A proposal by the Medicare Payment Advisory Commission to replace the current value-based purchasing program for skilled nursing facilities with a more equitable, value-incentive model would be a “win-win” for both provider and residents if adopted, according to a leading healthcare policy expert. 

MedPAC on Tuesday delivered its annual report to Congress on issues affecting the Medicare program and the healthcare delivery system. The report includes a recommendation — unanimously approved by the commission in April — to eliminate the current SNF VBP with an alternative incentive model that rewards providers more evenly based on the quality of care they provide. 

The commission in the past has argued that the current VBP program has several flaws, including assessing SNF performance based on a single outcome measure (hospital readmissions) and not fully distributing all withheld funds. It also doesn’t account for social risk factors in payment, and the rewards are too small to encourage all providers to improve quality of care, commissioners have said.

The recommended replacement would score SNFs based on multiple performance measures focused on patient outcomes, distribute all withheld funding each year to providers and account for social risk factors. 

McKnight's Long-Term Care News, December 2018, Resident Care, David Grabowski
David Grabowski, Ph.D.

“The proposed SNF VIP model addresses all of these flaws by incorporating a range of quality measures, building in strategies to ensure reliable results, distributing rewards across all facilities, accounting for differences in patients’ social risk factors and distributing the entire provider-funded pool of dollars,” Harvard’s David Grabowski, Ph.D., told McKnight’s Long-Term Care News on Wednesday. Grabowski, who is a member of the commission, emphasized that he was speaking on the record as a healthcare policy expert and not in his capacity as a commissioner or on behalf of the group. 

The commission in the past has also argued the switch would ultimately result in more equitable payments across SNFs with different mixes of patients. The change would be budget neutral if adopted. 

“By ensuring the best facilities are fairly and accurately rewarded, I believe this model would be a win-win for providers and short-stay patients,” Grabowski predicted.