Skilled Nursing Providers Could See Slight Changes in Value-Based Purchasing Penalties, Bonuses After CMS Error

Skilled nursing operators may notice some small changes to their final bonuses or penalties under a key value-based payment initiative after federal officials acknowledged a slight error in their calculations.

The Centers for Medicare & Medicaid Services (CMS) on Thursday announced that it incorrectly calculated its scores for the SNF Value-Based Purchasing (VBP) initiative, according to a report from industry trade group LeadingAge.

Under that program, SNFs automatically lose 2% of their Medicare reimbursements, which they can then win back by hitting certain readmission-rate benchmarks. The first round of results, released last fall, showed that about 73% of facilities would end up losing at least some money, with only 27% receiving their 2% back or a slight bonus.

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The gap between the winners and the losers, however, was generally narrow, with an average loss of less than 1% of total Medicare reimbursements — a relatively slight sum given the other payment cuts and pressures that operators face.

But those bonus or penalty numbers — known as the value-based incentive payment (VBIP) modifiers — aren’t yet final, because CMS made some errors in calculating the baseline performance rates for fiscal 2016. After fixing the numbers, CMS will issue corrected score reports no later than August 31, according to LeadingAge.

“SNFs do not need to take any additional action once the corrected reports are available in a SNF’s CASPER folder,” LeadingAge noted. “CMS anticipates that rate adjustments using the corrected VBIP modifier will still take effect as previously scheduled on October 1, 2019.”

The mistakes consisted of a small number of qualifying SNF stays that were either incorrectly included or excluded in the final calculation, according to a source familiar with the program; some operators may not even see any change at all to their final score once the VBIP figures are corrected.

CMS officials had not responded to requests for comment as of press time.

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