Performance and Penalties in Year 1 of the Skilled Nursing Facility Value-Based Purchasing Program.
Aged
Cross-Sectional Studies
Female
Humans
Male
Medicare
/ economics
Nursing Staff, Hospital
/ supply & distribution
Patient Readmission
/ economics
Quality Indicators, Health Care
/ statistics & numerical data
Retrospective Studies
Skilled Nursing Facilities
/ standards
United States
Value-Based Purchasing
/ economics
Medicare
readmission
skilled nursing facility
value-based purchasing
Journal
Journal of the American Geriatrics Society
ISSN: 1532-5415
Titre abrégé: J Am Geriatr Soc
Pays: United States
ID NLM: 7503062
Informations de publication
Date de publication:
04 2020
04 2020
Historique:
received:
15
07
2019
revised:
20
11
2019
accepted:
25
11
2019
pubmed:
19
12
2019
medline:
30
1
2021
entrez:
19
12
2019
Statut:
ppublish
Résumé
Launched in October 2018, Medicare's Skilled Nursing Facility Value-Based Purchasing (SNF VBP) program mandates financial penalties for SNFs with high 30-day readmission rates. Our objective was to identify characteristics of SNFs associated with provider performance under the program. Retrospective cross-sectional analysis using Nursing Home Compare data for the 2019 SNF VBP. Facility-level regressions examined the relationship between structural characteristics (nursing home size, rurality, profit status, hospital affiliation, region, and Star Ratings) and patient characteristics (neighborhood income, race/ethnicity, dual eligibility, disability, and frailty) and facility performance. US Medicare. A total of 14 558 SNFs. The 2019 SNF VBP performance scores and penalties. Nationally, 72% (10 436) of SNFs were penalized; 21% (2996) received the maximum penalty of 1.98%. In multivariate analyses, rural SNFs were less likely to be penalized (odds ratio [OR] = 0.85; 95% confidence interval [CI] = 0.78-0.92; P < .001; vs urban), while small SNFs were more likely to be penalized (≤70 beds: OR = 1.28; 95% CI = 1.15-1.42; P < .001; 71-120 beds: OR = 1.15; 95% CI = 1.05-1.26; P = .003; vs >120 beds). SNFs with lower nurse staffing had higher odds of penalties (low: OR = 1.15; 95% CI = 1.03-1.27; P = .010; vs high); nonprofit and government-owned SNFs had lower odds of penalties (OR = 0.79; 95% CI = 0.72-0.87; P < .001; government: OR = 0.72; 95% CI = 0.61-0.84; P < .001; vs for profit); and SNFs with higher Star Ratings had lower odds of penalties (5 stars: OR = 0.47; 95% CI = 0.40-0.54; P < .001; vs 1 star). In terms of patient population, SNFs located in low-income ZIP codes (OR = 1.17; 95% CI = 1.03-1.34; P = .019) or serving a high proportion of frail patients (OR = 1.39; 95% CI = 1.21-1.60; P < .001) were more likely to be penalized than other SNFs. SNFs with high proportions of dual, black, Hispanic, or disabled patients did not have higher odds of penalization. Structural and patient characteristics of SNFs may significantly impact provider performance under the SNF VBP. These findings have implications for policy makers and clinical leaders seeking to improve quality and avoid unintended consequences with VBP in SNFs. J Am Geriatr Soc 68:826-834, 2020.
Sections du résumé
BACKGROUND/OBJECTIVES
Launched in October 2018, Medicare's Skilled Nursing Facility Value-Based Purchasing (SNF VBP) program mandates financial penalties for SNFs with high 30-day readmission rates. Our objective was to identify characteristics of SNFs associated with provider performance under the program.
DESIGN
Retrospective cross-sectional analysis using Nursing Home Compare data for the 2019 SNF VBP. Facility-level regressions examined the relationship between structural characteristics (nursing home size, rurality, profit status, hospital affiliation, region, and Star Ratings) and patient characteristics (neighborhood income, race/ethnicity, dual eligibility, disability, and frailty) and facility performance.
SETTING
US Medicare.
PARTICIPANTS
A total of 14 558 SNFs.
MEASUREMENTS
The 2019 SNF VBP performance scores and penalties.
RESULTS
Nationally, 72% (10 436) of SNFs were penalized; 21% (2996) received the maximum penalty of 1.98%. In multivariate analyses, rural SNFs were less likely to be penalized (odds ratio [OR] = 0.85; 95% confidence interval [CI] = 0.78-0.92; P < .001; vs urban), while small SNFs were more likely to be penalized (≤70 beds: OR = 1.28; 95% CI = 1.15-1.42; P < .001; 71-120 beds: OR = 1.15; 95% CI = 1.05-1.26; P = .003; vs >120 beds). SNFs with lower nurse staffing had higher odds of penalties (low: OR = 1.15; 95% CI = 1.03-1.27; P = .010; vs high); nonprofit and government-owned SNFs had lower odds of penalties (OR = 0.79; 95% CI = 0.72-0.87; P < .001; government: OR = 0.72; 95% CI = 0.61-0.84; P < .001; vs for profit); and SNFs with higher Star Ratings had lower odds of penalties (5 stars: OR = 0.47; 95% CI = 0.40-0.54; P < .001; vs 1 star). In terms of patient population, SNFs located in low-income ZIP codes (OR = 1.17; 95% CI = 1.03-1.34; P = .019) or serving a high proportion of frail patients (OR = 1.39; 95% CI = 1.21-1.60; P < .001) were more likely to be penalized than other SNFs. SNFs with high proportions of dual, black, Hispanic, or disabled patients did not have higher odds of penalization.
CONCLUSION
Structural and patient characteristics of SNFs may significantly impact provider performance under the SNF VBP. These findings have implications for policy makers and clinical leaders seeking to improve quality and avoid unintended consequences with VBP in SNFs. J Am Geriatr Soc 68:826-834, 2020.
Types de publication
Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
826-834Subventions
Organisme : NHLBI NIH HHS
ID : R01 HL143421
Pays : United States
Organisme : NIA NIH HHS
ID : R01 AG060935
Pays : United States
Informations de copyright
© 2019 The American Geriatrics Society.
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