Skilled Nursing Facility ValueBased Purchasing What Providers Need

Skilled Nursing Facility Value-Based Purchasing What Providers Need to Know

2 Steady Shift Towards Value-Based Paradigm Arrival of Risk-Based Payment in Post-Acute Care Select Care Transformation Programs Medicare Shared Savings Program 2011 Hospital Readmissions Reduction Program 2012 CJR 1 Bundle Program 2016 Quality Reporting Program 2016 Key Proposed Cardiac Bundle Program 2017 Directed toward health systems SNF and Home Health VBP 2 Programs 2017 Directed toward post-acute providers Source: Centers for Medicare & Medicaid Services, “Shared Savings Program, ” https: //www. cms. gov/Medicare-Fee-For-Service-Payment/sharedsavings program/index. html; Centers for Medicare & Medicaid Services, “Readmissions Reduction Program (HRRP), ” https: //www. cms. gov/medicare-fee-forservice-payment/acuteinpatientpps/readmissions-reduction-program. html; Centers for Medicare & Medicaid Services, “Comprehensive Care for Joint Replacement Model, ” https: //innovation. cms. gov/initiatives/CJR; Centers for Medicare & Medicaid Services, “Quality Measures and the IMPACT Act, ” https: //www. cms. gov/Outre ach-and-Education/Outreach/NPC/Downloads/2016 -07 -07 -IMPACT-Act-Presentation. pdf; Centers for Medicare & Medicaid Services, “Notice of proposed rulemaking for bundled payment models for high-quality, coordinated cardiac and hip fracture care, ” https: //www. cms. gov/Newsroom/Media. Release. Database/Fact 1) Comprehensive care for joint replacement. sheets/2016 -Fact-sheets-items/2016 -07 -25. html; Centers for Medicare & Medicaid Services, “The Skilled Nursing Facility Value-Based Purchasing Program (SNFVBP), ” https: //www. cms. gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/Value-Based-Programs/Other-VBPs/SNF-VBP. html; Centers for 2) Value-based purchasing. Medicare & Medicaid Services, “Home Health Value-Based Purchasing Model, ” https: //innovation. cms. gov/initiatives/home-health-value-based-purchasing-model; © 2018 Advisory Board • All rights reserved • advisory. com Post-Acute Care Collaborative interviews and analysis.

3 Value-Based Purchasing Targets Readmission Rates VBP Aims to Cut Down on Excessive Preventable Readmissions SNF VBP In-Brief • Established by Protecting Access to Medicare Act of 2014 (PAMA) • Links readmission measure to reimbursement: • SNF 30 -Day All-Cause Readmission Measure (SNFRM): captures unplanned hospital readmissions within 30 -days of hospital discharge • CMS provides SNFs confidential quarterly feedback reports readmission performance Preventable Readmissions are Common, Costly, and Dangerous 24% of SNF patients are readmitted to the hospital 76% of readmissions from SNFs are preventable $12 B In yearly costs due to preventable readmissions Format of CMS Quarterly VBP Report for SNFs Measure Number of Eligible Stays Number of Readmissions National Average Readmission Rate Risk-Standardized Readmission Rate SNFRM 1) Skilled Nursing Facility (SNF) 30 -Day All Cause Readmission Measure. 2) SNF 30 -Day Potentially Preventable Readmission Measure. 3) Preventable readmissions result from inadequate management of chronic conditions, infections, injury prevention, and unplanned events. © 2018 Advisory Board • All rights reserved • advisory. com Source: CMS, “Medicare Program; Prospective Payment System and Consolidated Billing for Skilled Nursing Facilities Proposed Rule for FY 2017 SNF Value-Based Purchasing Program, SNF Quality Reporting Program, and SNF Payment Models Research; Proposed Rule, ”Federal Register 81, no. 79 (April 25, 2016): 24230, https: //www. gpo. gov/fdsys/pkg/FR-2016 -04 -25/pdf/2016 -09399. pdf; Mor, Vincent et al. , “The Revolving Door of Rehospitalization from Skilled Nursing Facilities. ” Health Affairs 29 (2010): 57 -64, http: //www. allhealth. org/briefingmaterials/moretal. Healthaff 2010 therevolvingdoorofrehospitalzationfromskillednursingfacilities-1720; Med. PAC, “Payment Policy for Inpatient Readmissions, ” Report to Congress: Promoting Greater Efficiency in Medicare (2007): 103 -120, http: //www. medpac. gov/documents/reports/Jun 07_Entire. Report. pdf. Post-Acute Care Collaborative interviews and analysis.

4 How SNF VBP Drives Savings Providers Must Earn Incentive Payments to Recoup VBP Withhold CMS withholds 2% of SNF Part A FFS payments SNFs recoup payment withhold through rate adjustments determined by individual improvement and performance compared to national rates. CMS will keep 30% of withheld payments, regardless of SNF performance, and distribute the remainder. Rate Adjustment Based on Relative Performance on Readmissions Lower 40 th percentile Earn less than would have if not for VBP program 1) Skilled nursing facility 30 -day all-cause readmission rate. 2) Patient and Medicare © 2018 Advisory Board • All rights reserved • advisory. com 40 th – 90 th percentile 0% CMS has not yet finalized whether providers can earn greater than 2% withhold Top decile 2% Source: Frilling, S. , “Skilled Nursing Facility Value-Based Purchasing Program, ” Medicare Learning Network and CMS, https: //www. cms. gov/Outreach-and-Education/Outreach/NPC/Downloads/201609 -28 -SNF-Presentation. pdf ; Fallon, N. , “SNF Value-Based Purchasing Program & Quality Measure Reporting, ” Leading Age, http: //c. ymcdn. com/sites/www. leadingagenc. org/resource/resmgr/member_ updates/New_Resource_to_Cut_Through. pdf ; Post-Acute Care Collaborative interviews and analysis.

