CMS NEWS
FOR IMMEDIATE RELEASE
March 9, 2016
Contact: CMS Media Relations
(202) 690-6145 | CMS
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CMS releases Skilled Nursing Facility utilization and
payment data
Data serve as comprehensive resource for information
on skilled nursing facility costs and services
As
part of our efforts to increase the transparency of federal health programs,
the Centers for Medicare & Medicaid Services (CMS) today released a public
data set that provides information on services provided to Medicare
beneficiaries by skilled nursing facilities (SNFs). 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.”
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:
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