A new National Quality Forum (NQF) report recommends that the Centers for Medicare & Medicaid Services (CMS) make performance measurement mandatory for rural healthcare providers. The report, which summarizes the recommendations of a multistakeholder Rural Health Committee convened by NQF, notes the urgency for integrating rural providers into Medicare quality improvement programs in light of recent Congressional legislative actions and efforts by the U.S. Department of Health and Human Services to accelerate a timeframe for paying providers based on quality and cost.
Although rural hospitals and clinicians participate in a
variety of private-sector, state, and federal quality measurement and
improvement efforts, many CMS quality initiatives exclude some rural hospitals
and clinicians because of how these providers are paid or measurement
challenges. According to the report, such exclusion may affect the ability of
these providers to identify and address opportunities for improvement and deny
rural residents access to data about provider performance. In addition,
exclusion from the CMS quality programs denies rural providers the ability to
earn payment incentives that are open to other providers.
“Quality improvement is important in all care settings and
for all patients,” said Marcia Wilson, senior vice president, quality
measurement, for NQF. “The Rural Health Committee’s recommendations to CMS are
an important step toward ensuring better quality of care for rural Americans.”
The report recommends that CMS allow a phased approach (over
two to four years) for rural providers’ participation across program types and
that the agency address the challenge of low case volume in measurement. To
ease the transition to mandatory reporting, the report suggests that CMS
develop rural-relevant measures; develop and use a core set of measures and an
optional menu of measures for providers; and create pay-for-performance
incentive programs that include incentive payments, but not penalties.
The report voiced strong Committee recommendations that
experts in rural health be given a role in the selection of measures through
the formation of a new NQF-convened Measure Applications Partnership workgroup
focused on rural health. Finally, the report made several recommendations for
how to address the issue of low case volume among rural providers, which results
in statistical challenges. Examples
include considering measures that are broadly applicable across rural providers
and measures that reflect population health.
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