In the Fiscal Year (FY) 2016 SNF Prospective Payment System (PPS) final rule, CMS adopted the SNFRM as the first measure for the Skilled Nursing Facility Value Based Purchasing (SNF VBP) Program. The measure is defined as the risk-standardized rate of all-cause, unplanned hospital readmissions of Medicare beneficiaries within 30 days of discharge from their prior hospitalization. Hospital readmissions are identified through Medicare hospital claims (not SNF claims) so no readmission data is collected from SNFs and there are no additional reporting requirements for the measure.
Readmissions to a hospital within the 30-day window are counted regardless of whether the beneficiary is readmitted directly from the SNF for after discharge from the SNF as long as the beneficiary was admitted to the SNF within 1 day of discharge from a hospital stay.
The measure excludes planned readmissions because they do not indicate poor quality of care.
The measure is risk-adjusted based on patient demographics, principal diagnosis from the prior hospitalization, comorbidities, and other health status variables that affect probability of readmission. In calculating the readmission measure, unplanned readmissions are identified using a modified version of the CMS planned readmissions algorithm.
Other exclusions include patients who were hospitalized for medical treatment of cancer, do not have Medicare Part A coverage for the full 30-day window, and do not have Part A coverage for the 12 months preceding the prior hospital discharge. Additional exclusions include SNF stays with:
- An intervening post-acute care admission within the 30-day window,
- Patient discharge from the SNF against medical advice,
- Principal diagnosis in prior hospitalization was for rehabilitation, fitting of prosthetics, or adjustment of devices,
- Prior hospitalization for pregnancy, and
- Other reasons documented in the measure’s technical specifications.
For more information on the SNF VBP Program, visit the CMS webpage at: https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/Value-Based-Programs/Other-VBPs/SNF-VBP.html.
For questions about the SNF VBP Program, contact: SNFVBPinquiries@cms.hhs.gov.