5 Timeline for SNF VBP Current Performance Determines Future Earnings 2016 Quarterly Performance Reporting Begins FY 2019 (Oct 18 – Sept 2019) First Payment Adjustment CMS withholds 2% of SNF payments; 2017 readmissions performance determine individual provider payment adjustments Available to SNFs from Oct. 1 via CASPER 2015 Baseline Period 2017 Performance Period CMS collects readmission data nationwide to establish comparison points for VBP program CMS collects preventable readmissions data for qualifying SNF stays © 2018 Advisory Board • All rights reserved • advisory. com Source: Frilling, S. , “Skilled Nursing Facility Value-Based Purchasing Program, ” Medicare Learning Network and CMS, https: //www. cms. gov/Outreach-and-Education/Outreach/NPC/Downloads/2016 -09 -28 -SNFPresentation. pdf ; Fallon, N. , “SNF Value-Based Purchasing Program & Quality Measure Reporting, ”Leading Age, http: //c. ymcdn. com/sites/www. leadingagenc. org/resource/resmgr/member_updates/New_Resource_to_Cut _Through. pdf; Centers for Medicare & Medicaid Services, “The Skilled Nursing Facility Value-Based Purchasing Program (SNFVBP), ” https: //www. cms. gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/Value. Based-Programs/Other-VBPs/SNF-VBP. html; Post-Acute Care Collaborative interviews and analysis.

6 Performance Assessment Methodology SNFs Have Two Opportunities to Earn Incentive Payments CMS will distribute incentive payments based on facility readmission rates relative to national and individual readmission rates in 2015 Comparison Points Established Using Baseline Period National Data Achievement Threshold (SNFRM 1 of 20. 4%2) Benchmark (SNFRM of 16. 4%) Achievement Score Based on agency’s performance in CY 2017 relative to national benchmark and threshold values from baseline period, CY 2015 Improvement Score Based on performance in CY 2017 relative to national benchmark value and individual performance in baseline period, CY 2015 Total Performance Score 25 th percentile Mean of top decile - Sum of achievement or improvement points, whichever is higher - Determines payment adjustment National SNF Readmission Rates, 2015 1) Skilled nursing facility 30 -day all-cause readmission measure. 2) For clarity, CMS inverts readmission rates (1 - SNFRM) to derive the achievement threshold and benchmark. Thus, the inverted risk-standardized readmission rates established for these two comparison points are 79. 6% and 83. 6%, respectively. © 2018 Advisory Board • All rights reserved • advisory. com Source: Frilling, S. , “Skilled Nursing Facility Value-Based Purchasing Program, ” Medicare Learning Network and CMS, https: //www. cms. gov/Outreach-and-Education/Outreach/NPC/Downloads/2016 -09 -28 -SNF-Presentation. pdf; Fallon, N. , “SNF Value-Based Purchasing Program & Quality Measure Reporting, ” Leading Age, http: //c. y mcdn. com/sites/www. leadingagenc. org/resource/resmgr/member_updates/New_Resource_to_Cut_Through. pdf; Post-Acute Care Collaborative interviews and analysis.

7 Readmissions Rise Over First Performance Year Results Indicated Need to Re-Focus on Readmissions Percentage of SNFs Receiving Bonus in First Performance Year CY 2017 performance Providers Receiving Minimum and Maximum Adjustments 3% of providers received the highest payment adjustment of +1. 6% of providers received the lowest 20% payment adjustment of -2. 0% 27% Results Reflect Rising Readmissions 19. 4% 19, 0% 73% of participating SNFs received no or negative payment adjustments © 2018 Advisory Board • All rights reserved • advisory. com CY 2015 CY 2017 Source: “Nursing Home Compare datasets, ” https: //data. medicare. gov/data/nursing-homecompare? sort=relevance&tag=skilled%20 nursing%20 facility%20 value%20 based%20 purcha sing: Post-Acute Care Collaborative interviews and analysis.

8 How Providers Should Respond for VBP Success Impossible Without Strong Data Analytics Capacity Develop your organization’s data competency and orient resources around weak areas to achieve success in value-based models, which will only continue to proliferate Precise 1 Develop Documentation Processes Improve processes for data collection and educate staff in order to meet VBP reporting requirements and prevent ratings penalties due to reporting errors Opportunities to 2 Identify Reduce Readmissions Analyze data to identify weak performance on quality measures and disease patterns. Evaluate potential underlying factors such as staffing, medication management, and transfers. Specialized Care 3 Develop Models Tailored to VBP Invest resources in specialized programs that address readmissions reduction. Closely monitor data to track progress. © 2018 Advisory Board • All rights reserved • advisory. com Source: Post-Acute Care Collaborative interviews and analysis.

9 VBP Makes SNFs Accountable, Even After Discharge Your Strategy: Partner with High Quality Downstream Providers SNFs Penalized for Readmissions Regardless of Setting SNF Hospital Home Health Discharge home Hospital readmission SNFs receive penalties for any rehospitalizations within 30 days of hospital discharge, even if the patient is discharged from SNF to home health within that time period What SNFs Should Do About It Establish network of high-quality post-acute providers, especially home health, committed to collaborating to prevent readmissions © 2018 Advisory Board • All rights reserved • advisory. com Partner with acute providers to enhance SNF coverage and timely de-escalation of potential contributors to readmission Source: Centers for Medicare & Medicaid Services, “The Skilled Nursing Facility Value-Based Purchasing Program (SNFVBP), ” https: //www. cms. gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/ Value-Based-Programs/Other-VBPs/SNF-VBP. html Post-Acute Care Collaborative interviews and analysis.

2445 M Street NW, Washington DC 20037 1 -202 -266 -5600 │ advisory. com