MAP 2019 Recommendations from the Rural Health Technical Expert Panel Final Report 

Low case-volume presents a significant measurement challenge for many rural providers, particularly when they want to compare their performance to that of other providers (both rural and non-rural) and when they want to identify areas for improvement. Rural areas are, by definition, sparsely populated, and this can affect the number of patients eligible for inclusion in healthcare performance measures, particularly condition- or procedure-specific measures. Other challenges faced by rural residents, such as distance to care or lack of transportation, can also lead to low case-volume in healthcare performance measurement. In 2018, as an extension of NQF’s work in convening the MAP Rural Health Workgroup, CMS tasked NQF with eliciting expert input on promising statistical approaches that could address the low case-volume challenge, as it pertains to healthcare performance measurement of rural providers. To develop recommendations to address the low case-volume challenge for rural providers, NQF convened a five-member Technical Expert Panel (TEP) comprised of statistical experts and measure methodologists. As part of the effort, the TEP reviewed previously identified approaches to the low case-volume challenge and offered four new recommendations. TEP members also suggested several additional ideas for future work that could further address the low case-volume challenge for rural providers.