Skilled nursing facilities paid for participating in new program, starting the summer of 2016

by  Christine Woolstenhulme, QMC QCC CMCS CPC CMRS
May 19th, 2016

Medicare plans to start a Skilled Nursing Facility Value-Based Purchasing Program (SNFVBP), beginning fiscal year 2019. This program will be used to promote better clinical outcomes for skilled nursing facility patients and improve care during their stay at a skilled nursing facility.   Skilled nursing facilities will be paid for participating.   Starting the summer of 2016 then quarterly Medicare will send confidential quality feedback reports on measurement performance; the results will be posted on Nursing Home Compare.

This measure is designed to capture the outcome of unplanned all-cause hospital readmissions (IPPS or CAH) of SNF patients occurring within 30 days of discharge from the patient’s prior proximal acute hospitalization.

 The all-cause SNFRM will be evaluated on a 1- year cycle, with the SNFRM numerator time window being 30 days after discharge from the prior proximal hospitalization.

Planned readmissions will not be counted against facilities because, as stated in the documentation for the HWR measure, “...planned readmissions are not a signal of quality of care.”

 The planned readmission algorithm is based on two main principles:

1. Planned readmissions are those in which one of a pre-specified list of procedures took place or readmissions for one of the following took place: bone marrow, kidney, or other transplants. Planned diagnosis categories include maintenance chemotherapy and rehabilitation. Pregnancy diagnoses and procedures such as normal pregnancy, Cesarean section; forceps delivery, vacuum, and breech delivery are also considered planned. Readmissions to psychiatric hospitals or units are also classified as planned readmissions.

2. Admissions for acute illness or for complications of care are not classified as “planned” Even a typically planned procedure performed during an admission for an acute illness would not likely have been planned. We used the principal diagnosis and all of the procedure codes from the readmission to identify planned readmissions. Unless a readmission met the algorithm definition of planned, it was considered unplanned and counted as a readmission in the measure.

 To read the entire report to congress click here