Key Takeaways From Nursing Home Quality Incentive Program Methodology

COVID-19; Reimbursement

Program Description

Under the $2 billion quality incentive payment (QIP) program​, eligible facilities will have their performance measured on two outcomes.  

First, facilities will be judged on their performance on the COVID infection measure (80 percent of total incentive payment). Performance on the infection measure for each facility will be compared to a baseline rate of COVID infection in the county in which a facility is located.  

Second, facilities with COVID infections will be further judged on their performance on COVID mortality. The mortality measure (remaining 20 percent of payment) will quantify how facilities with COVID infections perform relative to an expected level of mortality, given their number of infections and the demographic characteristics of their residents.  

Eligibility (will be determined for each separate month): 

  • Must have an active, non-terminated certification, including the Certification and Survey Provider Enhanced Reports (CASPER) and Provider of Services (POS) files. 
  • Facilities must submit data that passes NHSN data quality checks for each week in the performance data period, and the six weeks preceding the performance period. 
  • Facilities must report (in NHSN) positive, non-missing values for the count of occupied beds in each week of the performance period. 
  • Facilities must report (in NHSN) non-missing values for infected patients in each reporting week. 
  • For facilities that are directly contacted regarding NHSN submissions, they must clarify their mortality data for a given performance period. 

Exclusion Criteria:

  • Facilities that have a revoked enrollment in Provider Enrollment, Chain, and Ownership System (PECOS). 
  • Facilities that report (in NHSN) the unavailability of COVID testing for residents in the performance period are excluded. 
  • Facilities that are found to have an infection rate exceeding the estimated infection rate in their county during the performance period. 
  • Facilities that perform below benchmark levels on the rate of mortality among residents that contracted COVID in the facility.  
    • ​Facility benchmarks include age, gender and Medicare status. 
  • Facilities that have a mortality rate at or above 10 percent in a given performance period will be considered ineligible for that period. 

Performance Period Range: 

The schedule below provides a precise range of dates that will define the range of data considered for each of the reporting periods. While the performance periods are mostly limited to four-week blocks, the alignment of NHSN reporting weeks results in October containing five weeks of data. For reference, the performance period refers to the four-week period during which infection rates and death counts are totaled up. However, in order to accurately measure mortality rates, we look at the count of infections in an infection exposure window that covers the performance period and the six preceding weeks.