I love a good value, don’t you? It’s hard to find one these days in this economy.
Recently a friend of mine purchased a used vehicle from a reputable local dealership. Within a week, the engine failed catastrophically and he had to purchase a new one because the dealership would not accommodate.
Any way you slice it, value means something to those who are paying for it and those who are on the receiving end. This principle is strikingly evident in every recent Centers for Medicare & Medicaid Services initiative directed toward skilled nursing facilities.
The idea of Value Based Purchasing is not new. We used to call it pay for performance. It’s how CMS pays us now even if it doesn’t seem like it. Consider the following:
• The Patient Driven Payment Model (PDPM) pays providers based on how adept they are at identifying what is uniquely clinically true about a resident as captured on the 5-day and IPA MDS assessments. The attention providers must give this payment grouper drives everything else related to quality of care, i.e., CAAs, care plans and the next three programs listed below.
• The Skilled Nursing Facility Quality Reporting program (SNF QRP) Carries with it a compliance incentive of not receiving a 2% reduction to your Annual Payment Update (APU/Market Basket Update). This program will continue to expand. The FY 2023 SNF PPS final rule has added more Standardized Patient Assessment Data Elements (SPADES) and quality measures centered around reporting value-based concepts like Transfer of Health Information (MDS based), and Influenza Vaccination of Health Care Personnel (NHSN based). For the first time, CMS is considering adding a patient reported outcome measure using the CORE Q survey instrument.
• The Skilled Nursing Facility Value Based Purchasing program (SNF VBP) Carries with it an incentive of a payback of some or all of a 2% rate reduction based on performance related to rehospitalizations. In 2026, this will expand to include Healthcare Associated Infections and Total Nurse Staffing (calculated with MDS census and acuity data) and in 2027 Discharge to Community (MDS based). CMS has also determined that since data from the MDS impacts both QRP and VBP, MDS validity audits are anticipated to begin by 2026.
• The 5-Star Quality Rating System ties the QRP and VBP together to reflect the extent to which providers have welcomed these value-based concepts by publicly reporting measures like staffing, discharge to community, and functional outcomes along with a host of other MDS and claims-based measures. A poor Five-Star rating can have a devastating impact on a facility’s preferred provider status, referrals and managed care contracting capabilities.
• The National Academies of Sciences, Engineering, and Medicine (NASEM) released a report earlier this year indicating that there are multiple systemic changes that need to occur in the nursing home industry. This report has fostered several committees, including the Quality Measurement & Continuous Quality Improvement Committee whose focus will be, among other things, to recommend ways to improve the validity of the Minimum Data Set and develop other value-based measures.
• The Meaningful Measures Framework was developed by CMS to shape the entire ecosystem of quality measures that drive value-based care. This includes the SNF QRP measures. One of the five goals of this initiative is to leverage measures to drive outcome improvement through public reporting and payment programs by introducing additional Merit-Based Incentive Payment System Value Pathways.
As you can see, CMS is serious about getting value for the Medicare dollars it spends. Providers will do well to engage these concepts beyond simply ensuring adequate payments.
Remember, Medicare is not an entitlement. It is a benefit that its recipients have paid for. These individuals deserve our robust adoption of and engagement with value-based payment principles. Your solvency from a compliance and financial perspective may depend on it. Your residents and reputation will be better for it.
Some of you may know that I’m a beekeeper hobbyist. This time of year, in northeastern Tennessee, is known as the “dearth.” From now until the weather gets cold, I have to feed my bees a sugar water solution in preparation for winter.
Did you know that sugar, plain granulated sugar, has more than doubled in price in the last few months? It has. My bees are getting valuable sugar this year. My hope is that my valuable investment this fall will yield a valuable honey harvest next summer.
The question providers need to ask: “Is CMS getting the value they expect, and are my residents experiencing value, for the Medicare dollars being spent?”
Big RAI changes are coming next fall. It’s worth a new look at the MDS to see if that data reflects your love of a good value.
Joel VanEaton, BSN, RN, RAC-CT, RAC-CTA, is a master teacher and the executive vice president of PAC Regulatory Affairs and Education at Broad River Rehabilitation.
The opinions expressed in McKnight’s Long-Term Care News guest submissions are the author’s and are not necessarily those of McKnight’s Long-Term Care News or its editors.
