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Advocating for Continuity in Health Care Quality: Making a Push for QPP-SURS Reauthorization

December 20, 2023

By: Alan Katz, Associate Director of Advocacy and Public Policy, Civitas Networks for Health

In health care, ensuring the provision of quality services, especially in small, underserved, and rural areas, is a challenge that demands innovative solutions and sustained support. Recognizing this, a concerted effort is underway to restore a crucial program that has been pivotal in advancing health care quality in these communities. The focus of this endeavor is the reauthorization of the Medicare Quality Payment Program—Small, Underserved, Rural Support (QPP-SURS), a program that ran from 2017 until it expired in 2022 and would be revived by the passage of the bipartisan SURS Extension Act, H.R. 5935.

The Importance of QPP-SURS

Before it expired in February 2022, QPP-SURS was instrumental in providing technical assistance (TA) to small health care providers eligible to participate in Medicare’s Quality Payment Program who would otherwise have a much harder time managing an informed and effective transition to QPP themselves. Many of the specialized quality improvement organizations that were tasked by the Center for Medicare and Medicaid Services (CMS) with TA implementation under SURS are Civitas members, whose extensive experience facilitating value-based care through the ongoing Quality Improvement Network—Quality Improvement Organization (QIN-QIO) was critical to rural and underserved providers. In the process, the SURS program facilitated connectivity between these practices and their state and regional Health Information Exchanges (HIEs) to enable real-time data sharing. This support is not just a matter of administrative or technical aid; it’s a critical step in ensuring that smaller health care providers are not left behind in the rapidly evolving landscape that combines incentive payment structures with dynamic health information technology to realize new efficiencies and measurably enhance patient care.

Of particular significance is the role of seven Civitas Quality Improvement Organization (QIO) members who were integral to the implementation of the QPP-SURS program under contracts with CMS. Their involvement highlights the program’s tangible impact and the expertise that these organizations bring to the table.

This blog will feature the efforts of two Civitas Networks for Health members, but first let’s cover the current state of affairs.

Current Congressional Lobbying Efforts

To bolster support for the SURS Extension Act, a congressional lobbying effort is presently being organized, supported by several of Civitas’ QIO members and Civitas’ Government Relations team. The aim is to increase bipartisan backing and help build momentum for this bill on Capitol Hill, emphasizing the vital role of QPP-SURS in enhancing health care quality and accessibility. In the first set of meetings, key players like Comagine Health and Mountain Pacific Quality Health are set to participate, given that their QPP-SURS service areas cover several of the most critical congressional offices.

These efforts overlap with the plans of the American Health Quality Association (AHQA), which represents QIOs nationally, mutually reinforcing the interests of the unique and mission-critical QIO sector while also providing a more focused and direct appeal for the program’s reauthorization. The participation of these organizations is instrumental in illustrating the on-the-ground impacts and successes of the QPP-SURS program.

Assembling Information

The impact of advocacy in support of SURS reauthorization depends in large part on getting the right information about the program’s efficacy in front of the right people. Civitas QIO members are currently in the process of gathering this information to showcase the value of their QPP-SURS work for policymakers representing key states and detail best practices for SURS-funded activities. This information will be critical in crafting a compelling pitch to important congressional offices, highlighting the program’s successes—on average, over 107,000 clinicians nationwide received SURS TA each year of the program’s operation—and the ongoing repercussions of its discontinuation.

Why This Work Matters: Comagine Health and Mountain Pacific Quality Health’s QPP-SURS Efforts

As we advocate for the reauthorization of the QPP-SURS program, we will spotlight the significant contributions of Civitas members Comagine Health and Mountain Pacific Quality Health as case studies in the program’s successful implementation. Their dedicated work was a cornerstone of the QPP-SURS initiative in their eight-state contract service territory, providing much-needed support to small health care providers.

Before QPP-SURS expired last year, Mountain Pacific Quality Health and Comagine Health were instrumental in assisting nearly 18,000 eligible clinicians in small outpatient practices across Alaska, Idaho, Montana, Nevada, Oregon, Utah, Wyoming, and Washington. Their commitment to the program has ensured that small-practice clinicians are not left behind with federal reimbursement reporting requirements. As one practitioner in Nevada told the Comagine team, “I was clueless about my eligibility, the portal, or application…and grateful for the assistance” that the SURS program enabled.

Their support through the QPP-SURS program has been multifaceted. By offering no-cost assistance, these organizations helped providers streamline health care processes, effectively avoiding penalties that could impede their ability to deliver quality services. They guided these practices through the Merit-based Incentive Payment Plan (MIPS), aiding in the selection of MIPS measures that align with their priorities and ensuring compliance with evolving program requirements. The QIO implementers adopted a flexible and highly individualized approach toward provider engagement that emphasized “meeting them where they were”; assessing providers’ status and working proactively to help them achieve benchmarked progress in an interactive private lesson-based format. By the time SURS expired, the Comagine Health and Mountain Pacific teams had engaged 100% of eligible providers in Idaho (every SURS-eligible Medicare-enrolled practice), in some level of assistance (defined as bilateral exchange); approximately 99.7% of eligible providers in Washington, and 99% of eligible providers in Alaska, Montana, Nevada, Oregon, Utah, and Wyoming, while achieving a 100% referral response rate.

Collaboration between Mountain Pacific Quality Health, Comagine Health, and Civitas has enabled these small practices to connect with their state HIEs to fulfill MIPS interoperability requirements, building their capacity to succeed under QPP and contribute to the overall utility and reach of the program. This crucial support has not only facilitated immediate benefits in terms of improved reimbursements but also laid a foundation for long-term success in a rapidly changing health care environment.

The high engagement and customer satisfaction scores achieved by these organizations reflect their effectiveness in providing tailored support to clinicians in diverse settings. As we push for the continuation of the QPP-SURS program, the achievements of Comagine Health and Mountain Pacific Quality Health stand as a testament to the program’s potential for empowering small, underserved, and rural health care providers across the nation.

If you want to learn more about Civitas, Mountain Pacific Quality Health, and Comagine Health’s joint work, you can read the report on the Comagine Health website.

The Road Ahead for QPP-SURS

The reauthorization of QPP-SURS is more than a legislative goal – it’s about ensuring continuity in the quality of health care services in areas that most need it. By providing technical assistance to small health care providers and preparing for MIPS while also encouraging their integration into state and regional HIEs, QPP-SURS stands as a critical pillar of support for health care entities that are often overlooked.

The reauthorization of the QPP-SURS program is a pivotal step in ensuring that quality health care services continue to reach every corner of our nation. It is a testament to the commitment not just to maintain, but continually enhance the standard of care for all, regardless of geographical and economic barriers.

For more information about the legislative work being done, please email Civitas.