- Rural hospitals, on average, outdid their urban counterparts in Medicare’s value-based purchasing program, scoring higher on several key measures, according to a new HHS report.
- The program rewards or penalizes acute care hospitals based on the quality of care they provide to patients and hospitals in rural areas bested urban hospitals on patient experience as well as efficiency and costs.
- The higher total performance score rural hospitals had translated to a higher average payment, with an average payment adjustment factor of +0.22 of diagnosis-related group payments, versus +0.07 for urban hospitals.
HHS pointed out that the amount of barriers rural hospitals are facing, including lower operating margins and occupancy rates, "may accelerate hospital closures." Since 2010, 71 rural hospitals have closed as of March 2016 and the rate of closures was six times greater last year than in 2010. At least another 683 rural hospitals are at risk of closing, according to the National Rural Health Association.
However, HHS said the new findings are encouraging because "while rural hospitals face unique barriers, they have a number of strengths that might enable successful participation in and good performance under delivery reform efforts."
The agency speculated that the higher scores among rural hospitals may in part be due to the care coordination and cooperation that is required among a smaller group of providers and to the fact that a broad range of services often share the same physical site or owner. Another potential factor was the adoption of telemedicine in rural areas, increasing access to quality care.
Rural hospitals also had fewer postoperative wound infection and hospital-acquired infection rates than urban hospitals. Just 14% of rural hospitals faced penalties under the Hospital-Acquired Conditions Reduction Program, compared to 26% of urban facilities. Urban hospitals, on the other hand, did slightly better than rural hospitals with readmissions. In 2015, 79% of rural hospitals faced penalties under the Hospital Readmissions Reduction Program, compared with 76% of urban hospitals.