Long-Term Care Survey Alert

In June, CMS sent a report to Congress detailing its plans to implement a Value-Based Purchasing Program (VBP) for skilled nursing facilities. "We see the future of health care reimbursement moving from the current volume-based payment methodology to value-based purchasing," David Gifford, MD, MPH, senior vice-president quality and regulatory affairs, for the American Health Care Association (AHCA), tells Eli. Both AHCA and the National Center for Assisted Living (NCAL) strongly support this move, he notes.

The report, which was required by Section 3006 of the Affordable Care Act, discusses the current state of various elements that would be part of a SNF VBP and where the agency will go from there, explains Cassandra Black, senior technical advisor for CMS's Performance-Based Payment Policy Group. These include the following:

• The agency's current quality measures and process for developing them;
• Additional quality measures that the agency may want to add;
• A description of the process for reporting the measures;
• How payments could potentially be structured;
• Types of incentive payments;
• Possible funding sources for the payments; and
• How the agency would share any information gathered with the public.

The report concludes with a roadmap for implementation of a SNF VBP. CMS will analyze the results of the recently concluded Nursing Home Value Based Purchasing demonstration project, expected to be ready in the fall of 2013, before moving forward with a SNF VBP, Black notes.

Gifford says that this report summarizes many of the ongoing demonstrations on VBP which is helpful guide as SNFs transition from fee-for-service to value based purchasing. Copies of the report are available at: www.cms.gov/snfpps.

Payment for palliative care should be incorporated into Medicare's skilled nursing facility benefit, suggests a new study in the Archives of Internal Medicine.

"Almost one-third of older adults receive care in a SNF in the last 6 months of life under the Medicare" benefit, notes the abstract published in the October issue of the journal. And one out of 11 beneficiaries die while enrolled in SNF care.

"Often our focus on these patients is trying to keep them functional or independent for as long as we can. What we may be overlooking is that they are on an end-of-life trajectory," said Dr. Katherine Aragon, the study's lead author from Lawrence General Hospital in Massachusetts, according to press reports.

The abstract is at http://archinte.jamanetwork.com/article.aspx?articleid=1368358 .