As you’ve been exploring ways to increase your reimbursement from the Centers of Medicare & Medicaid Services (CMS), you may have noticed a common theme. The rewards are increasingly tied to providing value-based care. The more you can shift your services from volume to value, the more reimbursement opportunities like the SNF VBP will open up for you.
CMS withholds 2% of all fee-for-service FFS payments made to SNFs to fund the SNF VBP program. It then re-distributes 60% of program funds to SNFs that show improvement or achievement on a single value-based-care quality measure: unplanned hospital readmissions within 30 days.
Improvement is measured against a facility’s baseline, and achievement is measured against the national average.
The official name of the measure is: SNF 30-Day All-Cause Readmission Measure (SNFRM).
If your SNF receives reimbursement through the Medicare Prospective Payment System (PPS), you’re enrolled in the SNF VBP program automatically.
The next step is to establish a baseline for your hospital readmissions. First, the CMS will pull a baseline for your facility from a timeframe in the past. You’ll have a chance to review it and ask for adjustments. Then, the performance period begins, and you’ll have an opportunity to improve and achieve.
Key Dates: SNF VBP Baseline and Performance Periods
Fiscal year vs. calendar year
A fiscal year is a budget year for financial accounting and reporting, not necessarily a calendar year.
The CMS fiscal year begins October 1st and ends September 30.th
The baseline and performance timelines follow the fiscal year.
When does it open and close? The window opens on the day an acute patient is discharged from a hospital and admitted to an SNF. The window closes in 30 days or when the patient is readmitted to the hospital, whichever comes first.
Unplanned hospital readmissions are acute and may indicate a problem with the quality of care provided by an SNF. Planned readmissions are not acute and not reflective of SNF care. Examples of planned readmissions are chemotherapy treatment and organ transplant.
The CMS provides quarterly confidential, secure feedback reports to SNF VBP program participants.
|
Data |
Report type |
Month released (subject to change) |
|
Baseline year data |
Full-year workbook |
December |
|
Partial performance year data |
Interim (partial-year) workbook |
March |
|
Performance year data |
Full-year workbook |
June |
|
Performance score, SNF VBP program rank and incentive payment multiplier |
Performance Score Report (PSR) |
August |
Performance Score Reports (PSR) include a reimbursement forecast to help you see your progress, spot gaps and change your strategies as needed.
You have 30 days from receiving a PSR to review and submit corrections before the information is made public.
SNF VBP program performance is reported publicly at the facility level and in aggregate at the national level.
Facility-level data includes:
National data includes:
If your SNF participates in the SNF VBP program and experiences a natural disaster or other catastrophic event, you may be eligible for an Extraordinary Circumstance Exception (ECE). With an ECE, performance data during the time of the disruption is excluded from reporting.
Additional quality measures—and more opportunities to earn incentives—we may see in the next few years include:
Stay up to date on program developments and reach out to the SNF VBP Program Help Desk with questions: SNFVBP@rti.org.
Why was the SNF VBP program created?
Unplanned hospital readmissions take a heavy toll on residents physically, emotionally and psychologically. They also cost the CMS billions of dollars that could be better spent elsewhere.
How does the SNF VBP program work?
CMS withholds 2% of all FFS payments made to SNFs to fund the SNF VBP program. It then re-distributes 60% of program funds to SNFs who show improvement or achievement on a single value-based-care quality measure: unplanned hospital readmissions within 30 days.
Which score matters more—improvement or achievement?
Both scores carry equal weight. The CMS will go with your higher score.
Is the SNF VBP performance measure also used in the SNF Quality Reporting Program or the Five-Star Quality Rating System?
No. These programs use different measures.
The SNF QRP uses this measure: Potentially Preventable 30-Day Post-Discharge Readmission.
The Five-Star Quality Rating System uses these measures:
Is the SNF VBP program optional?
It’s optional unless you receive Medicare reimbursement through the SNF PPS program. If you receive PPS reimbursement, the SNF VBP program is mandatory.
What’s the difference between unplanned and planned hospital readmissions?Unplanned hospital readmissions are acute and may indicate a problem with the quality of care provided by an SNF. Planned readmissions are not acute and not reflective of SNF performance. Examples are chemotherapy treatment and organ transplant.
When does the hospital readmissions window open and close?
The window opens on the day an acute patient is discharged from a hospital and admitted to an SNF. The window closes in 30 days or when the patient is readmitted to the hospital, whichever comes first.
When will I receive feedback reports from the CMS?
The CMS provides confidential, secure feedback reports to SNF VBP program participants quarterly.
|
Data |
Report Type |
Month Released (subject to change) |
|
Baseline year data |
Full-year workbook |
December |
|
Partial performance year data |
Interim (partial-year) workbook |
March |
|
Performance year data |
Full-year workbook |
June |
|
Performance score, SNF VBP program rank and incentive payment multiplier |
Performance Score Report (PSR) |
August |
What can I do if I don’t agree with my Performance Score Report (PSR)?
Don’t worry. You’ll have 30 days to submit corrections before the information is made public.
Is the SNF VBP program performance reported publicly?
Yes. It’s reported publicly at an aggregate facility level and national all-facility level.
Where can I find the SNF PPS final rules?
What is an Extraordinary Circumstance Exception (ECE)?
If your SNF participates in the SNF VBP and experiences a natural disaster or other catastrophic event, you may be eligible for an ECE. With an ECE, performance data during the time of the disruption is excluded from reporting.
What additional measures are on the horizon?
Additional quality measures—and more opportunities to earn incentives—we may see in the next few years include:
Who can I contact with questions about the SNF VBP program?
Email the SNF VBP Program Help Desk at SNFVBP@rti.org.
Who can I contact with questions about access to quarterly feedback reports?
Quarterly feedback reports are distributed through the Quality Improvement and Evaluation System (iQIES). Email the QIES/iQIES Service Center at iqies@cms.hhs.gov.
CCN – CMS Certification Number
CMS – Centers for Medicare & Medicaid Services
ECE - Extraordinary Circumstance Exception
FFS – Fee-for-service
PPS – Prospective Payment System
PSR – Performance Score Reports
QIES - Quality Improvement and Evaluation System
RSRRs - Risk-standardized readmission rates
SNF – Skilled nursing facility
SNFRM – Skilled Nursing Facilities 30-Day All-Cause Readmission Measure
SNF VBP – Skilled Nursing Facility Value-Based Purchasing