CMS Updates SNF Quality Reporting & Value-Based Purchasing Programs

The Centers for Medicare and Medicaid Services (CMS) has updated the assessment calculations in the Skilled Nursing Facility (SNF) Quality Reporting Program (QRP). Previously, the Prospective Payment System (PPS) 5-day and End-of-Stay assessments were assessed together, but they will now be evaluated separately. Facilities must complete both assessments to meet the 90% data completion requirement, crucial for avoiding a 2% annual payment penalty. This change underscores potential compliance challenges, as emphasized by Pat Newberry, a clinical reimbursement consultant with SimpleLTC.

Financial predictions through 2028 are influenced by these revisions. The SNF Value-Based Purchasing (VBP) program is also broadening its scope beyond the all-cause 30-day hospital readmission standard. States are increasingly adopting value-based purchasing models, pooling funds from CMS, states, and facilities. By October 2025, the VBP program will include eight new quality measures, focusing on infection rates, staffing, and preventable readmissions, with further enhancements planned through 2028. Unlike the QRP, the VBP redistributes withheld Medicare payments based on performance improvements.

Ongoing Minimum Data Set (MDS) data validation audits, targeting around 1,500 nursing homes, demand precise submission timelines to ensure compliance. Furthermore, increased oversight of the Patient-Driven Payment Model (PDPM) billing accuracy by the Office of the Inspector General (OIG) highlights concerns about prevalent error rates. The Special Focus Facility (SFF) program changes prioritize long-stay fall prevalence for facility selection. CMS has also refined public reporting by removing certain complaints due to system transition data discrepancies, although substantiated complaints remain accessible.