C.A.R.E.

Compliance • Audits/Analysis • Reimbursement/Regulatory • Education/Efficiency

Effective October 1, 2018 (Fiscal Year 2019) Skilled Nursing Facilities across the country will be subject to the first metric of Value Bases Purchasing, Hospital Re-admissions. Value Based Purchasing is comprised of 3 components: Measurement, Report and Reward.  

• Measurement
  
  SNFRM (Skilled Nursing Facility Hospital Re-Admission) score for the individual SNF measure performance rate information is based on SNF performance on the Skilled Nursing Facility 30-Day All-Cause Readmission Measure (SNFRM) during calendar year (CY) 2015. The National Average is 19.002%.  
  
  In the Fiscal Year (FY) 2016 SNF Prospective Payment System (PPS) Final Rule, CMS adopted the SNFRM as the first measure for the Skilled Nursing Facility Value-Based Purchasing (SNF VBP) Program. The measure is defined as the risk-standardized rate of all-cause, unplanned hospital readmissions of Medicare beneficiaries within 30 days of discharge from their prior hospitalization.  Hospital readmissions are identified through Medicare hospital claims (not SNF claims) so no readmission data is collected from SNFs and there are no additional reporting requirements for the measure. 

• Report 
  
  SNF RM QIES Report which is accessible at the facility level through the Quality Improvement and Evaluation System Report. A Sample SNF’s Performance on the Skilled Nursing Facility 30-Day All-Cause Readmission Measure (SNFRM) in 2015 is below: 

Source: Medicare claims and eligibility data from calendar year 2015 

* The number of stays at your SNF that were followed by an unplanned hospital readmission within 30 days of discharge from a prior proximal hospitalization. 

** The risk-standardized readmission rate is your SNF’s risk-adjusted rate of unplanned readmissions. 

*** The national average readmission rate reported here is the average unadjusted unplanned readmission rate for all eligible SNF stays nationally. 

• Reward
  
  The concept is to incentivize healthcare organizations to improve in certain areas with an ultimate link to payment. The hospital readmission payment adjustment is a 2% cut or potentially a 1% increase in SNF Part A rates for 1 year (fiscal year) based on SNF’s rehospitalization score. 
  
  Example:  If you bill out $1,000,000 per month in Medicare Part A and your hospital re-admissions are greater than the national average of 19.002%,  expect to pay2% which equates to $240,000 October 1, 2018. 

Harmony Healthcare International (HHI) performs monthly compliance audits. During this time, we assess and monitor all aspects of Value Based Purchasing.  If you need help with this area, please contact us by clicking here.  Looking to train your staff?  Join us in person at one of our our upcoming Competency/Certification Courses.  Click here to see the dates and locations.