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Skilled Nursing Facilities VBP


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

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

The SNF VBP Program focuses on better outcomes and rewards skilled nursing facilities with incentive payments for the quality of care they give to people with Medicare, in particular reducing hospital readmissions. The SNF VBP Program moves CMS toward paying providers based on the quality, rather than the quantity, of care they give patients.

When will SNFs receive SNF VBP incentive payments?

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.

How will the program work?

A healthcare law called the 2014 Protecting Access to Medicare Act (PAMA) started the SNF VBP Program. Every year, CMS publishes a regulation that outlines what is required for the SNF VBP program. The most recent regulation can be found here. Under the SNF VBP Program:

  • SNFs will be evaluated on a hospital readmissions measure after a patient is discharged and has a hospital admission within 30 days.
  • SNFs will receive a performance score based on their individual performance and a performance score based on their comparison to other SNFs in the country.
  • SNFs will receive confidential quarterly and annual reports about their performance on the program’s measure.
  • SNFs will receive payment incentives based on their performance.

Since October 2016, CMS has 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 Quality Improvement and Evaluation System (QIES)/Certification and Survey Provider Enhanced Reports (CASPER) system.

Public reporting of SNF performance will occur on the Nursing Home Compare website. In October 2017, performance data from the baseline year of the SNF VBP program was made available here. This includes SNFs’ performance on the Skilled Nursing Facility Readmission Measure (NQF# 2510) from Calendar Year (CY) 2015. Performance period data from CY 2017 will also be available on the Nursing Home Compare website. As a result of Phase Two review and corrections, an updated ranking file can be found here.

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 Prospective Payment System (PPS) are included in the SNF VBP Program and are eligible for payment incentives based on their performance on the program’s measure. The types of SNFs in the Program include freestanding SNFs, SNFs associated with acute care facilities, and all non-critical access hospital (CAH) swing bed rural facilities.

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 and the FY 2019 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 more about your SNF VBP Reports:

  • Accessing your Quarterly and Annual Reports tutorial slides.
  • Reviewing your Annual Performance Score Report 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 CMS.gov Twitter channel for more information.

For questions about the SNF VBP Program, please send inquires to the SNFVBPInquiries@cms.hhs.gov mailbox.

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

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