National Rural Health Day 2015: Quality Wins

October 29, 2015
iVantage Health

by Hunter Clark, Rural Health Consultant

With the onset of the PPACA, a Republican Congress and Senate, and a Presidential election looming, the future of rural healthcare promises more uncertainty. Secretary Burwell’s announcement and further reform proposals to Medicare payments specific to hips and knee cases continues to push from the historic volume-based model. Although not yet instituted at CAHs, the message to all hospitals from Medicare is clear: Quality and cost of care are now more important than ever.

In partnership with the National Rural Health Association (NRHA), iVantage recently recognized the Top 20 Critical Access Hospitals (CAHs) in the areas of overall performance, Quality, Patient Satisfaction, and Financial Stability. Seventy-six hospitals were presented with performance leadership awards at the 14th annual NRHA Rural Health Clinic and Critical Access Hospital Conference. The session celebrated those CAHs that are — despite the challenges — outperforming the majority of hospitals around the country. By highlighting the excellent work at each of these facilities, iVantage and the NRHA hope to inspire the entire rural healthcare community.

What Separates a Top Performer from the Rest?

iVantage has completed research surrounding the Top 20 CAH cohorts, highlighting their relative strength to all CAHs around the country. In order to recognize the Top Quality performers, iVantage leveraged the well-known, publicly reported Medicare Process of Care measures that have become an industry standard. The results seen in the graph below speak for themselves:

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Although CAHs are not mandated to report these measures, and receive no compensation for performance, top CAHs are taking these metrics very seriously. Not only are they taking the time to monitor, track, and report these measures, but the top CAHs in the country are already performing perfectly on Medicare’s POC measures. If you believe that Secretary Burwell will continue to aggressively marry payments with performance, then you can look to these leaders as those who are most prepared to accept the challenge of value-based reimbursement.

As Medicare sets standards around specific measures, hospitals adapt to comply. The result? Topped out performance metrics that require Medicare to retire the old and bring in the new. There is no better example than the current VBP program and its treatment of the aforementioned Quality POC measures. In program year 2017 they will represent just 5% of the VBP “market basket.”

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Join us on November 19!

As National Rural Health Day approaches on November 19, we honor the top quartile performers who, like the Top 20 CAHs, are the value leaders. These hospitals set a high standard for all and make it clear that to deliver top quality, leaders must confront the challenges around the corner with innovation. A future “VBP for Rural” will likely place emphasis on not only patient safety, mortality, readmissions, but also on more relevant measures such as care transition and ED transfer communication, to name a few. As all strive to meet these new measures, we look forward to seeing the innovative and progressive steps taken as CAHs continue to improve their quality.

Hunter Clark can be reached at

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