CMS Announces Final Rule Implementing Quality Care in SNFs

Value-based payment and quality care continue to prove high on the Centers for Medicare & Medicaid Services’ (CMS) agenda. On July 30, the Centers for Medicare & Medicaid Services (CMS) announced their final rules for the fiscal year (FY) 2016 for skilled nursing facilities (SNFs), increasing the presence of quality-based payment over fee-for-service payment, according to a press release.

CMS has been implementing standards to increase value-based payments to 90 percent by 2018, according to RevCycleIntelligence.com. These new policies, which aid in the shift into value-based payment models and hold care facilities accountable, are one more step toward that goal.

“The Administration has set measurable goals and a timeline to move the Medicare program, and the health care system at large, toward paying providers based on the quality, rather than the quantity of care they give patients,” CMS says. “The final rule includes policies that advance that vision and support building a health care system that delivers better care, spends health care dollars more wisely and results in healthier people.”

As of October 2014, SNFs have been required to submit adequate care quality reporting in accordance with The Improving Medicare Post-Acute Care Transformation Act. This requirement will continue into 2016 as a part of the SNF Quality Reporting Program (QRP). CMS also states that starting in 2018, there will be penalties for not adequately reporting quality of care.

SNFs will be required to specifically report on three major areas of care quality beginning in 2018: skin integrity, major falls, and functional status and cognitive function. Measures of skin integrity will measure the percent of patients who have new or deteriorated ulcers, the percent of patients who were injured in one or more falls, and the percent of patients who have care plans specifically dealing with their cognitive function.

CMS expects total payments for 2016 to increase by 1.2 percent from 2015, or $430 million. This is based on a 2.3 percent market basket increase, 0.6 percent decrease due to forecast error adjustment, and a 0.5 percent decrease due to the multifactor productivity adjustment law.

SNF Value-Based Purchasing (VBP) program

In accordance to the Protecting Access to Medicare Act, SNFs qualify for VBPs starting in FY 2019. VBPs allow SNFs to receive value-based incentive payments for adequately implementing hospital readmission measures in accordance with the Skilled Nursing Facility 30-Day All-Cause Readmission Measure.

“This measure estimates the risk-standardized rate of all-cause, unplanned, hospital readmissions for SNF Medicare beneficiaries within 30 days of their prior proximal short-stay acute hospital discharge,” CMS writes.

Collection of staff data

The final rule also calls for greater accountability in long term care (LTC) facilities. In accordance with a new subsection of the Affordable Care Act (ACA), LTC facilities will be required to submit all staffing data. Staffing data required for submission entails “information for agency and contract staff, based on payroll and other verifiable and auditable data in a uniform format according to specifications established by the Secretary in consultation with such programs, groups, and parties,” CMS says.

CMS is hopeful that these policy changes, which go into effect on October 1, will ensure quality of care in all facilities and increase value-based payment models, reinforcing their overall goal of improving the whole healthcare system.