The Medicare Payment Advisory Commission is urging Congress to eliminate the current value-based purchasing program for skilled nursing facilities and establish an alternative that builds in more equitable incentives for providers. 

Commission members on Thursday unanimously approved the recommendation to Congressional lawmakers. They also overwhelmingly approved an additional proposal that calls on federal health agencies to finalize development of and implementation of a patient-experience reporting measure for SNFs. 

The group argued the current VBP program has several flaws, including assessing SNF performance based on a single outcome measure (hospital readmission), not using all withheld funds, and using rewards too small to encourage all providers to improve care quality.

The recommended replacement would depend on multiple performance measures focused on patient outcomes and resource-use to score SNFs, distribute all withheld funding each year to providers, and account for social risk factors. The change would ultimately result in more equitable payments across SNFs with different mixes of patients, according to the commission. 

The change would be budget neutral. Commission members also expect the alternative model would increase beneficiary access to SNF services and increase incentive payments for SNFs who improve their performances. 

Commission members expressed strong support for the recommendations during Thursday’s meeting but warned the group must continue to focus on outcome measures in post-acute patients. 

“I feel very good about the specific measure recommendations that you’ve made but just want to underscore that we can’t rest on those,” Commission member Dana Safran said. “Those will, even with patient experience included, not give us the holistic and complete view that we would like to have of the quality of care and outcomes of care being achieved.” 

She added that “the next biggest gap would be to have measures of functional outcomes and well-being outcomes.” 

“We should not give up on that work. It’s critically important,” Safran said. 

David Grabowski, Ph.D., Harvard healthcare policy expert and commission member, echoed her comments. 

“We really need to continue to work on growing the measures set here,” he said. “I love that we’ve expanded it with the VIP (value incentive program) from the existing VBP, but there’s still a ways to go…. There’s a lot of good potential measures that are out there and we should continue to identify and improve those measures.”