Skilled nursing facility value-based purchasing program (SNF VBP)

The Skilled Nursing Facility Value-Based Purchasing Program (SNF VBP) is a payment initiative introduced by the Centers for Medicare and Medicaid Services (CMS) in an effort to improve the quality of care provided by skilled nursing facilities (SNFs) and incentivize positive patient outcomes. SNF VBP is designed to shift the focus from volume-based care to value-based care, encouraging SNFs to deliver high-quality services while reducing costs.Under the SNF VBP program, SNFs are evaluated based on their performance in specific quality measures, and their Medicare payments are adjusted accordingly. The program aims to reward SNFs that provide better care and penalize those that fall short in meeting quality standards. By linking payment to performance, SNF VBP encourages facilities to continuously improve the quality of care they deliver to their patients.

SNF VBP is often compared to other payment models, such as the Skilled Nursing Facility Prospective Payment System (SNF PPS) and the Nursing Home Value-Based Purchasing (NHVBP) program. While these models share some similarities, they also have distinct differences.

1. Skilled Nursing Facility Prospective Payment System (SNF PPS):

The SNF PPS is a payment system that reimburses SNFs based on a predetermined rate for each patient stay, depending on the patient's classification under the Resource Utilization Group (RUG) system. This payment model primarily focuses on the volume of services provided, rather than the quality of care or patient outcomes. In contrast, SNF VBP incorporates quality measures and outcomes into the payment calculation, incentivizing SNFs to improve care quality.

2. Nursing Home Value-Based Purchasing (NHVBP):

The NHVBP program, also introduced by CMS, is another value-based payment initiative that applies to nursing homes. While SNF VBP specifically targets SNFs, NHVBP focuses on nursing homes that participate in the Medicare program. Both programs share the goal of improving care quality and incentivizing positive patient outcomes, but they have different sets of quality measures and payment adjustments.

SNF VBP operates through a two-step process: measure selection and payment adjustment.

1. Measure Selection:

CMS selects a set of quality measures that are relevant to SNFs and reflect the quality of care provided. These measures cover various aspects of care, including clinical outcomes, patient experience, and safety. The selected measures are publicly reported on the Nursing Home Compare website, allowing patients and their families to make informed decisions when choosing a SNF.

2. Payment Adjustment:

SNFs' performance on the selected quality measures is evaluated, and their Medicare payments are adjusted based on their performance scores. The payment adjustment is calculated using a scoring methodology that compares each SNF's performance to a baseline performance period. SNFs with higher performance scores receive a payment increase, while those with lower scores may face a payment reduction.

To provide a better understanding of the SNF VBP program, here are a few examples of quality measures that may be included:

1. Percentage of residents with pressure ulcers:

This measure assesses the facility's ability to prevent and manage pressure ulcers, which are a common concern in SNFs. It measures the percentage of residents who develop new or worsening pressure ulcers during their stay.

2. Percentage of residents experiencing falls with major injury:

This measure evaluates the facility's fall prevention strategies and the effectiveness of interventions to minimize fall-related injuries. It measures the percentage of residents who experience falls resulting in major injuries, such as fractures or head trauma.

3. Percentage of residents who received an antipsychotic medication:

This measure focuses on the appropriate use of antipsychotic medications in SNFs. It assesses the percentage of residents who receive these medications, as they can have significant side effects and should only be prescribed when necessary.

These are just a few examples, and the specific measures included in the SNF VBP program may vary over time as CMS updates and refines the program.

In conclusion, the Skilled Nursing Facility Value-Based Purchasing Program (SNF VBP) is a payment initiative that aims to improve the quality of care provided by SNFs. By linking payment to performance on specific quality measures, SNF VBP incentivizes SNFs to deliver high-quality care and achieve positive patient outcomes. This program represents a shift from volume-based care to value-based care, ultimately benefiting both patients and SNFs.