Rural Quality is Subpar According to the AHRQ

Sue Deitz, Regional Vice President, National Rural Accountable Care Consortium

One of the discussions in our region is about how rural areas score in quality?  Well, according to Agency for Healthcare Research and Quality (AHRQ) Chartbook on Rural Health, not too good.  The AHRQ publication released in August 2015 explains that rural counties report “worse” in the four of five NQF priorities: effective treatment, patient safety, healthy living, and access when compared to their urban counterpart.  Rural scores the “same” in patient centeredness, but on no occasion does rural score “better.” In fact the more rural you get, the worse the quality scores. This is not good news for rural providers given the increasing reporting requirements on the horizon. 

Take hospitalizations due to ambulatory care-sensitive conditions (ACSCs) such as hypertension and pneumonia. How does rural score on these hospitalizations that can be largely prevented if ambulatory care is provided in a timely and effective manner?  You guessed it: not too good.  According to the report, the rate of potentially avoidable hospitalizations for all conditions for people living in rural counties was higher than for residents living in metropolitan areas. 

Same thing with Emergency Department (ED) utilization: the further you get away from the city the more people use the ED.  AHRQ reports that the rate of ED visits per 100,000 was higher for rural residents when compared with urban. ED visits are costly and may be indicative of poor care management, inadequate access to care, or poor choices on the part of beneficiaries. ED visits for conditions that are preventable or treatable with appropriate primary care lower health system efficiency and raise costs.

This data is very representative of what we see in our National Rural Accountable Care Organization (NRACO) data, and it is driving our services. Understanding your quality scores in preparation for value-based payment models must be a priority for all rural healthcare providers. How do you score?