The Centers for Medicare & Medicaid Services (CMS) launched its Quality Payment Program (QPP) in 2017, which considerably changes the way physicians are paid under Medicare. There has been significant concern about the ability of small rural practices to successfully participate in the program. To address these concerns, RAND researchers conducted interviews with physicians in small rural practices on the initial implementation of the QPP in order to understand the flexibility provisions for small rural practices and to inform future federal rulemaking for the QPP.
The findings of this work suggested that small rural practices were struggling to participate in the QPP. Interviewees reported frustration with a lack of clarity of program details, requirements that appeared to be determined late and were subject to change, and the amount of effort needed to participate. Interviewees suggested several changes to the QPP and Medicare policy to improve the ability of small rural practices to participate in the program. These changes included clarifying and specifying program requirements, reducing the frequency of program policy changes, avoiding penalizing small practices that serve vulnerable populations, developing less obtrusive methods for assessing the quality of care of small practices, providing additional information technology support for small rural practices, and enabling greater engagement of rural physicians by policymakers.
This report summarized strategies Indian Health Service (IHS) clinics have used to implement the Patient-Centered Medical Home (PCMH) model of care, challenges they faced during implementation, and lessons learned that might benefit IHS clinics that have not yet received PCMH recognition. Common strategies to address challenges included use of telemedicine and partnerships with academic medical centers, and engaging tribal leaders and publicizing PCMH-related changes to the community to secure buy-in on major changes. Many IHS clinics faced PCMH implementation challenges broadly consistent with those of small and rural clinics outside of the IHS.
Findings in this report included lessons learned to help facilitate broader implementation of the patient-centered medical home model throughout the IHS system of care.
This report examined the participation and performance of rural hospitals in delivery system reform efforts and practices a discussion of potential enabling factors for and barriers to hospitals’ successful participation and performance in delivery system reform. The report found that rural hospitals and communities have many strengths that lend themselves particularly well to the type of coordination and cooperation that delivery system reform hopes to promote. The report also found that rural inpatient prospective payment hospitals participating in value-based payment programs had generally good results.