Providers welcome proposed SNF pay hike, express concerns over quality measures

CMS needs to give providers a "clear link" between practice and outcomes for the new quality measures, Phillips said
CMS needs to give providers a "clear link" between practice and outcomes for the new quality measures, Phillips said

Long-term care's biggest provider groups expressed relief last week over a proposal to increase skilled nursing payments by 2.1%, but remain wary about the four new quality measures that are attached.

The Centers for Medicare & Medicaid Services' proposed payment increase, which would boost payments to skilled nursing facilities by $800 million for FY 2017, earned praise from both LeadingAge and the American Health Care Association.

“The 2.1 percent inflationary increase is essential,” said AHCA President and CEO Mark Parkinson, in a statement. “We are facing unprecedented pressures, and with MedPAC reporting our margins at only 1.9%, a failure to keep track with inflation would be devastating."

CMS' proposals for FY 2017 also contained four new quality measures, including a value-based measure on potentially preventable 30-day post-discharge readmissions that LeadingAge Senior Vice President Cheryl Phillips, M.D. said is largely positive. But its benchmarking measures should be studied, she said.

“Unless this benchmarking is done correctly, the unintended consequence may be that nursing homes have incentives to not accept medically complex, or otherwise high-risk patients, thus creating a potential access issue for the most vulnerable groups,” Phillips said in a statement to McKnight's.

Philips also voiced support for the proposals' discharge to community measure, but stress the need for testing on proposed measures for medication reconciliation and Medicare spending per beneficiary.

“For all of these measures we remain concerned about the methodology for eventual incentive payments or penalties, as well as the time lapse between the actual events and the reporting date,” Phillips said. “If these are truly to be incentives for meaningful quality improvement, providers need a clear link between practice and outcomes.”

AHCA said it was still evaluating the proposed quality measures guidelines as of Friday afternoon. Earlier last week, AHCA Senior Vice President David Gifford, M.D., warned that the measure on medication reconciliation would need more testing.

The proposal also included a potential Medicare payment hike of $330 million for hospice providers, as well as new quality measures and the creation of a Hospice Compare site set to go live in 2017. While the support of consumer information is positive, Phillips said, the website's potential “evolution to a quality rating system based on a 5-star model” is cause for worry.

“Our experience with the 5-star ratings in nursing homes has shown that there are basic flaws in how they are calculated, how the various star ranking compare between regions, and how confusing they can be to consumers,” Phillips said. “We would hope that CMS would not repeat the same mistakes in the Hospice 5 star system.”