The onset of the Patient Driven Payment Model may be driving some providers to admit more clinically complex residents, but that might not be the most lucrative strategy, according to new research.

Nursing facilities that serve frailer patients are more likely to be penalized under Medicare’s SNF Value-Based Purchasing program, investigators at Washington University recently found.

Characteristics such as frailty, and structural components, such as nursing home size, profitability and star ratings, could have a significant impact on providers’ performance under the SNF VBP program, researchers said. 

“These findings have implications for policy makers and clinical leaders seeking to improve quality and avoid unintended consequences with VBP in SNFs,” they concluded. 

Investigators used 2019 skilled nursing facility VBP performance scores and penalties for the analysis. In all, 72% of SNFs were penalized and 21% received the maximum penalty of 1.98%. 

Nonprofit and government‐owned SNFs had lower odds of being penalized under VBP, as did facilities with higher star ratings.

Meanwhile, SNFs with lower nurse staffing ratios had higher odds of being penalized.

Among other discoveries: Rural SNFs were less likely to be cited, while small SNFs were more likely to be cited. 

SNFs located in low‐income ZIP codes had a higher chance of being penalized than others. Facilities with high proportions of mixed-race, black, Hispanic or disabled patients “did not have higher odds of penalization,” researchers stated.

Findings were published online in the Journal of the American Geriatrics Society