Nearly One In Five Skilled Nursing Facilities Awarded Positive Incentives Under Value-Based Purchasing

Daras, Laura Coots; Vadnais, Alison; Pogue, Ye Zhang; DiBello, Michael; Karwaski, Christopher; Ingber, Melvin J.; He, Fang; Segelman, Micah; Le, Lang; Poyer, James

doi:10.1377/hlthaff.2019.01244

Cited by 2 publications

(3 citation statements)

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“…We selected characteristics of interest based on prior literature [7][8][9] regarding associations with SNF readmission rates. These characteristics included (1) SNF ownership characteristics (whether the SNF was multifacility, hospital based, for profit, not for profit, or owned by the government, and the number of ownership changes in the past year); (2) financial indicators, including net operating margin (calculated as a ratio of the net operating profit or loss [numerator] to the operating revenue [denominator]), occupancy rate, and proportion of Medicaid bed-days; (3) treated patient population (age, race and ethnicity, number of deficiencies in activities of daily living, and case-mix index); (4) treatment characteristics (SNF length of stay and number of admissions per bed as a marker of turnover); and (5) performance on other quality metrics (Nursing Home Compare overall star ratings and individual components, including staffing, quality, and inspection star ratings).…”

Section: Descriptorsmentioning

confidence: 99%

“…[4][5][6] Early evaluations suggested that three-quarters of SNFs in the US received a financial penalty in 2019, which increased in 2020. 7,8 Furthermore, penalized SNFs were more likely to serve vulnerable populations. 9 However, prior studies have not disentangled the differences between achievers-defined as those that had higher baseline scores than improvement scores-and improvers-defined as those with higher improvement scores than baseline scores.…”

Section: Introductionmentioning

confidence: 99%

“…Rewarding improvement could therefore also enhance health equity, given substantial evidence that historically underperforming SNFs disproportionately serve racial and ethnic minority populations in poorer areas . Early evaluations suggested that three-quarters of SNFs in the US received a financial penalty in 2019, which increased in 2020 . Furthermore, penalized SNFs were more likely to serve vulnerable populations …”

Section: Introductionmentioning

confidence: 99%

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Skilled Nursing Facility Performance and Readmission Rates Under Value-Based Purchasing

Burke

Rose

2022

JAMA Netw Open

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IMPORTANCEThe new Medicare Skilled Nursing Facility Value-Based Purchasing program (SNF VBP) seeks to improve patient outcomes by awarding financial incentives or penalties based on 30-day hospital readmission rates. Skilled nursing facilities (SNFs) can avoid a penalty through low baseline readmission rates or improvement over time. OBJECTIVE To assess the baseline performance and improvement over time of SNFs in the SNF VBP program. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study examined readmission rates, financial penalties and incentives, and facility and patient characteristics associated with these outcomes at 14 959 US SNFs that received Medicare payments between January 1, 2015, and December 31, 2019.MAIN OUTCOMES AND MEASURES Outcomes were readmission rates and financial penalties by facility. The SNFs were classified as improvers in the analysis if they had better improvement scores than baseline scores under the program and achievers if they had higher baseline scores than improvement scores. RESULTSOf 14 959 SNFs studied, 1849 (12.3%) were assigned their improvement score as their performance score in the first year of the program. Of these, 1167 (63.1%) received a financial penalty, whereas 374 (20.2%) received a bonus. Only 52 facilities that performed poorly at baseline (0.3% of all SNFs and 0.7% of below-median performers) were able to improve enough to avoid a financial penalty, despite large improvements in readmission rates. Improver SNFs treated larger racial minority populations (mean [SD], 74.57% [23.42%] White in the improver group vs 79.15% [22.18%] in the achiever group) and were located in counties with larger minority populations (mean [SD], 15.48% [14.05%] Black in the improver group vs 11.57% [12.72%] Black in the achiever group). The most important predictors of improvement were related to SNF finances, such as operating margin (mean [SD], −0.74 [13.87]) and occupancy rates (mean [SD], 79.93 [14.81]). CONCLUSIONS AND RELEVANCEThis cross-sectional study suggests that the SNF VBP program did not offer a viable path for nearly all low-performing SNFs to avoid financial penalties through improved readmission rates.

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Section: Descriptorsmentioning

confidence: 99%