Version 1.2 Revised 7/20/2025

What Quality Measures are included in the Quality Incentive calculations?

The following quality measures are included in Virginia’s Value-Based Purchasing calculations:

  • Hospitalizations per 1,000 resident days (L)

  • ED visits per 1,000 resident days (L)

  • Pressure Ulcers (L)

  • UTI (L)

  • Total Nursing Staff per Resident per Day (Adjusted)

How is the Quality Incentive Payment calculated?

Virginia’s VBP for MDS QMs is calculated using real time QM Scores calculated by DatAlign for chs.care for the four-quarter rolling period ending with the current quarter to simulate how current performance would impact reimbursement. For the staffing QM, VBP is calculated using the latest CMS staffing data. Claims-based measures data is sourced from the latest CMS dataset, with the numerator extrapolated from our calculation of the denominator.

Points Assignment

Virginia’s VBP points are provided by the Department of Medical Assistance Services. For the Long Stay Pressure Ulcer QM, cut points have yet to be provided by DMAS. DatAlign calculated cut points by creating quartiles from the available QM data for CHS facilities. Points correspond with the 3 performance tiers (Best [75th percentile +, 100% of per diem], Better [Median - 75th percentile, 75% of per diem], Fair [25th percentile - Median, 50% of per diem], Below [< 25th percentile, 0% of per diem]) and range from 0-3.

From Points to Dollars and Cents

The Quality Incentive Payment is calculated using the following formula:

Per diem payment rate × Number of Medicaid days in the period

  • Per diem payment rates: 

    • For Hospitalizations

      • 1 point: $3.13

      • 2 points: $4.69

      • 3 points: $6.25

    • For ED Visits

      • 1point: $3.38

      • 2 points: $5.06

      • 3 points: $6.75

    • For Pressure Ulcers 

      • 1 point: $3.13

      • 2 points: $4.69

      • 3 points: $6.25

    • For UTI

      • 1 point: $2.13

      • 2 points: $3.19

      • 3 points: $4.25

    • For Staffing Hours 

      • 1 point: $4.73

      • 2 points: $7.09

      • 3 points: $9.45

  • Number of Medicaid days in the period: The sum of the days of care in the period for patients whose primary payer is Medicaid.

References

Virginia Department of Medical Assistance Services: REVISED/UPDATED SFY 2026 Nursing Facility Value-Based Purchasing Methodology


Version 1.2 Revised 7/20/2025