Penalties in 2024 in Medicare's Skilled Nursing Facility Value-Based Purchasing Program

Area of Science:

• Health Services Research
• Healthcare Policy
• Gerontology

Background:

• The Medicare Skilled Nursing Facility (SNF) Value-Based Purchasing (VBP) Program adjusts payments based on 30-day readmission rates.
• Understanding facility-level factors associated with penalties is crucial for program improvement.

Purpose of the Study:

• To identify facility-level characteristics linked to maximum penalties in the 2024 SNF VBP program.

Main Methods:

• Retrospective, cross-sectional analysis of 10,278 SNFs using public CMS data for the 2024 SNF VBP program.
• Logistic regression was employed to analyze associations between patient demographics, facility structure, and community factors with maximum penalty receipt.

Main Results:

• A majority of SNFs (71.7%) received penalties, with 33.1% incurring the maximum penalty.
• Higher proportions of Black and Hispanic patients, for-profit status, urban location, and socioeconomically deprived ZIP codes were significantly associated with increased odds of maximum penalties.
• Facilities in the South region also showed a higher likelihood of maximum penalties.

Conclusions:

• Penalties in the SNF VBP program are influenced by patient mix, ownership, and geographic factors.
• Findings can inform policymakers on refining the SNF VBP program, targeting areas for quality improvement, and directing investments.