Medicare Compliance & Reimbursement

Pay attention to quality measures, or P4P transition will hurt more.

If Medicare links reimbursement to a long-term care facility's performance, providers must be up to the challenge or their rates could take a dive.

Nursing homes should take the prospect of a pay-for-performance system seriously, starting now, says Steve Jones of Moore Stephens Lovelace in Clearwater, FL.

At a June 30 Skilled Nursing Facility/Long-Term Care Open Door Forum, officials from the Centers for Medicare and Medicaid Services acknowledged that plans for a P4P payment scheme are already underway.
 
That means that the feds' plan to link long-term care payments to a facility's ability to provide top-notch care may come to fruition much sooner than expected, at least for some of the nation's SNFs.

Here's why: CMS met in May with its Minimum Data Set Coalition to solicit the panel's thoughts on a P4P demonstration. Armed with that information, CMS plans to draft a design for the demonstration project that will include details about how quality measures could be linked to payment levels.

The feds say they won't necessarily limit themselves to existing quality measures to determine how to assess quality as it may relate to payments. Other measures of efficiency may also come into play, said Lambert.

Bottom line: Even if CMS looks beyond QMs, facilities are likely to fare better come P4P time if they take an active interest in the quality measures now.