Skilled Nursing Facility Care Coordination Toolkit

Collaborating with partners, providers, patients, families,and caregivers to improve and lower healthcare Nursing Facility care Coordination ToolkitAn overview of care Coordination best practices to avert hospital readmissionsDownload available at: Page | 1 Table of Contents Executive Summary Readmission Prevention .. Skilled Nursing Facility (SNF) Resident Rehospitalization Tip Sheet Top 10 Things to Know About SNF Readmissions Measure SNF Readmission Exclusion Criteria Accessing Official Rehospitalization Data Tip Sheet Readmission Pre/Post Assessment Readmission PIP Sample Readmission Strategy Tree Sample Reducing Adverse Drug Events.

Skilled Nursing Facilities Readmission Measure (SNFRM) The SNFRM is the measure used to evaluate SNFs in the SNF VBP Program. The program ties portions of SNFs payments to their performance on this measure, which is calculated by assessing the risk-standardized rate of all-cause, unplanned hospital readmissions for Medicare

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