Zero readmissions can hinder SNFs in new VBP program

According to the latest “Proposed Rounding Clarification for SNF VBP Scoring”, an analysis of the historical Skilled Nursing Facility 30-Day All-Cause Readmission Measure data found that a small number of facilities had zero readmissions during the applicable performance period. While the exemplary outcome should be viewed as a remarkable achievement, attaining this benchmark during the performance period may actually inadvertently penalize these facilities with a net negative value-based incentive payment. This is due to the statistical approach used to calculate the VBP measure, where outlier values are shifted towards the mean. With this formula, observed readmission rates of zero result in risk-standardized readmission rates that are greater than zero.

While CMS acknowledges that assigning a net negative value-based incentive payment to a SNF that achieved zero readmissions during the applicable performance period does not support the Program’s goals, it is difficult to carve out VBP exceptions for specific facilities. CMS is soliciting comments for suggested approaches for other options to ensure that SNFs achieving zero readmissions among their patient populations during the performance period do not receive a negative payment adjustment.

While this statistical challenge impacts only a small number of facilities (the exact number was not provided), a lesson can be extrapolated for all SNFs; be wary of extreme outliers in your readmissions performance. As indicated in this example, having some room to improve can be a better situation than trying to maintain the standards of an uncharacteristically high benchmark.

1 Response

  1. Can you elaborate on how this calculation works to create a negative incentive for facilities with no readmissions?

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