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Home Health Care Policies: Skilled Nursing Facility Utilization and Payment Data

Posted by Nathan Hope on Mar 14, 2016

Home Health Care Policies: The Skilled Nursing Facility Utilization and Payment Public Use File (SNF PUF) contains information on utilization, payments, and submitted charges organized by provider, state, and resource utilization group (RUG).  The data include information on 15,055 skilled nursing facilities, over 2.5 million stays, and almost $27 billion in Medicare payments for 2013. The data set does not contain any individually identifiable information about Medicare beneficiaries.

“The Skilled Nursing Facility data released today is yet another example of our commitment to greater data transparency,” said CMS Chief Data Officer Niall Brennan.  “CMS believes that when information flows more freely, the health care system functions more efficiently.  This leads to better care, smarter spending, and healthier people.”    14-11-04-CMS

In addition to information on payments and charges, the SNF PUF contains information on two categories of RUGs for patients who receive a significant amount of therapy: Ultra-High (RU) and Very High (RV) Rehabilitation RUGs. Consistent with prior CMS findings, the SNF PUF shows that for these two RUGs, the amount of therapy provided is often very close to the minimum amount of minutes needed to qualify a patient for these categories.  Medicare SNF per diem payment amounts for rehabilitation RUGs are primarily based on therapy minutes and payment amounts for these two RUGs can exceed payments for comparable RUGs with fewer therapy minutes by more than 25 percent.

“CMS strives to ensure that patient need, rather than payment system incentives, are driving the provision of therapy services,” says Dr. Shantanu Agrawal, Deputy Administrator for Program Integrity and Director of the Center for Program Integrity.  “These concerns have prompted us to refer this issue to the Recovery Auditor Contractors (RAC) for further investigation, and our hope is that data transparency will facilitate real changes.”  

The SNF PUF was created from CMS administrative claims data for Medicare beneficiaries enrolled in the fee-for-service program available from the CMS Chronic Condition Data Warehouse (www.ccwdata.org).  The data cover calendar year 2013 and is based on SNF Part A institutional claims.

To view a fact sheet on the Skilled Nursing Facility data set, visit:https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2016-Fact-sheets-items/2016-03-09.html

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