What to Know: The Value-Based Purchasing Shift

The SNF Value-Based Purchasing program is transitioning to a multi-measure system for performance assessment instead of a single performance measure. The transition will occur over several fiscal years starting in 2026.

Here is the breakdown and what you need to know for the transition:

FY 2026 – four measures will be used:

• SNF 30-Day All Cause Readmission Measure – (SNFRM)
• Skilled Nursing Facility Healthcare-Associated infections Requiring Hospitalization (SN-HAI)
• Total Nursing Staff Turnover
• Total Nurse Staffing Hours per Resident Day

FY 2027

• Discharge Function Score
• Long-Stay Hospitalization Measure
• Percent of Residents Experiencing One or More Falls with Major Injury (Long Stay)

FY 2028

• The SNFRM will be replaced by the SNF Within- stay Potentially Preventable Readmissions (SN-WS PPR) measure.

Other changes include a new reconsideration process for appealing CMS decisions and the removal of the Health Equity Adjustment.

Providers must prepare for the transition of the Skilled Nursing Facility (SNF) Value-Based Purchasing (VBP) program and focus on data analysis, quality improvement initiatives, staff management, and have a strategic planning process.

Recommended Action:

• Understand the new measures by familiarizing your team with the specific measures that will be used for payment adjustments in the coming fiscal years that are listed above.
• Monitor and track performance by reviewing confidential reports. Access your facility’s confidential feedback reports routinely and the quarterly supplemental workbooks through the Quality Improvement Evaluation System (QIES) Certification and Survey Provider Enhanced Reporting (CASPER) system. The reports provide patient-level data for quality improvement and offer insight into how CMS is modeling your performance. Always know where you stand with performance and why.
• Implement Performance Improvement Plans to address the following:
  • Focus on care coordination during admissions and readmissions, to reduce unplanned hospital readmissions. Ensure strong infection control protocols are in place to prevent healthcare-associated infections.
  • Develop strategies to address nurse staffing levels and reduce turnover. Improve workplace conditions, offer professional development and mentorship programs so that your employees have a career learning and progression ladder.
  • Ensure that you are capturing the excellent work that you do in your documentation. Ensure consistent interdisciplinary input into function scoring by training clinicians and MDS teams to accurately document functional gains to ensure that care provided is reflected in the scores.
• Make sure to optimize data and documentation to ensure accuracy. Conduct a review of coding and the use of ICD-10 codes for accuracy and completeness. This is vital for correct PDPM (Patient-Driven Payment Model) category assignment and quality measure scores.
  • Focus on the alignment of documentation with outcomes to accurately reflect the resident outcomes achieved, reducing gaps between actual performance and reported data.
• Leadership and staff strategic planning to position VBP performance as a key goal for the entire organization top-down bottom up. Ensure consistent attention and resources are provided and that there is QAPI oversight.
• Ensure staff have received education (at all levels) and are familiar with the measures and understand their impact on reimbursement. Invite everyone in your organization on the journey to excellence.