Payment hike achieved, providers turn focus to quality aspects of FY 2017 rule

The release of the final skilled nursing payment rule for fiscal year 2017 gave relief to providers, and rightfully so: it boosted payments to the sector by $920 million. But other provisions tucked in the rule now need attention, provider groups told McKnight's.

Along with the 2.4% payment increase, the Centers for Medicare & Medicaid Services' skilled nursing rule for FY 2017 included four new quality measures, including one — the SNF 30-Day Potentially Preventable Readmission Measure — that will be used for the sector's value-based purchasing program, set to start in FY 2019.

“A lot of people are talking about the financial piece of it but there are a lot of aspects of this that need consideration,” said Theresa Sanderson, CNHA, FACHCA, secretary and treasurer of the American College of Health Care Administrators board. “All of these measures that we might not necessarily track now, we have to start tracking and we have to understand all the technical requirements that go into CMS' calculations.”

The American Health Care Association and LeadingAge both echoed Sanderson's sentiments, expressing gratitude that the payment increase was higher than the one proposed in April but acknowledging the work still to come. Both LeadingAge and AHCA are spending time evaluating the rule for its value-based purchasing and reporting requirements. 

“We are pleased that the final rule provides a larger Medicare payment update for 2017, 2.4% on average versus 2.1% in the proposed rule,” LeadingAge said in its comments to McKnight's. “We are evaluating the final rule in this light and will work to make sure that the right measures are used to assess nursing home quality and performance.”

The rule's inclusion of the value-based purchasing measure serves as a “paradigm shift” for the industry, said Cynthia Morton, MPA, executive vice president of the National Association for the Support of Long-Term Care.

“It's a bit of a game changer with this final rule, it is our changeover from fee-for-service to fee-for-value, for at least part of our reimbursement,” Morton said. “In some ways that's bigger than the larger reimbursement that was finalized. And it's going to sneak up on providers, that's the worry.”

Providers should also keep an eye on the rule's drug regimen review measure, since it's “fairly new for a lot of people” and “pretty open ended right now,” Sanderson added. The drug regimen measure is slated for implementation in 2020.

“The further we get from the day of the announcement, the smarter we are in determining how this will impact our members,” Greg Crist, senior vice president of AHCA, told McKnight's. “A lot of factors are trending in the right direction, and we're going to keep monitoring it.”