Why it's vital to integrate rural hospitals into value-based payment programs

Integrating rural healthcare providers into federal public reporting and value-based payment programs would help the providers improve, give rural patients a better idea of how their providers perform, and make rural providers eligible for payment incentives, according to a new National Quality Forum (NQF) report.

Rural providers face different challenges than urban and suburban providers, making it difficult for many to achieve typical measures of quality, the NQF noted in an announcement. As a result, a number of federal quality initiatives exclude rural providers because of their low patient numbers or how they are paid.

The report recommends that the Centers for Medicare & Medicaid Services (CMS) phase rural providers into reporting and value-based payment programs over two to four years and create rural pay-for-performance incentive programs that do not include penalties. It also recommends developing quality measures specific to rural providers "with the flexibility to choose additional measures from a menu of choices to better reflect their unique characteristics."

Experts in rural health should have a role in determining appropriate measures through a new Measure Applications Partnership workgroup created by the NQF, the report says. It also recommends several measures to address the statistical challenges posed by rural providers' low case volume.

Specific pay-for-performance recommendations include

• Offering rewards based on achievement or improvement
• Encouraging rural providers to voluntarily group together to obtain payment incentives
• Funding additional work to consider how to define peer groups for rural providers to be used for comparison purposes

"Quality improvement is important in all care settings and for all patients," Marcia Wilson, NQF's senior vice president for quality measurement, said in the announcement. "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."

Not participating in CMS quality-improvement programs "potentially signals that rural providers cannot provide high-quality care," according to the report. The report comes a few weeks after a Leapfrog Group report finding that rural hospitals as a whole had lower safety scores than urban hospitals.

The findings also come in the wake of research indicating that 1 in 8 rural hospitals nationwide is at risk of closing.