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Effect of post-acute care pay for performance in skilled nursing facilities on outcomes and disparities

Award Number: R01AG071610
ORGANIZATION: NATIONAL INSTITUTE ON AGING
OPDIV: NIH
AWARD CLASS: DISCRETIONARY
AWARD ACTIVITY TYPE: SCIENTIFIC/HEALTH RESEARCH (INCLUDES SURVEYS)
PERIOD OF PERFORMANCE START DATE: 03/01/2022
PERIOD OF PERFORMANCE END DATE: 11/30/2026

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Effect of post-acute care pay for performance in skilled nursing facilities on outcomes and disparities - Project summary Post-acute care (PAC) is increasingly common and costly. One in five Medicare beneficiaries receives care after hospitalization in a skilled nursing facility at a cost of more than $28 billion annually. Unfortunately, more than 1 in 4 Medicare beneficiaries are readmitted to the hospital within 30 days, and these readmissions are associated with increased mortality. The Skilled Nursing Facility Value-Based Purchasing program (SNF VBP) ties Medicare reimbursements to SNF to their 30-day all-cause hospital readmission rates. Determining the effect of SNF VBP on patient outcomes is crucial for patients, health systems, and policymakers, and will inform the development and implementation of similar programs in other post-acute care settings. Evaluating potential unintended consequences of this policy is especially important because SNFs face significant financial pressure, and SNFs that care for large proportions of patients who are especially vulnerable to adverse outcomes (e.g. frail, cognitively impaired, poor, or racial and ethnic minority populations) are most likely to be penalized under the program, potentially leading to increased disparities. The COVID-19 pandemic may have magnified the effects of SNF VBP, acting as a second “stress” on SNFs already stressed by SNF VBP. There is an urgent need to determine the effect of SNF VBP on patient outcomes and on disparities, especially given the magnifying effect of COVID-19. Our long-term goal is to drive the delivery of high-value care for all older adults leaving the hospital. SNF VBP is among the first pay-for-performance programs in post- acute care settings. In order to improve the development and success of these policies, it is crucial to understand how their design and implementation influences outcomes. Our central hypothesis, based on preliminary data, is that SNF VBP achieves its intended effects at SNFs that were already high-performing, but has unintended and negative effects at low-performing SNFs. Our specific aims are to: 1) Determine the impact of SNF VBP on intended outcomes prior to the COVID-19 pandemic; 2) Determine the effect of SNF VBP on disparities in outcomes in vulnerable populations; 3) Determine how financial penalties from SNF VBP impacted COVID-19 readiness and outcomes; and 4) Assess key aspects of organizational context among SNFs that improved performance in SNF VBP and explore how this impacted their response to COVID-19. Accomplishing these aims will improve the design of future VBP initiatives, and lead to higher-value care for the growing number of vulnerable older adults receiving SNF care.


Issue Date FY	Funding FY	Legal Entity Name	Legal Entity Address	Legal Entity City	Legal Entity State	Legal Entity Zip Code	Legal Entity COUNTY	Legal Entity COUNTRY	Assistance Listing	Award Code	Budget Year	Action Date	Action Type	Action Amount

Issue Date FY: 2026 ( Subtotal = $0 )
2026	2025	TRUSTEES OF THE UNIVERSITY OF PENNSYLVANIA, THE	3451 WALNUT STREET	PHILADELPHIA	PA	19104	PHILADELPHIA	USA	Aging Research	000	4	10/14/2025	NON-COMPETING CONTINUATION	$0
														Subtotal = $0

Issue Date FY: 2025 ( Subtotal = $582,417 )
2025	2025	TRUSTEES OF THE UNIVERSITY OF PENNSYLVANIA, THE	3451 WALNUT ST STE 440A	PHILADELPHIA	PA	19104	PHILADELPHIA	USA	Aging Research	001	4	7/23/2025	NON-COMPETING CONTINUATION	$47,545
2025	2025	TRUSTEES OF THE UNIVERSITY OF PENNSYLVANIA, THE	3451 WALNUT ST STE 440A	PHILADELPHIA	PA	19104	PHILADELPHIA	USA	Aging Research	000	4	11/21/2024	NON-COMPETING CONTINUATION	$534,872
														Subtotal = $582,417

Issue Date FY: 2024 ( Subtotal = $614,754 )
2024	2024	TRUSTEES OF THE UNIVERSITY OF PENNSYLVANIA, THE	3451 WALNUT ST STE 440A	PHILADELPHIA	PA	19104	PHILADELPHIA	USA	Aging Research	001	3	5/13/2024	NON-COMPETING CONTINUATION	$61,474
2024	2024	TRUSTEES OF THE UNIVERSITY OF PENNSYLVANIA, THE	3451 WALNUT ST STE 440A	PHILADELPHIA	PA	19104	PHILADELPHIA	USA	Aging Research	000	3	11/16/2023	NON-COMPETING CONTINUATION	$553,280
														Subtotal = $614,754

Issue Date FY: 2023 ( Subtotal = $589,630 )
2023	2023	TRUSTEES OF THE UNIVERSITY OF PENNSYLVANIA, THE	3451 WALNUT ST STE 440A	PHILADELPHIA	PA	19104	PHILADELPHIA	USA	Aging Research	000	2	1/5/2023	NON-COMPETING CONTINUATION	$589,630
														Subtotal = $589,630

Issue Date FY: 2022 ( Subtotal = $330,148 )
2022	2022	TRUSTEES OF THE UNIVERSITY OF PENNSYLVANIA, THE	3451 WALNUT ST STE 440A	PHILADELPHIA	PA	19104	PHILADELPHIA	USA	Aging Research	000	1	3/1/2022	NEW	$330,148
														Subtotal = $330,148

Grand Total All Awards = $2,116,949

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Effect of post-acute care pay for performance in skilled nursing facilities on outcomes and disparities

Award Number: R01AG071610

ORGANIZATION: NATIONAL INSTITUTE ON AGING

OPDIV: NIH

AWARD CLASS: DISCRETIONARY

AWARD ACTIVITY TYPE: SCIENTIFIC/HEALTH RESEARCH (INCLUDES SURVEYS)

PERIOD OF PERFORMANCE START DATE: 03/01/2022

PERIOD OF PERFORMANCE END DATE: 11/30/2026

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