United States

Senior Living Connection: Another value-based purchasing update

SENIOR LIVING HEALTH CARE CONNECTION  | 

Skilled nursing facilities (SNFs) should now be aware that their Medicare fee-for-service payments for services provided starting Oct. 1, 2018, reflect the rate adjustments due to value-based purchasing (VBP). Payments include both the VBP adjustments and the sequestration amount of 2 percent. The adjustment is calculated using the 30-day all-cause readmission measure (SNFRM) This measure assesses the SNF patient’s planned hospital readmissions within 30 days of being discharged from a prior hospital stay. Per Centers for Medicare and Medicaid Services (CMS), the SNFRM does not affect other types of claims such as Medicare Advantage claims, Medicaid claims or Medicaid managed care claims. The rates for fiscal year 2019 will be in effect from Oct. 1, 2018, through Sept. 30, 2019. SNFs are encouraged to determine the multiplier for their SNF by reviewing this web page.

The rate contains the “incentive” payment after the reduction of 2 percent and then compared to other facilities to determine the multiplier. Find the facility multiplier and ranking by looking at the “facility information” on the web page or in your facility Certification and Survey Provider Enhanced Reports (CASPER). Facilities are listed according to their facility CMS Certification Number (CCN), also called the provider number. The multiplier will show the percentage that your facility will be paid based on your ranking with other SNFs. To determine your fiscal year 2019 Medicare payment rate for each Resource Utilization Group (RUG) category, take the gross payment amount for each Prospective Payment System (PPS) category then multiply that by the multiplier and reduce that by the 2 percent sequestration amount. For example:

RUG Gross Rate  VBP Multiplier
0.9802457176
Less the 2%
Sequestration
RUA $546.81 $536.01 $525.29

This facility will be paid $525.29 for the Rehab Ultra High A (RUA) category. In this case, there is a net .07 percent increase in the rate effective Oct. 1, 2018.

Each facility will have a different VBP multiplier and the VBP multipliers range from .9802457176 to 1.0139129915.

For additional information, contact Joan McCarthy, RSM health care consultant, at +1 312 634 3479.