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Concerns about the ability of small rural practices to successfully participate in the QPP are warranted

• Even physicians who were knowledgeable about the QPP and who were prepared to participate reported frustration with the 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.

Interviewees suggested changes to the QPP to support small rural practices

• Guidance provided in simpler language would be beneficial. Respondents mentioned difficulty answering questions about the effects of the QPP on their practices because they did not understand key requirements.
• Because many practices were not aware of the need to report for the Merit-Based Incentive Payment System (MIPS) by October 2017 and because of the perceived lack of clarity and shifting requirements, respondents suggested that Medicare delay implementation of all or some requirements for small practices.
• Respondents suggested avoiding penalizing small practices that serve vulnerable populations and that are least able to absorb payment reductions.
• One respondent suggested that alternate methods of assessing physician quality, such as observational site visits, similar to teacher in-classroom assessments, would be less burdensome and more accurate for small rural practices.
• Additional information technology support for small rural practices is needed, including for those that currently have electronic health record systems.
• Soliciting rural practice input earlier in policy development would increase engagement of rural physicians and provide better understanding of the realities of small rural practices.