The New SNF VBP Readmission Measure: What Counts Starting FY 2028

For years, the readmission piece of the SNF Value-Based Purchasing (VBP) program has been the SNF 30-Day All-Cause Readmission Measure, known as SNFRM. That is changing. Starting with the FY 2028 program year, CMS replaces it with the SNF Within-Stay Potentially Preventable Readmission measure, or SNF WS PPR. The new measure looks only at what happens while a resident is in your building, and only at readmissions CMS considers potentially preventable.

When the Change Takes Effect

CMS adopted the replacement in the FY 2024 SNF PPS final rule, published in August 2023. The SNFRM's last program year is FY 2027. SNF WS PPR is the readmission measure starting with the FY 2028 program year, which sets payment adjustments for Medicare claims from October 1, 2027 through September 30, 2028.

Here are the confirmed data periods for that first year:

• Performance period: October 1, 2024 through September 30, 2026 (FY 2025 and FY 2026)
• Baseline period: October 1, 2021 through September 30, 2023 (FY 2022 and FY 2023)

Unlike the SNFRM, which uses one year of data, SNF WS PPR is a two-year measure. That means the first performance period has already ended. Stays from those two years have been counted, and today's work will show up in later program years.

What the Measure Counts

The measure estimates a risk-standardized rate of unplanned, potentially preventable hospital readmissions during SNF stays for Medicare fee-for-service residents. A few details matter for your team:

• "Within stay" means the SNF stay itself. The window runs from the day after admission through the day of discharge. It includes a direct transfer to the hospital at the end of the stay.
• "Potentially preventable" is a defined list. CMS uses a set of conditions identified with input from a technical expert panel and a clinician review team. Readmissions for other reasons do not count against you.
• Planned readmissions are excluded. A scheduled procedure, for example, is not counted.
• It is risk adjusted. The model accounts for factors such as age, sex, the reason for the prior hospital stay, surgery during that stay, comorbidities and prior hospital use. A facility that takes sicker residents is not compared as if its residents were average.
• No extra reporting. The measure is calculated entirely from Medicare claims, so there is nothing new to submit.

Facilities need at least 25 eligible stays across the two-year performance period for the measure to be scored. Some groups are excluded, such as residents who leave against medical advice and stays that begin more than 30 days after a hospital discharge.

How Scoring and Payment Work

The scoring method itself is not new. CMS confirmed in the FY 2026 final rule that the program's existing scoring rules apply to SNF WS PPR.

For each measure, CMS calculates two scores and keeps the higher one:

• Achievement score (0 to 10): your result compared with national performance during the baseline period.
• Improvement score (0 to 9): your result compared with your own baseline.

Measure scores are normalized and added together into a total performance score from 0 to 100. CMS withholds 2% of each SNF's Medicare fee-for-service Part A payments and pays back 60% of that pool as incentive payments based on those scores. The other 40% stays with Medicare. Higher scores earn back more of the withhold. Lower performers can end up with a net payment reduction.

Why the Focus Moves Inside the Building

The old measure looked at unplanned readmissions within a 30-day window, from any cause. All-cause means a readmission counted whatever the reason, whether or not anyone could reasonably have prevented it.

SNF WS PPR narrows the lens. It counts preventable readmissions that happen on your watch. That puts more weight on how quickly staff notice a change in condition, how clearly it is reported and documented, and how reliably the team follows its protocols when a resident starts to decline. Because the window opens the day after admission, the early days of a stay count from the start.

What to Do Now

These steps keep the focus on systems and teamwork, not individual blame.

• Review recent transfers back to the hospital. Look at timing, how the change in condition was first noticed and how it was communicated. Look for patterns, not fault.
• Tighten change-in-condition reporting. Make sure CNAs and nurses know what to report, to whom and how fast, using your facility's tools and protocols.
• Strengthen the first 72 hours. Confirm that admission reconciliation, baseline assessments and handoffs are complete and documented.
• Bring the data to QAPI. Track hospital transfers by unit, shift and day of stay, and review them with your medical director.
• Watch your VBP results. Review your facility's SNF VBP reports from CMS as they are released so you know where your readmission scores stand.

A daily admission risk screen, such as the one Keystone runs from PointClickCare data, is one way to help teams spot residents who may need closer watching sooner.

This article is general education for skilled nursing teams. Follow your facility's policies and the direction of your medical director and providers.