The Centers for Medicare & Medicaid Services (CMS) SNF Value-Based Purchasing (VBP) Program aims to reward quality and improve health care by reducing hospital readmissions from skilled nursing facilities. Starting in FY 2019, SNF VBP began to apply incentives and penalties to Medicare reimbursement payments. VBP establishes a hospital readmissions reduction program for providers, encouraging SNFs to address potentially avoidable readmissions by establishing an incentive pool for high performers and payment penalties for under-performers.

Here are the Top 5 Questions Regarding Skilled Nursing Facility Value-Based Purchasing:

#5. What measure is used in the SNF VBP Program?  The SNF 30-Day All-Cause Readmission Measure (SNFRM; NQF #2510) is the measure currently used in the SNF VBP Program. It evaluates the risk-standardized rate of unplanned, all-cause acute care hospital readmissions for fee-for-service Medicare beneficiaries. This measure assesses SNF residents’ hospital readmissions within 30 days after discharge from a prior hospital stay to a SNF.

#4. Is the SNFRM also used in the SNF Quality Reporting Program (SNF QRP) or when calculating star ratings on Nursing Home Compare?
No. The SNF VBP Program uses the SNFRM, which calculates the risk-standardized rate of unplanned, all-cause inpatient hospital readmissions within 30 days of a SNF patient’s discharge from a prior hospital stay.  The SNF QRP uses the Potentially Preventable 30-Day Post-Discharge Readmission Measure, which is a different hospital readmission measure from the SNFRM. Measures used in the SNF QRP do not impact the SNF VBP Program in any way. Also, the SNFRM is not used to calculate star ratings on Nursing Home Compare.

#3. How are performance scores determined?
SNFs’ risk-standardized readmission rates (RSRRs) in the performance period are compared to two metrics to determine the performance score:


• Their own past performance during the baseline period, used to calculate an improvement score (scores range from 0 to 90)

• National SNF performance during the baseline period, used to calculate an achievement score (scores range from 0 to 100)


A SNF’s achievement and improvement scores are compared; whichever score is higher becomes that SNF’s performance score.

#2.  How are SNFs ranked in the SNF VBP Program?
SNFs are ranked by their performance scores each year, as required by statute. SNFs with the same performance score receive the same rank. For example, if 200 SNFs receive a perfect performance score of 100, these 200 SNFs will each hold a rank of 1. In this example, the SNF with the next-highest performance score would receive a rank of 201.

#1. Will the COVID-19 public health emergency (PHE) impact SNF VBP Program policies?
On March 27, 2020, CMS announced a nationwide extraordinary circumstance exception (ECE) policy in which qualifying claims from January 1, 2020, through June 30, 2020, will be excluded from the claims-based SNFRM calculations. This policy will automatically apply to all SNFs, and no action is required on the part of SNF providers. SNFs do not need to submit an ECE form in order to qualify for this blanket ECE. CMS is aware that the ECE period falls within the currently planned performance period (FY 2020) of the FY 2022 SNF VBP Program. CMS continues to assess the impact of the COVID-19 ECE on the SNF VBP Program and will continue to communicate to SNFs any further policy adjustments to the SNF VBP Program as needed.

References: CMS Skilled Nursing Facility Value-Based Purchasing Program: Frequently Asked Questions Updated August 2020,

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