Rural Health Final Report 

Challenges such as geographic isolation, small practice size, heterogeneity in settings and patient population, and low case volume make participation in performance measurement and improvement efforts especially challenging for many rural providers. Although rural hospitals and clinicians participate in a variety of private-sector, state, and federal quality measurement and improvement efforts, many quality initiatives run by the Centers for Medicare & Medicaid Services (CMS) exclude rural healthcare providers. The Performance Measurement for Rural Low-Volume Providers report presents 14 recommendations from a multistakeholder Committee that was tasked to address these and other challenges of healthcare performance measurement for rural providers, particularly in the context of CMS pay-for-performance programs. The resulting recommendations can help advance a thoughtful, practical, and relatively rapid integration of rural providers into CMS quality improvement efforts. The recommendations also can be used to enhance the quality measurement and improvement efforts of other public- and private-sector stakeholders.