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Date ArticleType
2/6/2017 Payment/Reimbursement
CMS Releases SNF Utilization and Payment Data for 2014

On Wednesday, January 18, 2017, the Centers for Medicare and Medicaid Services (CMS) posted its second annual release of the Skilled Nursing Facility Public Use File (SNF PUF) with data for calendar year (CY) 2014. The 2014 SNF PUF provides facility-level, state aggregate, and national aggregate data with a special focus on two specific Resource Utilization Group (RUG) categories: RV (Very-High Rehab) and RU (Ultra-High Rehab).

The 2014 SNF PUF file is part of the CMS data transparency initiative and follows up on a similar release of CY 2013 SNF PUF on March 9, 2013. Last year's SNF PUF data was subsequently reported in the press and was used as part of the U.S. News and World Report's nursing home rankings methodology, as well as part of a CMS Recovery Audit Contractor (RAC) investigation. 

The 2014 SNF PUF contains information on utilization, payment (allowed amount, Medicare payment and standardized payment), and submitted charges organized by six-digit identification number, RUG, and state of service. This PUF is based on information from CMS's Chronic Conditions Data Warehouse data files, the 2014 Long-Term Care Minimum Data Set 3.0, and the CMS Provider of Service file. The data in the SNF PUF contains 100 percent final-action (i.e., all claim adjustments have been resolved) SNF Part A claims for the Medicare fee-for-service (FFS) population. For privacy purposes, CMS did not report data in cell tables that represented 10 or fewer beneficiaries.
The 2014 SNF PUF contains five tables:

• Aggregated information by provider
• Aggregated information by provider and RUG
• Aggregated information by RUG
• Aggregated information by RUG and state
• Aggregated information on therapy minutes

The Methodology Overview also highlights some limitations in these files. The most notable includes the information presented "does not indicate the quality of care provided."    

New in 2014 SNF PUF data is demographic and chronic condition information via hierarchical condition categories (HCCs) that helps better identify patient characteristics and attributes spending risk to facility-level detail. A brief discussion of the new HCC data is below.
Because the 2104 SNF PUF data files contain facility-specific Medicare Part A utilization data, AHCA recommends that members look up your centers in the tables listed near the bottom of this message. Files that contain SNF-specific data are those that include the six-digit "Provider ID" in the first column.
New Patient Characteristics/Risk-Adjustment HCC Information in 2014 SNF PUF

The Data Methodology file indicates that for this analysis, CMS applied an existing risk-adjustment model that uses HCCs to assign risk scores at the facility-level. Those scores traditionally have been used to estimate how beneficiaries' FFS spending will compare to the overall average for the entire Medicare population. The average risk score is set at 1.08. Beneficiaries with scores greater than that are expected to have above-average spending - and vice versa. 

Risk scores are based on the following for beneficiaries:

• Age and sex
• Whether they are eligible for Medicaid, first qualified for Medicare on the basis of disability, or live in an institution (usually a nursing home)
• Diagnoses from the previous year

The HCC model was designed for risk adjustment on larger populations, such as the enrollees in a Medicare Advantage (MA) plan, and generates more accurate results when used to compare groups of beneficiaries rather than individuals. 

CMS has not indicated what it plans to do with this new application of HCCs as the SNF facility-level. However, the following highlights some of the AHCA preliminary findings about the average SNF HCC scores in 2014 PUF for all 15,026 SNF Part A stays. These results reflect to some degree, the complexity of the SNF Part A population. 

The specific HCCs listed in the 2014 SNF PUF also reveal some detail at the facility-level. The summary table below indicates just how common several chronic conditions are observed in SNF and must often be managed during a beneficiary's Part A stay.

Important Links and Resources

Provider Aggregate Table: Contains information on utilization and payment (provider charges, allowed amount, Medicare payment, standard payment, stay profiles, beneficiary demographics, and chronic conditions), organized by SNF.
Provider by RUG Aggregate Table: Contains information on utilization and payment (provider charges, allowed amount, Medicare payment, and standard payment), organized by SNF and RUG. Note: Due to beneficiary privacy requirements, this file provides facility-level RUG details only if there were more than 10 beneficiary assessments that qualified for that specific RUG case mix. 
RUG Aggregate Table and RUG/State Aggregate Table: Contain information on utilization, Medicare payment, and submitted charges organized by RUG and RUG by state respectively.

Therapy Minutes Aggregate Table: Contains information on the number of RV and RU assessments submitted by a SNF, as well as the percent of RV and RU assessments where the number of therapy minutes falls within 10 minutes of the minimum therapy minute threshold necessary to qualify for that RUG category.

Additional information can be found at the CMS Frequently Asked Questions page. Inquiries regarding this data can be sent to MedicareProviderData@cms.hhs.gov.

AHCA also plans to host a member-only webinar on the data and how to use it. Please look for more information to come soon. In the meantime, please contact Dan Ciolek with any questions.