The Institute of Medicine cautioned in a new report that rural healthcare could be left behind in the national campaign for quality-improvement and payment incentives unless rural hospitals' unique needs and fragile finances are considered.
The 235-page report, called Quality Through Collaboration: The Future of Rural Health, re-examined in a rural context the IOM's 3-year-old blueprint for improving healthcare quality. That 2001 blueprint, Crossing the Quality Chasm: A New Health System for the 21st Century, presented a plan for transforming the U.S. healthcare system through changes in care approaches, reform of reimbursement to reward quality and intensive use of advances in information technology.
But because of their typical small scale and low operating margins, hospitals and physician offices in rural areas have found it difficult to make the investments necessary to set themselves up for quality programs, the report noted. In addition, rural areas find it more difficult to attract enough physicians and other healthcare professionals to provide a core set of primary-, emergency-, acute- and long-term-care services needed to assure health quality.
Citing the "great deal of experimentation" under way to align payment incentives with quality aims, the report cautioned that the historically fragile financial positions of rural facilities might make it difficult for them to participate in such innovations. "It would be wise to conduct demonstration projects in rural communities to field-test the applicability of both standardized performance measures and performance-based approaches to rural providers," said the report, expected to be released this week.
Among its recommendations, the IOM called for the CMS to establish five-year pay-for-performance projects in five rural communities starting in fiscal 2006. It also said the federal Agency for Healthcare Research and Quality should produce a report no later than fiscal 2006 analyzing the impact of changes to the Medicare and Medicaid programs, private health plans and insurance coverage on the financial stability of rural healthcare programs.
The IOM's Quality Chasm report was the second on the shortcomings of the healthcare industry in providing systematically safe and high-quality care. The first report, To Err is Human, declared medical errors and adverse events caused by hospital care were widespread in hospitals.