​Recent changes to the Centers for Medicare & Medicaid Services’ (CMS) Skilled Nursing Facility Value-Based Purchasing (SNF VBP) program add seven new performance measures that affect SNFs’ Medicare Part A reimbursements. While incentive payments will still be based on a single metric—30-day all-cause hospital readmissions—until FY 2026, that doesn’t mean providers can put off worrying about the newly adopted measures until then: their performance starting in FY 2024 will determine their reimbursement rates when the incentive calculations change.

A new AHCA/NCAL online course, SNF VBP Essentials, gives operators the tools they need to prepare for these changes.

A Brief History of the SNF VBP Program

Established by the Protecting Access to Medicare Act of 2014 (PAMA), the SNF VBP program incentivizes SNFs to provide high-quality care by offering payments based on certain performance metrics. The program’s goal is to shift providers away from fee-for-service models that encourage a quantity of services with little incentive to improve patient outcomes.

As the name suggests, VBP steers providers towards a value-based care model: the idea is not only to slash expenditures and boost efficiencies, but also to focus on preventive care services that ultimately serve patients best. At the same time, VBP holds providers more accountable for their services, levying penalties on organizations that perform poorly.

Since the program went into effect, it has focused on one performance metric: the 30-Day All-Cause Readmission Measure, or SNFRM, which assesses a facility’s unplanned all-cause readmission rate for patients discharged from a hospital within 30 days.

“Initially, the program was just focused on readmissions,” explained Kiran Sreenivas, AHCA/NCAL’s vice president of research. “People would go into the nursing home, they would receive quality care, get better, and then stay in the nursing home if they need to, or go back to the community without having to go back to the hospital. Hospitalizations tend to be the highest cost in care; that’s why we try to reduce readmissions.”

Logistically speaking, the SNFRM includes patients who are enrolled in Medicare FFS Part A for at least one year before an SNF admission; who have a qualifying SNF admission within 24 hours after being discharged from a hospital; or who are enrolled in Medicare FFS Part A for 30 days after a qualifying SNF admission, according to CMS. The measure includes risk adjustments by patient demographic, comorbidity, and other factors. CMS funds the program by withholding 2 percent of an SNF’s Medicare FFS Part A payments, redistributing 60 percent of those withheld funds as incentives and keeping 40 percent in the Medicare Trust Fund.

From One Metric to Seven

As of October 1, 2023, the SNFRM is no longer the only performance measure included in the SNF VBP program. CMS recently added seven new metrics that will affect incentive payments in the coming years:

• In FY 2026, payments will incorporate healthcare-acquired infection hospitalizations, total nurse hours per resident day, and total nurse turnover.
• In FY 2027, payments will incorporate long-stay falls with major injury, discharge to community, discharge function score, and long-stay hospitalizations.

Importantly for providers, Medicare reimbursement rates in these years will be based on performance periods beginning as early as FY 2024—that is, in October 2023. To maximize their payments and avoid potentially costly penalties, providers should start focusing on these measures imminently.

Preparing for Significant VBP Program Changes

To help providers understand these new measures, AHCA/NCAL is offering an online course, SNF VBP Essentials. Presented by Sreenivas, the module thoroughly covers the following:

• How CMS calculates VBP measures, risk adjustments for various factors (like COVID-19 diagnoses), facility scores, and payment adjustments.
• How CMS applies the incentive payment multiplier.
• How facilities can use an SNF VBP prediction calculator to estimate the impacts of relevant quality measures on their Medicare Part A revenue.
• What best practices SNFs can employ to thrive under the program.

The course includes vital material for facility administrators, directors of nursing, QAPI coordinators, and anyone overseeing operational or finance matters in an SNF setting. It dives deep into the program’s intricacies, like what exactly qualifies as a hospital readmission or healthcare-acquired infection hospitalization.

Perhaps most crucially, it unpacks how SNF VBP scoring calculations will change as new measures are added to the program. After several years in which the SNF VBP program was essentially paused due to the COVID-19 pandemic, the course will also catch SNF leaders up on the all-cause hospital readmission that currently affects incentive payments, equipping them with everything they need to know to avoid losing as much as two percent of their facility’s Medicare reimbursements.

In other words, the course is designed to help SNF leaders hit the ground running as the SNF VBP program’s new measures go into effect. 

“You’ve got to be able to set goals in terms of measuring yourself and knowing what performance targets you need to meet,” Sreenivas told Provider. “We provide some tools to let you know what those thresholds are for the different measures, and then how your performance in each one could relate to that score. We also highlight some of the other ways you could get some resident-level information, like how to identify what reports you can run through CASPER and then do root-cause analysis for.”

For those who complete SNF VBP Essentials, 1.25 NAB continuing education credits and one contact hour are available through the Iowa Board of Nursing. Registration is $40 for AHCA members and $80 for non-members.

Steve Manning is a journalist based in New York City.