You are here

Why It's Vital to Integrate Rural Hospitals Into Value-Based Payment Programs

Measures of quality should be tailored to rural realities, National Quality Forum says

Integrating rural health care providers into federal public reporting and value-based payment programs would help the providers improve, give rural patients a better idea of how their providers perform, and make rural providers eligible for payment incentives, according to a report from the National Quality Forum (NQF).

Rural providers face different challenges than urban and suburban providers, making it difficult for many to achieve typical measures of quality, the NQF noted in an announcement reported by FierceHealthcare. As a result, a number of federal quality initiatives exclude rural providers because of their low patient numbers or how they are paid.

The report recommends that the Centers for Medicare and Medicaid Services (CMS) phase rural providers into reporting and value-based payment programs over two to four years and create rural pay-for-performance incentive programs that do not include penalties. It also recommends developing quality measures specific to rural providers "with the flexibility to choose additional measures from a menu of choices to better reflect their unique characteristics."

Experts in rural health should have a role in determining appropriate measures through a new Measure Applications Partnership workgroup created by the NQF, the report says. It also recommends several measures to address the statistical challenges posed by rural providers' low case volume.

Specific pay-for-performance recommendations include:

  • Offering rewards based on achievement or improvement.
  • Encouraging rural providers to voluntarily group together to obtain payment incentives.
  • Funding additional work to consider how to define peer groups for rural providers to be used for comparison purposes.

"Quality improvement is important in all care settings and for all patients," said Marcia Wilson, NQF's senior vice president for quality measurement. "The Rural Health Committee's recommendations to the Centers for Medicare and Medicaid Services are an important step toward ensuring better quality of care for rural Americans."

Not participating in CMS quality-improvement programs "potentially signals that rural providers cannot provide high-quality care," according to the report. The report comes a few weeks after a Leapfrog Group report finding that rural hospitals as a whole had lower safety scores than urban hospitals. The findings also come in the wake of research indicating that one in eight rural hospitals nationwide is at risk of closing.

Sources: FierceHealthcare, December 1, 2015.

Recent Headlines

Despite older, sicker patients, mortality rate fell by a third in 10 years
Study finds fewer than half of trials followed the law
WHO to meet tomorrow to decide on international public heath emergency declaration
Study of posted prices finds wild variations and missing data
Potential contamination could lead to supply chain disruptions
Delayed surgery reduces benefits; premature surgery raises risks
Mortality nearly doubled when patients stopped using their drugs
Acasti reports disappointing results for a second Omega-3-based drug
Declining lung cancer mortality helped fuel the progress