Perspectives of Physicians in Small Rural Practices on the Medicare Quality Payment Program

Background

The Centers for Medicare & Medicaid Services (CMS) recently launched its Quality Payment Program (QPP), 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. There is therefore a need for early feedback on the initial implementation of the QPP among these practices.

Methods

This study presents results of interviews conducted with physicians in small rural practices from September 7 to 27, 2017. Physicians were recruited using a combination of stratified random sampling and referrals from CMS technical assistance contractors. We sought to obtain variation by geographic region and include members of four groups reflecting different combinations of physician specialty (primary versus specialty care), Merit-Based Incentive Payment System eligibility, and knowledge of the QPP. A total of 20 small rural practices were interviewed. Interviews were conducted by telephone, using a semistructured format lasting approximately an hour.

Results

Although this research is based on a small sample, our findings suggest that small rural practices are struggling to participate in the QPP. Even those who were relatively knowledgeable about the QPP and who had been preparing for months to participate—either on their own or with a CMS support contractor—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.

Interview participants 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, delaying program implementation for small practices, 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.

Conclusion

The qualitative findings from this study could help in interpreting the first-year QPP participation results and performance scores and inform future policy changes and evaluation questions for the QPP.