SNF Payment Exposure for Discharged Residents

Beginning in FY 2019, skilled nursing provider’s Medicare Part A rates will be reduced by 2% to fund SNF
VBP “incentive” payments. The SNF‐PPS payments from 10/1/2018 ‐ 9/30/2019 will be adjusted based on the skilled nursing provider’s readmission performance for stays starting from January 1st of this year to 12/31/2017. As the first quarter of the performance period comes to an end, it’s worth reinforcing that the SNF 30‐Day All‐Cause Readmission Measure (NQF #2510) counts rehospitalizations during 30-day window from admission to the SNF and extends to after the SNF stay if the resident is discharged
home prior to 30 days.

This means that a short-stay skilled nursing facility with an average length of stay (LOS) of 14 days has more risk-exposure after discharge from a facility then under the direct care. To address this new exposure, skilled nursing providers can implement a post discharge follow up program to:

  • Review the clinical status of the former resident
  • Communicate and reinforce the yellow and red flags to monitor for a decline in clinical condition
  • Instruct the former resident and their family to call them if a yellow flag is detected

These steps, taken as soon as possible, can help to improve the financial outcomes for the entire payment period from Oct 1, 2018 to Oct 1, 2019.

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