Participation in CMS quality measurement and quality improvement programs is mandatory for all rural providers”, according to a report released by the National Quality Forum’s Rural Health Committee. 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. Secretary Burwell’s 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 percent by the end of 2018). HHS also seeks to tie 85 percent of Medicare fee-for-service payments to quality by 2016 (90 percent 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 dialog 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 a 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 have a legacy of policies and programs that often do not “fit” current local needs and often have misaligned incentives that undermine high-value and efficient care delivery. Cost-based reimbursement, for example, has not created incentives for value-based models that invest less in technology-intensive medical services and more in health promotion, care coordination, improved clinical care quality, enhanced patient safety and experience, and better population health at lower per capita costs. Nonetheless, rural communities have enormous potential for achieving the objectives of the Triple Aim. Smaller systems can be more nimble in making the kind of change necessary to succeed in the current environment. New delivery arrangements may be pursued more easily among local clinical, behavior and public health providers who know and trust one another. Together, they share a collective interest in improving their community’s well-being. While the transition from the status quo will require a change in the balance and configuration of essential services, greater integration within and across service sectors, attention to population health, and shared governance and management structures, it is doable. My take away – rural providers can no longer stay idle. 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.