Welcome to the HealthPRO Heritage Blog

The VBP Score Reports Are Published: Now What?

CMS released 2019 SNF Value Based Purchasing (VBP) Score Reports on Friday, August 3.

The Score Report identifies whether SNFs are eligible for any portion of the 2% withhold of the Medicare Fee for Service revenues this October.

The implications are critical. Two percent (2%) of your Fee for Service Medicare revenue will be withheld, a potential negative impact exists on revenue and/or budget (if the 2% was not considered in budgeting processes for Q4 2018). Do you know if you will receive any incentive payments based on your performance in CY 2017?

This measure is based on 30-day all-cause SNF readmissions (i.e., 30 days not just within the SNF) including discharges to senior living and to home with outpatient or home health services (and demonstrates why upstream and downstream partnerships with only high performing providers are vital)!

Beginning FY 2019 (October 1, 2018) the SNF VBP Program will reduce the adjusted federal per diem rate otherwise applicable to each SNF for a fiscal year under Medicare by two percentage points and then redistribute 60% of the total amount of those reductions to SNFs for services furnished during that fiscal year based on their performance under the program.

The reports detail all of the SNF VBP scoring, including the most imperative: 

  • Total performance score
  • SNF ranking out of 15,421 total
  • Incentive payment multiplier, which is a result of performance in the SNF VBP Program and will be applied to the SNF's adjusted Federal per diem rate. When making payments to SNF claims, the adjusted Federal per diem rate will be multiplied by this factor.

Example:  An incentive payment multiplier of 0.99 would reflect a net payment reduction of 1%.  A 2% withhold for all Medicare FFS payments beginning 10/01/18 and then receiving only 1% back in payments

Excel files containing patient-level data for eligible stays used in the calculations are available as reports, or workbooks here:

  • Quality Improvement Evaluation System (QIES) / Certification and Survey Enhanced Reporting application (CASPER)
  • Your MDS Coordinator should know how to access.

Consider the following sample performance worksheet:

Performance Information 
Baseline Period (CY 2015) RSRR 0.17024
Improvement Threshold (Baseline Period Inverted RSRR) 0.82976
Performance Period (CY 2017) RSRR 0.17304
Performance Period Inverted RSRR 0.82696
FY 2019 Achievement Threshold 0.79590
FY 2019 Brenchmark 0.83601
SNF VBP Achievement Score 74.69334
SNF VBP Improvement Score  0.000000
SNF VBP Performance Score  74.69334
Incentive Payment Multiplier 1.0138484716

In this example, this provider has:

  • SNF ranking of 1,382/15,421 and an incentive payment multiplier of 1.013. (i.e., positive incentive payment of just slightly over the 2% that was withheld).
  • SNF readmission measure of 17.3% inverted into the Risk-Standardized Readmission Rate (RSRR) at .82696. This value is greater than the FY 2019 Achievement Threshold (25th percentile of national SNF performance on the SNFRM during the baseline period (CY 2015).
  • SNFs with a performance period (CY 2017) inverted RSRR < Achievement Threshold receive an achievement score of zero.
  • A potential of 100 point achievement score only if this SNF had scored higher than in the CY 2017 Performance Period. Instead, 0.79590 (20.4% readmission measure) landing at a 74.69334 SNF VBP Achievement Score but under the FY 2019 Benchmark of .83601 (16.4% readmission measure).
  • Zero score allocated for the SNF VBP Improvement Score because there was a higher readmission in CY 2017 than baseline period of CY 2015. (SNF VBP Improvement Score is the measure of improvement in the SNF VBP Program from the baseline period to the performance period).
  • This report compares the SNF VBP Achievement versus SNF VBP Improvement. The higher score determines how the rank and incentive payment multiplier is derived.

For current HealthPRO® Heritage clients:
Your regional team will reach out this week to discuss your facilities’ VBP Score Report. In the interim, obtain all relevant reports and feel free to proactively contact our team at clinicalstrategies@healthpro-heritage.com for guidance and/or schedule time to discuss your SNF’s performance.

Written By: Kristy Yoskey, MOT, OTR/L, RAC-CT, Senior Vice President of Clinical Strategies
Edited By: Michele Saunders, PT, Regional Vice President of Business Development

Tags: SNF VBP, CMS Update 2018