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Making SNF Care More Cost-Effective with Better Outcomes

Skilled Nursing Facilities (SNFs) are an important long-term care option for the aging U.S. population. They are essential in delivering quality care that is cost-effective.

SNFs primarily differ from nursing homes in that SNF care is often covered by Medicare while nursing homes are not. Additionally, SNFs often serve as rehabilitation center for patients after significant health traumas such as strokes.

In July 2017, CMS finalized SNF payment and policy changes for 2018, including repayment rates and value-based purchasing implementation. CMS estimates that aggregate payments to SNFs will increase by approximately $370 million—or about 1 percent—between 2017 and 2018 due to a required increase from MACRA. In comparison, SNFs received an increase of $920 million between 2016 and 2017. Additionally, CMS will be reporting six new measures by fall 2018.

CMS also announced four new measures beginning in 2020:

  • Change in Self-Care Score for Rehabilitation Patients
  • Change in Mobility Score for Rehabilitation Patients
  • Discharge Self-Care Score for Rehabilitation Patients
  • Discharge Mobility Score for Rehabilitation Patients

These new scoring measures will be accompanied by an altered version of the current pressure ulcer measures.

One factor that could have contributed to a need for improved measures is hospital spending on post-acute care. A new study released in the July issue of the Journal of Health Economics found a link between hospital inpatient spending and decreased mortality. Hospitals that focused spending on intensive inpatient care in order to send patients home generated lower one-year mortality rates than hospitals that focused spending on post-acute SNF care.

CMS will also be implementing SNF value-based purchasing (VBP) programs beginning in October 2018, and updated the End-Stage Renal Disease (ESRD) quality incentive program. The implementation of SNF VBP is a shift away from fee-for-service payments that are being phased out in hospitals and other facilities. CMS is aiming to transfer half of its traditional fee-for-service Medicare payments to alternative payment methods by 2018.

Definitive Healthcare currently tracks more than 900 SNF corporations and over 18,000 individual SNFs. Below are the top SNF Corporations by net patient revenue.

Top 10 SNF Corporations by Net Patient Revenue

SNF Corporation Net Patient Revenue (M) # Staffed Beds
Genesis HealthCare $4,854 55,524
Heartland ManorCare $2,967 34,001
Life Care Centers of America $2,240 26,144
SavaSeniorCare $1,689 24,452
Consulate Health Care $1,532 18,799
Ensign Group $1,389 9,841
Brookdale Senior Living $937 9,841
Good Samaritan Society – Sioux Falls $899 15,181
Senior Care Centers $823 12,468
Trilogy Health Services $798 10,861

Fig 1 Data from Definitive Healthcare based on the most recent CMS reports available.

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Definitive Healthcare has the most up-to-date, comprehensive and integrated data on over 7,700 hospitals, 1.4 million physicians, and numerous other healthcare providers. Our database features detailed clinical information on physicians and physician groups, including procedure analytics, payments, and participation in CMS programs.

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