CMS to Boost Skilled Nursing Payments by 2.1% in 2017

Skilled nursing facilities across the United States are expected to see Medicare reimbursements increase by 2.1% in 2017, or a total increase of $800 million from payments in 2016, under the proposed payment rate released by the Centers for Medicare and Medicaid Services Thursday. 

The increase is based on a market basket increase of 2.6%, a measure used by CMS to determine the reimbursement levels across the sectors the agency serves. 

The proposals continue to shift Medicare payments from volume to value, CMS said.

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“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 provide to their patients,” CMS stated in a press release. “The Administration met the goal of tying 30% of Medicare payments to care provided in alternative payment models ahead of schedule and is continuing this momentum to reach the goal of tying 50 percent of payments to care provided in alternative payment models by the end of 2018.”

The so-called IMPACT Act of 2014 specifies that all skilled nursing facilities must implement quality reporting programs (QRP) beginning in fiscal year 2018; those that do not submit required data under the QRP are subject to a 2% reduction to their annual updates, CMS noted.

The rule also proposes to specify the SNF 30-Day Potentially Preventable Readmission Measure, as the “all-cause, all-condition risk-adjusted potentially preventable hospital readmission measure” to meet the requirements of the Social Security Act. The Measure assesses facility-level risk or unplanned, potentially preventable hospital readmissions within 30 days of discharge from a prior admission. 

CMS also is proposing one new assessment-based quality measure and three claims-based quality measures under the IMPACT act for inclusion in the QRP as follows: 

Assessment-based measure for the FY 2020 payment determination and subsequent years:

  • Drug Regimen Review Conducted with Follow-Up for Identified Issues.

Claims-based measures for the FY 2018 payment determination and subsequent years:

  • Discharge to Community – Post Acute Care (PAC) SNF QRP;
  • Medicare Spending Per Beneficiary (MSPB) – PAC SNF QRP; and
  • Potentially Preventable 30 Day Post-Discharge Readmission Measure for SNFs.

The proposal follows a 1.4% payment boost for skilled nursing facilities in 2016, which fell short of the 2% increase in 2015.

Written by Elizabeth Ecker

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