Why am I not receiving incentive payments for FY 2019
SNF Quality Reporting Program (QRP) and Value-Based Purchasing (VBP) are separate, but related, programs.
QRP is required by the IMPACT ACT to collect data from five domains using assessment data as well as assessing measures related to resource use and claims-based measures. If a facility does not submit the required data, it will receive a two percentage-point reduction to its annual payment update. This is the data that is contained in your review and correct reports.
Currently, data is being collected on: Cross-Setting Pressure Ulcer Measure: Changes in Skin Integrity Post-Acute Care: Pressure Ulcer/Injury; An Application of IRF Functional Outcome Measure: Change in Self-Care Score for Medical Rehabilitation Patients; and many others.
On the flip side, VBP offers incentive payments to skilled nursing facilities based on the performance of readmissions. Two percent of payments have been withheld to fund the incentive payments, and 60% of the amount withheld will be returned to high-performing facilities.
There is a curve to determine who gets incentives, and how much. The bottom 40% of facilities will receive less payment than normal.
VBP incentives are based this year on the SNF 30-Day All Cause Readmission Measure.
CMS uses a computer program to assign an incentive multiplier. This multiplier can be anywhere from 0 to 3%, based on performance scores. This can be a double-whammy for those facilities that lost 2% for not meeting thresholds, and yet another 2% without achieving any of the incentive payments.