Are rural hospitals properly tracking and reporting healthcare-associated infections like clostridium difficile? What about screening their patients in ambulatory clinics for alcohol use and abuse?
Those quality measures are among a set of suggested measures the National Quality Forum released Tuesday in an effort to put rural providers “on a pathway” to improvement.
The measures are part of the NQF’s Measure Applications Partnership (MAP), created under the Affordable Care Act to provide input to the U.S. Department of Health and Human Services on the best performance measures for public reporting and performance-based payments.
In this latest project, MAP singled out 20 measures that to fit the unique needs of rural providers and address their key concerns, such as access to care.
Shantanu Agrawal, CEO of the forum, told FierceHealthcare that rural providers are often left out of quality improvement programs—but they don’t necessarily want to be. “The clinicians themselves have been asking for this kind of approach,” Agrawal said. “This is not something unexpected for them.”
The forum has recommended that the Centers for Medicare & Medicaid Services adopt the measures in Medicare first, and then potentially expand them to Medicare Advantage.
Ensuring that rural hospitals and providers can participate in quality improvement is crucial, he said, as 59 million Americans live in rural areas covered by these facilities.
The set includes nine measures intended for a hospital setting—such as scores on the Hospital Consumer Assessment of Healthcare Providers (HCAHPS) survey and Cesarean section rates—and 11 for ambulatory care settings, such as medication reconciliation postdischarge and preventive screenings for diabetes, behavioral health issues and tobacco use.
“We’re in a healthcare crisis in rural America. Every American is entitled to quality healthcare. If we don’t pay attention, rural America will fail.” Thank you @SenatorHeitkamp for your commitment to improving access in #rural communities. pic.twitter.com/qcyac00Lfy— NationalQualityForum (@NatQualityForum) September 18, 2018
Agrawal said the measure set is a “first important iteration” that NQF can continue to evolve and polish.
In addition to providing benchmarks for rural facilities, providing them with a set of quality measures can jump start their adoption of new payment models, Agrawal said.
Having a set of core measures, he said, can also ease the administrative burden on rural providers and offer a standardized system for reporting.
MAP’s push to quality measures for rural hospitals could also have broader implications, Agrawal said.
Developing the measures, he said, raised a larger red flag—quality measures related to access are lacking in general, not just for rural providers. Elisa Munthali, senior vice president of quality measurement at NQF, told FierceHealthcare the group hopes that spotlighting this issue can lead to more funding for research into ways to measure access issues more broadly.
“We learned through this work that access measures today really aren’t where they need to be,” Agrawal said.