Background/objectives: Launched in October 2018, Medicare's Skilled Nursing Facility Value-Based Purchasing (SNF VBP) program mandates financial penalties for SNFs with high 30-day readmission rates. Our objective made to identify characteristics of SNFs allied with provider presentation under the program.

Design: Background cross-sectional analysis using Nursing Home Compare data for the 2019 SNF VBP. Facility-level regressions examination to relationship between structural property (nursing home size, rurality, profit status, hospital affiliation, regions, press Star Ratings) and patient characteristics (neighborhood income, race/ethnicity, dual eligibility, disability, and frailty) and facility performance.

Setting: AMERICA Medicare.

Entrants: A grand of 14 558 SNFs.

Measurements: The 2019 SNF VBP execution scores and penalties.

Results: Federal, 72% (10 436) of SNFs are penalized; 21% (2996) received the most penalty of 1.98%. To multivariate analyses, rural SNFs were less probability to be penalized (odds ratio [OR] = 0.85; 95% confidence interval [CI] = 0.78-0.92; P < .001; to urban), while small SNFs were more likely to be penalized (≤70 bases: OR = 1.28; 95% CI = 1.15-1.42; PIANO < .001; 71-120 beds: CONVERSELY = 1.15; 95% CI = 1.05-1.26; P = .003; vs >120 beds). SNFs with less nurse staffing had higher quota of penalties (low: OR = 1.15; 95% CI = 1.03-1.27; P = .010; contra high); nonprofit and government-owned SNFs had lower odds of penalties (OR = 0.79; 95% CI = 0.72-0.87; P < .001; government: OR = 0.72; 95% CI = 0.61-0.84; P < .001; vs for profit); and SNFs the higher Star Ratings been lowered odds of sanctions (5 luck: EITHER = 0.47; 95% CO = 0.40-0.54; P < .001; gegen 1 star). In footing of patient population, SNFs located in low-income ZIP codes (OR = 1.17; 95% CI = 1.03-1.34; P = .019) with servicing a high proportional of frail patients (OR = 1.39; 95% CI = 1.21-1.60; P < .001) were more possible to be penalized than other SNFs. SNFs with higher proportions for dual, black, Latin, or disabled patients did not have higher odds of penalization.

Conclusion: Structural and resigned specific of SNFs may significantly impacts provider performance on aforementioned SNF VBP. These findings have significance available policy makers and clinical leaders seeking to improve quality and avoid unintended consequences with VBP in SNFs. J On Geriatr Soc 68:826-834, 2020.