Included in H.R. 4302, the Protecting Access to Medicare Act of 2014, a one-year patch of the sustainable growth rate (also known as the “Doc Fix”), was a value-based purchasing (VBP) program for skilled nursing facilities (SNFs). This program establishes a hospital readmissions reduction program for these providers, encouraging SNFs to address potentially avoidable readmissions by establishing an incentive pool for high performers. The Congressional Budget Office scored the program to save Medicare $2 billion over the next 10 years.
The program uses a withhold approach, creating an incentive pool from a 2 percent withhold. The incentive pool, which is 50-70 percent of the withhold, is “returned” to centers based on rehospitalization scores. These scores are based on rehospitalization rate and degree of improvement from prior year(s).
The top performers will receive most or all of their withhold – and possibly more. Middle performers will receive some of their withhold, and the bottom 40 percent of performers receive less or nothing.
Now is the time to prepare for implementation of the VBP Program. There is good news. Unlike other Medicare hits – such as Sequestration, Productivity Adjustment and Wage Index – you have an opportunity to dictate and ensure success by starting to prepare now. It will be possible to avoid any penalty and may be possible for some to achieve a greater payment rate.
Click here to view an issue brief on the Skilled Nursing Center Value-Based Purchasing Program.