CMS officials offer insight into proposed changes to value-based purchasing for nursing homes

Officials from the Center for Medicare & Medicaid Services (CMS) provided more clarity on updates to the value-based purchasing program for nursing homes, including information on the usefulness of analytics reports preliminary at the facility level and details on three new quality measures that will now be linked to incentive payments in fiscal year 2025.

These proposed changes to the VBP program are considered among the most significant contained in CMS’s recently released Skilled Nursing Facilities Potential Payment System (SNF PPS) rule for next year.

In a recent webinar hosted by CMS’s Value Incentives and Quality Reporting Division, officials detailed how CMS will now calculate performance scores and collect data on new quality metrics related to job turnover. nursing staff, infection prevention and control and nursing care. hours of custody.

Christopher Palmer, SNF VBP program coordinator, and Nikkilyn Morrison, SNF VBP program researcher, provided an overview of the program’s new Early Performance Score reports for 2026, which have been shared with institutions but are based on more data old ones to allow insight into how the installation could hypothetically work.

“All of us at CMS are very excited about the expansion of the VBP program and believe these initial reports will be helpful in previewing the upcoming expansion of the program and the impact it may have on your facilities,” Palmer said .

Nursing home providers should note that the FY 2025 SNF PPS proposal is open for public comment until May 28, CMS officials said.

More measurements, changes in notation

The SNF VBP program, launched in fiscal year 2019, aims to improve the quality of care delivered by nursing homes by encouraging improvement in the quality of care. Morrison emphasized that all SNFs in the Medicare SNF Prospective Payment System are automatically considered for inclusion in the program.

Under the guidance of the Protecting Access to Health Insurance Act of 2014 (PAMA), SNFs are evaluated based on their performance on quality measures related to both improvement and success.

The program initially evaluated performance using a single measure of all-cause hospital readmissions, known as SNF RM.

However, with the FY 2026 expansion, three additional quality measures are introduced: SNF hospital-acquired infections requiring hospitalization, total nursing staff turnover, and total hours of care per resident day. These measures will be evaluated using FY 2022 as the base period and FY 2024 as the performance period.

One notable change in scoring methodology is the combination of multiple measurement scores to calculate an overall performance score for each SNF. This score, out of 100 points, will determine the incentive payment multiplier (IPM), which will be applied prospectively to SNF Medicare Fee-for-Service Part A claims throughout fiscal year 2026, Morrison said.

“Informative” preliminary report

The Early Look Performance Score report for 2026, provided to SNFs for informational purposes only, provides an overview of the expanded program’s scoring format and methodology. It uses historical data from FY 2021 as the base period and FY 2022 as the performance period, providing SNFs with an approximation of their future performance.

So brand new SNFs opening in December 2023, for example, would have no data in their preliminary report because the report is based on FY 2021 and FY 2022 data.

Morrison also emphasized that while the preliminary report does not impact payments, it serves to familiarize SNFs with the upcoming changes and allows them to evaluate their performance against the new measures. SNFs will continue to receive confidential quarterly reports for the current fiscal year 2025 program, with the final report expected in August, Morrison said.

“For the current FY 2026 program, your FY 2022 will be based on the baseline period and FY 2024 as the performance period for the four included quality measures,” Morrison said.

During the webinar, Morrison also addressed issues regarding eligibility, the distinction between preliminary reporting and quarterly reporting, and the inclusion of agency nurses in turnover calculations. She clarified that the incentive payment multiplier for the VBP program only applies to Medicare fee-for-service claims.

“When CMS makes payments for a Medicare Part A fee-for-service claim in FY 2026, the adjusted federal per diem rate will be multiplied by the official SNF incentive payment multiplier,” it said. she declared.

Regarding the sources of facility data, Morrison said the nurse turnover measure is calculated using Payroll-Based Journal (PBJ) data.

“The turnover measure only includes individuals who worked at least 120 hours and the 90-day period begins from the first observed day of work in the reporting quarter,” Morrison said. Additionally, both regular employees and contingent staff are included in the turnover measurement if they have worked enough hours to be eligible, she explained.

Meanwhile, the Infection Prevention Measure, or officially called the Healthcare-Associated Infections Measure (SNF HAI), is calculated using Medicare Fee-for-Service claims data.

CMS officials said the expansion of the SNF VBP program for fiscal year 2026 marks an important step in incentivizing improvements in the quality of SNFs. With the introduction of new measures and improved scoring methodologies, officials said SNFs should be on track to providing higher standards of care for their residents. In the meantime, the first reports for 2026 provide NSFs with a valuable opportunity to prepare for the program’s evolution and optimize their performance in the years to come, officials said.