Dec 9, 2018

Skilled Nursing Facility Value-Based Purchasing Program

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NPR reported on the federal government’s new step to reduce avoidable hospital readmissions of nursing home patients. They are using the carrot and the stick approach.  Reward those who complied and improved, and punish those who have not.  Money is the chief motivator of many for-profit nursing homes so CMS is targeting their profit margins.

The new Medicare program is altering a year’s worth of payments to 14,959 skilled nursing facilities, based on how often their residents ended up back in hospitals within 30 days of leaving. The move will lower a year’s worth of payments to nearly 11,000 nursing homes, and giving bonuses to nearly 4,000 others.  Over this fiscal year, which began Oct. 1 and goes through the end of September 2019, the best-performing homes will receive 1.6 percent more for each Medicare patient than they would have otherwise. The worst-performing homes will lose nearly 2 percent of each payment. The others will fall in between.

These financial incentives, determined by each home’s readmission rates, significantly expand Medicare’s effort to pay medical providers based on the quality of care instead of just the number or condition of their patients.

Nearly 11 percent of patients in 2016 were sent to hospitals for conditions that could have been averted with better nursing and custodial care.

These bonuses and penalties are also intended to discourage nursing homes from discharging patients too quickly — something that is financially tempting as Medicare fully covers only the first 20 days of a stay and generally stops paying anything after 100 days.

For-profit nursing homes, which make up two-thirds of the nation’s facilities, face deeper cuts on average than do nonprofit and government-owned homes, a Kaiser Health News analysis of the data found.

Congress created the Skilled Nursing Facility Value-Based Purchasing Program incentives in the 2014 Protecting Access to Medicare Act. In assigning bonuses and penalties, Medicare judged each facility’s performances in two ways: how its hospitalization rates in calendar year 2017 compared with other facilities and how much those rates changed from calendar year 2015.

Facilities received scores of 0 to 100 for their performances and 0 to 90 for their improvements; the higher of the two scores was used to determine their overall score. Facilities were then ranked highest to lowest.


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Advocacy · Medicare

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