Medicare Compliance & Reimbursement

Project not slated to start for at least a year.

Long-term care facilities will soon get a chance to try pay-for-performance on for size.

As early as next year, some nursing homes could be getting paid for their extra attention to quality of care.  At a recent special Open Door Forum, officials from the Centers for Medicare and Medicaid Services laid out the basics of a plan to offer top-performing nursing homes incentives to keep up the good work.

The pilot will involve as many as 200 homes in three or four states. The initiative would improve nursing home care by offering financial incentives to facilities that provide excellent care or demonstrate significant improvements in care quality, according to Abt Associates, a CMS contractor working on the project. Participation in the pilot is voluntary and carries no financial risk.

Facilities interested in participating should consider these basics about the P4P pilot:

• The project will start late in 2006 or early 2007.

• Both hospital-based and freestanding facilities may participate in the pilot.

• Quality measures taken from the MDS may be used to determine quality.

• CMS may consider other QMs, including staffing levels, survey results and avoidable hospitalizations.

Expect More Details Soon

CMS has yet to address some questions about the pilot, which means interested providers should be on the lookout for updates about the P4P pilot. Among the questions CMS still needs to answer:

• How much will each QM count toward a facility's performance score?

• How will the agency coordinate with individual state Medicaid programs?

• How much incentive pay should facilities receive?

• How will CMS decide which states will be selected for the demonstration project?