Skilled Nursing Facility Value-Based Purchasing Initiative Launched By CMS

Medical Billing Consultants

New Initiative By CMS

The Centers for Medicare & Medicaid Services (CMS) has recently launched a new initiative, named Skilled Nursing Facility Value-Based Purchasing (SNF VBP) program. Though the program aims to streamline health care services, reports say that the project is immensely complex. CMS is now trying to fix the issue and clarify the program by providing new resources and details about their new venture.

CMS conducted an open conference call through their Medicare Learning Network on SNF VBP in order to review the program specifics and to provide new sources of information to their providers. The SNF VBP permits a 2 percent withhold to claims for services, which are furnished on or after October 1, 2016. This will give an opportunity for the health care providers to get either some or all of their investments or reimbursements. However, this will depend on how well the providers are good in meeting or exceeding their performance standards and managing hospital readmissions.

Reports indicate that there are chances for top performing health care providers to get more than 2 percent withheld. However, CMS has stated that the specifics and details on how much more the incentive will be and how many providers will be eligible for this are not yet determined.

SNFs will be compared and rated against their own improvement and with all other facilities in the nation. The SNF rate in the year 2017 will be compared with their own preceded performance during the year 2015.

SNF 30-Day All-Cause Readmission Measure (SNFRM) is the name given to the key metric of CMS’s latest initiative. The risk-standardized rate of all-cause, unplanned hospital readmissions of Medicare SNF beneficiaries will be estimated by the SNFRM within 30 days of patient discharge.

Medical Billing Outsourcing

Value-Based Purchasing Program

The program also allows the health care providers to identify hospital readmissions, and those that take place within 30 days would be recorded and counted regardless of whether the beneficiary is readmitted either from home or from a SNF.

Reports also indicate that the rates will be risk adjusted and they will depend on factors such as comorbidities, principal diagnosis in prior hospitalization, patient demographics, and many other health states variables, which affect the chances or probability of readmission of a patient.

SNF VBP program has also excluded planned readmissions from their plans since they are not considered as preventable. CMS has also excluded many other patients including the ones, who were hospitalized for cancer treatment, and patients who did not have coverage under Medicare Part A program for the 30-day window.