Skilled Nursing Facility Performance and Readmission Rates Under Value-Based Purchasing

Area of Science:

• Healthcare Policy
• Quality Improvement Initiatives
• Geriatric Care

Background:

• The Skilled Nursing Facility Value-Based Purchasing (SNF VBP) program incentivizes SNFs to reduce hospital readmissions.
• Facilities face financial penalties or bonuses based on their 30-day readmission rates.
• Avoiding penalties requires either low baseline rates or significant improvement over time.

Purpose of the Study:

• To evaluate the performance of SNFs within the SNF VBP program.
• To assess SNFs' ability to improve and avoid penalties.
• To identify characteristics associated with SNF performance and improvement.

Main Methods:

• A cross-sectional study analyzed data from 14,959 US SNFs (2015-2019).
• Readmission rates, financial penalties/incentives, and facility/patient characteristics were examined.
• SNFs were categorized as 'improvers' or 'achievers' based on performance scores.

Main Results:

• Only 12.3% of SNFs had their performance score based on improvement.
• A majority (63.1%) of these improvers received penalties, while 20.2% received bonuses.
• Few low-performing SNFs (0.3%) successfully avoided penalties through improvement.
• Improver SNFs served more minority patients and had stronger financial indicators (e.g., operating margin, occupancy).

Conclusions:

• The SNF VBP program's design may not provide a practical pathway for most low-performing SNFs to avoid penalties via readmission rate improvements.
• Facility financial health and occupancy rates appear to be significant predictors of success within the program.
• Further research is needed to understand disparities and optimize program effectiveness.