SNF PPS Proposed Rule Outlines First Steps in Linking Medicare Payment with Quality Outcomes

David Gifford, MD, MPH

On April 15, 2015, CMS released its proposed rule for the Fiscal Year 2016 SNF Prospective Payment System (PPS).  CMS is proposing a net estimated market basket growth rate of 1.4%.  The increase is projected to offer the profession an additional $500 million.  For the first time, the rule also include a new topic to the SNF PPS – quality measures and reporting provisions – further heightening the importance of quality performance to business success going forward.  

The rule outlines CMS’ proposed approaches to begin implementation of the SNF Value Based Purchasing Program (VBP).  This program will create payment incentives and penalties for SNFs linked to their rehospitalization rates, as well as the SNF Quality Reporting Program (QRP), which will establish standardized quality measures across post-acute care settings, paving the way for future changes in payment systems.  

The three areas CMS proposes to begin with measuring under the QRP are pressure ulcers, falls and functional status assessment.  AHCA is currently preparing extensive comments on the proposals, which will be submitted by June 19. Additional information about the proposed rule can be found on the AHCA SNF PPS webpage.