October 1, 2018 = The Beginning of a New Era for Skilled Nursing Facilities

The clock is counting down for skilled nursing facilities across the nation. This Monday, October 1, 2018, marks the beginning of transformative change, sweeping through our industry, leaving us breathless on a daily basis.

Below are some of the changes affecting organizations and how we do business today and in the future:

  • SNFVBP, SNFRM, SNFPPR– The implementation of Skilled Nursing Facility Value Based Purchasing (SNFVBP) and the Skilled Nursing Facility Readmission Measure (SNFRM) as well as the continued data collection and comparison of each facilities outcomes for the Skilled Nursing Facility Potentially Preventable Readmission measure (SNFPPR). After years of beta testing and study, we are commencing the transition from fee-for-service to value-based-care. Utilization of your organization data to determine your facility “value” in the new marketplace, leading the quality incentive payment on your base Medicare rate (2% earn back potential via the SNFVBP requirements).
  • Patient-Driven Payment Model (PDPM) – Commencement of the conversion from RUGs to PDPM – how we receive reimbursement for the care and services we provide. Facilities will have a year to transition to PDPM from RUG-IV by the October 1, 2019 implementation date. The new payment methodology focuses on resident characteristics and value-based care.
  • MDS/RAI Process – MDS 3.0 changes effective October 1st with an updated RAI Manual, specific section and coding changes and more. These changes will impact calculations in the Skilled Nursing Facility Quality Reporting Program (SNFQRP), SNF PPS, SNF VBP – ultimately impacting our organization data, quality outcomes and reimbursement. These changes mark the transformation towards PDPM and reimbursement methodology changes coupled with quality measure changes.
  • BPCI Advanced – Bundled Payments for Care Improvement Advanced, CMS’ newest bundled payment model, begins Oct. 1. This bundle payment model includes 32 clinical episodes with seven specific quality measures that will determine quality and reimbursement outcomes for acute care providers/practitioners. Two of the measures are required for all clinical episodes – all cause readmission measure and the advance care plan measure. Hospitals and practitioners will align with post-acute care partners that can effectively improve these quality benchmarks. Readmissions/hospitalizations are key for ALL health care providers starting October 1st!

Leadership Considerations:

These changes continue to stretch our leadership skills and organization resources as we prepare for all that is now upon us. I recommend following the below leadership strategy, to assist you in guiding your team through change:


  • First take a deep breath and know that your team has skills and talents that have gone untapped!
  • Collaborate – The changes require staff at all levels. Gather your key team members!
  • As a team, enhance your knowledge and understanding of the changes (regulatory, reimbursement, quality measurement)
  • Pull together with your team, what requires attention and what needs to be completed


  • Review the list with the team and ask: what is immediate (which could have a serious and immediate negative impact) and what is important (that which needs to be accomplished, however there are possibly a few more days to complete some of the tasks).
  • Determine if any of the tasks listed are inter-related or have inter-dependencies.
  • Assess the status of the listed priority items to determine the actions needed to align with the change requirements (often times the current system or policy needs a slight revision and can be accomplished with minimal actions needed)
  • Determine top priorities with your team – remember during change, many leaders believe everything is a priority which is not realistic. Through an organized process, you and your team (including staff at all levels), can achieve successful results related to all of the changes.


  • Assess organization current status as it relates to the specific change needs
  • Determine the actions needed to revise current processes, training, potential competency testing as well as monitoring of implementation outcomes, identifying improvement opportunities
  • Assign priority leads for each priority area agreed upon
  • Create an overall education plan to include related to the priorities, engaging staff at all levels. The more your team collaborates, the more engaged your staff will become.
  • Communicate! Leading through change requires an increased level of communication to all layers of the organization. Why are things changing? How are we going to get there? What is my role?
  • Present your vision for change and the transformation needed


  • Monitor outcomes and integrate into the facility QAPI process
  • Determine areas requiring modification or improvement
  • Communicate outcomes with your team and key stakeholders as applicable
  • Don’t forget to celebrate successes with your entire team

With the health care environment increasing in complexity, transforming the way we lead and how healthcare is delivered and managed within our organization and in collaboration with our partners is the key to success. The key competitive advantage today is the ability to change, adapt, and evolve, in order to achieve sustainable and successful outcomes.

Pathway Health can support and assist the implementation of SNFVBP.

Contact us to learn how.