Tuesday, January 24, 2017

CMS Releases SNF Utilization and Payment Data for 2014



On Wednesday, January 18, 2017, the Centers of Medicare and Medicaid Services (CMS) posted their second annual release of the Skilled Nursing Facility Public Use File (SNF-PUF) with data for calendar year 2014. The 2014 SNF PUF provides facility-level, state aggregate, and national aggregate data, with a special focus on two specific RUGs, the RV (Very-high Rehab) and RU (Ultra-high Rehab) categories.


Because the 2104 SNF PUF data files contain facility-specific Medicare Part A utilization data, AHCA recommends that members look up your centers in the tables listed near the bottom of this message. Files that contain data for specific SNFs are those that include the 6-digit “Provider ID” in the first column.    


Background
This 2014 SNF PUF file is part of the CMS data transparency initiative, and follows-up on a similar release of CY 2013 SNF PUF on March 9, 2013. Last year’s SNF PUF data was subsequently reported in the press, was used as part of the U.S. News and World Report nursing home rankings methodology, and used as part of a CMS Recovery Audit Contractor (RAC) investigation. 


The 2014 SNF PUF contains information on utilization, payment (allowed amount, Medicare payment and standardized payment), and submitted charges organized by 6-digit identification number, Resource Utilization Group (RUG), and state of service. This PUF is based on information from CMS’s Chronic Conditions Data Warehouse (CCW) data files, the 2014 Long-Term Care Minimum Data Set 3.0 (MDS), and the CMS Provider of Service (POS) file.


The data in the SNF PUF contains 100% final-action (i.e., all claim adjustments have been resolved) SNF Part A claims for the Medicare fee-for-service (FFS) population. For privacy purposes, CMS did not report data in cell tables that represented 10 or fewer beneficiaries.  


The 2014 SNF PUF contains five tables: 1) aggregated information by provider, 2) aggregated information by provider and RUG, 3) aggregated information by RUG, 4) aggregated information by RUG and state, and 5) aggregated information on therapy minutes. The Methodology Overview document also highlights some limitations in these files; the most notable including being that the information presented “does not indicate the quality of care provided.”     


New in 2014 SNF PUF data is demographic and chronic condition information via hierarchical condition categories (HCCs) that helps better identify patient characteristics and attributes spending risk to facility-level detail.    

Links to the Specific 2014 SNF PUF Files and other CMS resources are listed below:

Provider Aggregate Table


Contains information on utilization and payment (provider charges, allowed amount, Medicare payment, standard payment, stay profiles, beneficiary demographics, and chronic conditions), organized by SNF.  

Provider by RUG Aggregate Table


Contains information on utilization and payment (provider charges, allowed amount, Medicare payment, and standard payment), organized by SNF and RUG. Note: Due to beneficiary privacy requirements, this file provides facility-level RUG details only if there were more than 10 beneficiary assessments that qualified for that specific RUG case mix. 


RUG Aggregate Table and RUG/State Aggregate Table


Contain information on utilization, Medicare payment, and submitted charges organized by RUG and RUG by state respectively.


Therapy Minutes Aggregate Table

Contains information on the number of RV and RU assessments submitted by a SNF, and the percent of RV and RU assessments where the number of therapy minutes falls within 10 minutes of the minimum therapy minute threshold necessary to qualify for that RUG category.


Additional information can be found at the CMS Frequently Asked Questions page.
Inquiries regarding this data can be sent to MedicareProviderData@cms.hhs.gov.
If you have any further questions, please contact Dan Ciolek at dciolek@ahca.org.

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