Division of General Internal Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia.
Center for Health Equity Research and Promotion, Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania.
JAMA Netw Open. 2022 Feb 1;5(2):e220721. doi: 10.1001/jamanetworkopen.2022.0721.
The new Medicare Skilled Nursing Facility Value-Based Purchasing program (SNF VBP) seeks to improve patient outcomes by awarding financial incentives or penalties based on 30-day hospital readmission rates. Skilled nursing facilities (SNFs) can avoid a penalty through low baseline readmission rates or improvement over time.
To assess the baseline performance and improvement over time of SNFs in the SNF VBP program.
DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study examined readmission rates, financial penalties and incentives, and facility and patient characteristics associated with these outcomes at 14 959 US SNFs that received Medicare payments between January 1, 2015, and December 31, 2019.
Outcomes were readmission rates and financial penalties by facility. The SNFs were classified as improvers in the analysis if they had better improvement scores than baseline scores under the program and achievers if they had higher baseline scores than improvement scores.
Of 14 959 SNFs studied, 1849 (12.3%) were assigned their improvement score as their performance score in the first year of the program. Of these, 1167 (63.1%) received a financial penalty, whereas 374 (20.2%) received a bonus. Only 52 facilities that performed poorly at baseline (0.3% of all SNFs and 0.7% of below-median performers) were able to improve enough to avoid a financial penalty, despite large improvements in readmission rates. Improver SNFs treated larger racial minority populations (mean [SD], 74.57% [23.42%] White in the improver group vs 79.15% [22.18%] in the achiever group) and were located in counties with larger minority populations (mean [SD], 15.48% [14.05%] Black in the improver group vs 11.57% [12.72%] Black in the achiever group). The most important predictors of improvement were related to SNF finances, such as operating margin (mean [SD], -0.74 [13.87]) and occupancy rates (mean [SD], 79.93 [14.81]).
This cross-sectional study suggests that the SNF VBP program did not offer a viable path for nearly all low-performing SNFs to avoid financial penalties through improved readmission rates.
新的医疗保险熟练护理机构基于价值的购买计划（SNF VBP）旨在通过基于 30 天住院再入院率来奖励财务奖励或惩罚，以改善患者的结果。熟练护理机构（SNF）可以通过低基线再入院率或随时间的改善来避免处罚。
评估 SNF 在 SNF VBP 计划中的基线表现和随时间的改善。
设计、地点和参与者：这项横断面研究检查了 14959 家美国 SNF 的再入院率、财务处罚和奖励，以及与这些结果相关的设施和患者特征，这些 SNF 在 2015 年 1 月 1 日至 2019 年 12 月 31 日期间收到了 Medicare 付款。
结果是每个设施的再入院率和财务处罚。如果在该计划下，SNF 的改进评分高于基线评分，则将其归类为改进者；如果 SNF 的基线评分高于改进评分，则将其归类为实现者。
在研究的 14959 家 SNF 中，有 1849 家（12.3%）在该计划的第一年将其改进评分作为其绩效评分。其中，1167 家（63.1%）收到了财务处罚，而 374 家（20.2%）收到了奖金。尽管再入院率大幅提高，但只有少数表现不佳的 SNF 能够在基线时表现不佳（所有 SNF 的 0.3%和中位数以下表现者的 0.7%），从而获得足够的改善以避免财务处罚。改进者 SNF 治疗的种族少数群体比例较大（改善组的平均[标准差]为 74.57%[23.42%]白人，而实现者组为 79.15%[22.18%]白人），并且位于少数民族比例较大的县（改善组的平均[标准差]为 15.48%[14.05%]黑人，而实现者组为 11.57%[12.72%]黑人）。改进的最重要预测因素与 SNF 的财务状况有关，例如运营利润率（平均[标准差]，-0.74[13.87]）和入住率（平均[标准差]，79.93[14.81]）。
这项横断面研究表明，SNF VBP 计划并未为几乎所有表现不佳的 SNF 提供可行的途径，通过改善再入院率来避免财务处罚。
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