affects payment determination, SNFs are scored based on their performance during the applicable baseline period and performance period.

The baseline period affecting payment determination in FY 2019 is calendar year (CY) 2015 (January 1, 2015 through December 31, 2015).

The performance period affecting payment determination in FY 2019 is CY 2017 (January 1, 2017 through December 31, 2017).

How will SNFs' performance be scored under the SNF VBP Program?

SNFs will earn a SNF VBP Performance score (0 to 100) and ranking which is calculated based on that SNF’s performance on the measure specified for the Program during the performance period and the baseline period. The SNF VBP performance score is equal to the higher of the achievement score and improvement score.

  • 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.

For more in-depth information on SNF VBP performance scoring, we refer you to the FY 2018 SNF PPS final rule.

This report provides the analyses that were performed when proposing and finalizing the Program’s exchange function used to translate SNF performance scores into incentive payments.

Where can I learn more about the SNF VBP Program?

Review frequently asked questions about the Program:

Find out how to get your SNF VBP Reports:

  • Accessing your Quarterly and Annual Reports tutorial slides.

Find out about the SNF VBP Program’s updates:

  • Skilled Nursing Facility Value-Based Purchasing Program FY 2018 Final Rule Call slides.

You can also read our MLN article or follow the Twitter channel for more information.

For questions about the SNF VBP Program, please send inquires to the mailbox.

**Please note that this mailbox is not secured to receive protected health information or patient-level data with direct identifiers.**