NQF Report Recommends Rural Health Providers Participate in Medicare Quality Initiatives 

NOV 25, 2015

CONTACT: Sofia Kosmetatos


NQF Report Recommends Rural Health Providers Participate in Medicare Quality Initiatives

Washington, DC—A new National Quality Forum (NQF) report recommends integration of rural healthcare providers into federal public reporting and value-based payment programs. The report, which summarizes the recommendations of a multi-stakeholder 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 federal quality initiatives exclude some rural hospitals and clinicians because of how these providers are paid or due to the measurement challenges they pose given the low volume of patients they serve. According to the report, such exclusion may affect the ability of these providers to identify and address opportunities for improvement and demonstrate how they perform compared to their non-rural counterparts. Such exclusions also may deny rural residents access to data about provider performance. In addition, exclusion from federal quality programs may deny rural providers the ability to earn payment incentives that are available to other providers.

“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 & Medicaid Services are an important step toward ensuring better quality of care for rural Americans.”

The report recommends phasing in rural providers’ participation in federal public reporting and value-based payment programs over two to four years and addressing the challenge of low case volume for measurement. To ease the transition to mandatory reporting, the report suggests the development of rural-relevant measures and requiring reporting of a core set of measures across all rural providers, with the flexibility to choose additional measures from a menu of choices to better reflect their unique characteristics. The report also recommends the creation of pay-for-performance incentive programs that include incentive payments, but not penalties.

The report voices 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 makes 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.


The National Quality Forum leads national collaboration to improve health and healthcare quality through measurement. Learn more at www.qualityforum.org.