Rural Providers must participate in CMS quality measurement and improvement

Sue Deitz, Regional Vice President, National Rural ACO

According to a report released by the National Quality Forum (NQF) Rural Health Committee, “Participation in CMS (Centers for Medicare & Medicaid Services) quality measurement and quality improvement programs is mandatory for all rural providers.”

The NQF report, Performance Measurement for Rural Low-Volume Providers, outlines recommendations that transition rural providers into value based purchasing and is further evidence that rural performance measurement is here to stay. It is no longer a choice.

U.S. Department of Health and Human Services (HHS) Secretary Burwell has laid the track when she announced that 30% of all Medicare provider payments will be tied to alternative payment models—e.g., accountable care organizations (ACOs), primary care medical home (PCMH) models, bundled payment arrangements, etc.—by the end of 2016 (50% by the end of 2018).

HHS also seeks to tie 85% of Medicare fee-for-service payments to quality by 2016 (90% by 2018) through programs such as the Hospital Value-Based Purchasing and the Hospital Readmissions Reduction Program. 

The recommendations in the NQF report furthered our dialogue of how we can accomplish Secretary Burwell’s goal given the challenges faced by the rural providers. Specifically, the report called for the need for rural-relevant measures that can address low case volume explicitly and consideration of a sociodemographic risk adjustment. 

It proposed the use a core set of measures, along with a menu of optional measures for rural providers and encouraged the measures that are used in patient-centered medical home models.  It recommended performance be tied to incentive payments, not penalties.

And most striking was the accelerated timeframe with the creation of incentive-only payment programs for rural providers within three years and mandatory participation in CMS quality improvement programs within two to four years.

Rural providers do not ignore this shift.  The greatest threat to the sustainability of rural healthcare systems is not participating in rural performance measurement. The market will force doctors and patients to choose high value providers and partners—and rural will be left behind.

The NQF recommendations provide a framework to adapt rural practice delivery models. Programs will support adequately and appropriately staff providers, develop health information architectures with the capacity exchange of health information and support care transition/coordination among the continuum of care, adequately reimburse and promote the use of telehealth, and encourage prevention, wellness and local public health.

I am well aware that it’s not that simple. To have a sustainable system, we must provide evidence-based care that meets the Triple Aim, but how does a complex system comprised of dozens of separate interests, thousands of actors and varying practice traditions move to embrace such dramatic change? As a NRHA Fellow I will aim to answer this question.