The United States spends more on health care than any other country in the world. Unfortunately this cost is not justified. Statistics and outcomes have proven that the cost is not matched to improved quality and health outcomes. This progressive realization from regulators and government officials is one of the major incentives to shift toward a values-based model of care.
“All entities from CMS to MedPAC are seeking measurable, trackable data to prove that care services are worth what they cost to deliver,” says Long-Term Living.
What is the CMS Values Based Program (VBP)?
The Values Based Program (VBP), which was authorized by the Protecting Access to Medicare Act of 2014 (PAMA) and goes into full effect in fiscal year 2019, is an alternative reimbursement model to replace the fee-for-service that is currently in place, moving to a quality measurement model.
The VBP applies to freestanding skilled nursing facilities (SNFs), SNFs affiliated with acute care facilities, and all non-CAH swing-bed rural hospitals.
According to CMS, the changes have not only been put in place to provide accountability in practice, but also to provide consumers with more meaningful information to guide their choice of facility. The consumer oriented changes are set to be reflected on Nursing Home Compare’s five-star rating system from mid 2016.
Shift in Hospital Reporting
Part of the VBP includes the addition of six new quality measures, making a total of 24. And for the first time ever, a few of the new changes see self-reported MDS data shift to hospital reporting, while other measures shift focus to various parameters of short and long stay residents.
Reducing unnecessary hospitalizations has already been a focus for many facilities. But with the new changes, there is an even greater emphasis on rehospitalizations. Therefore, the challenge will be to sustain your facility’s hospitalization rates over the long-term.
The other two hospital reporting measures are emergency department utilization and discharge-to-community processes.
And of course, the new Payroll-Based Journal (PBJ) requires reporting of staffing and census data on a quarterly basis using the CMS new standardized system. See our 3 part series on PBJ here.
Here are the major VBP shifts as outlined by Baker Tilly.
Featured Image Credit: Preparing your healthcare organization for value-based care via Baker Tilly.
Payments Under the New Value-Based Program
The goal of CMS for 2016 is that 30-55% of fee-for-service payments will be switched to values-based payments.
Based upon data, payment differentials will be fully rolling out in fiscal year 2019. Basically, SNF performance will be calculated on an “achievement/ improvement” methodology, facilities given points on a scale that establishes ranking data.
The lowest performers will be hit the worst, as the reduction amount of 2% will be taken from “the losers” and funding will be given to “the winners” (top performers under the scheme).
“SNFs will be ranked such that the bottom 40% will be in penalty-eligible range,” says Qualis Health.
- CMS values-based program
- More on CMS payments
- CMS VBP material by The National Law Review
- CMS resources to improve care
- CMS transforming clinical practice
- Webinar recording by Baker Tilly with important aspects to consider