Skilled Nursing Facility 30-Day All-Cause Readmission Measure (SNFRM)

The following are excluded from the denominator:
1. SNF stays where the patient had one or more intervening post-acute care (PAC) admissions (inpatient rehabilitation facility [IRF] or long-term care hospital [LTCH]) which occurred either between the prior proximal hospital discharge and SNF admission or after the SNF discharge, within the 30-day risk window. Also excluded are SNF admissions where the patient had multiple SNF
admissions after the prior proximal hospitalization, within the 30-day risk window.

Rationale: For patients who have IRF or LTCH admissions prior to their first SNF admission, these patients are starting their SNF admission later in the 30-day risk window and receiving other additional types of services as compared to patients admitted directly to the SNF from the prior proximal hospitalization and their risk for readmission is different than the rest of SNF admissions. Additionally, when patients have multiple PAC admissions, evaluating quality of care coordination is confounded and even controversial in terms of attributing responsibility for a readmission among multiple PAC providers. Similarly, assigning responsibility for a readmission for patients who have multiple SNF admissions subsequent to their prior proximal hospitalization is also controversial.

2. SNF stays with a gap of greater than 1 day between discharge from the prior proximal hospitalization and the SNF admission.

Rationale: These patients are starting their SNF admissions later in the 30-day risk window than patients admitted directly to the SNF from the prior proximal hospitalization. They are clinically different and their risk for readmission is different than the rest of SNF admissions.

3. SNF stays where the patient did not have at least 12 months of FFS Medicare enrollment prior to the proximal hospital discharge and throughout the entire risk period (measured as enrollment during the month of proximal hospital discharge, for 11 months prior to that discharge, and the month after the month of discharge).

Rationale: FFS Medicare claims are used to identify comorbidities during the 12-month period prior to the proximal hospital discharge for risk adjustment. Readmissions occurring within the 30-day risk window when the patient does not have FFS Medicare coverage cannot be detected using claims.

4. SNF stays where the patient was discharged from the SNF against medical advice.

Rationale: The SNF was not able to complete care as needed.

5. SNF stays in which the principal diagnosis for the prior proximal hospitalization was for the medical treatment of cancer. Patients with cancer whose principal diagnosis from the prior proximal hospitalization was for other diagnoses or for surgical treatment of their cancer remain in the measure.

Rationale: Patients with a principal diagnosis of cancer for the prior hospitalization have a very different mortality and readmission risk than the rest of the Medicare population, and outcomes for these admissions do not correlate well with outcomes for other admissions.

6. SNF stays in which the principal primary diagnosis for the prior proximal hospitalization was for “rehabilitation care; fitting of prostheses and for the adjustment of devices”.

Rationale: Hospital admissions for these conditions are not for acute care.

7. SNF stays in which the prior proximal hospitalization was for pregnancy.

Rationale: While SNF stays in which the prior proximal hospitalization for pregnancy are very rare (for example, there were only 9 instances in FY2017) this measure is not intended to measure care related to pregnancy.

8. SNF stays in which data were missing or problematic on any covariate or variable used in the measure’s constructions.

Rationale: The needed data are not available to reliably calculate the measure score for the SNF.

9. SNF stays that took place in a CAH swing bed.

Rationale: CAHs are not paid on the SNF Prospective Payment System (PPS), therefore they are not eligible for the SNF VBP Program.