Helping Small Practices Navigate Value-Based Reimbursement While Improving Patient Care


Small clinical practices, or those located in rural or underserved areas, play an important role in the health care landscape and are critical in addressing health disparities. However, these practices are often constrained by limited resources on the path to fulfilling regulatory requirements. In addition to financial strain, they also face significant capacity challenges due to staff turnover and technological limitations. As rural providers tend to serve populations that are older, poorer, and sicker than those in urban areas, they also rely more on Medicare and Medicaid reimbursements. Faced with these capacity constraints, these practices often find it challenging to navigate government payment programs aimed at improving the health of their patients.


With funding from the Centers for Medicare & Medicaid Services (CMS), Altarum led the creation of a resource and support center to simplify compliance with CMS requirements for such practices. The cornerstone of the Quality Payment Program for Small, Underserved and Rural Support (QPP-SURS) was the Quality Payment Program Resource Center® website. After launching in 2017, this resource center provided clinicians across seven midwestern states (Michigan, Ohio, Minnesota, Wisconsin, Illinois, Indiana, and Kentucky) with free, self-paced tools and resources to help them successfully navigate the Quality Payment Program (QPP) within the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). It also connected clinicians directly with Altarum’s experienced practice facilitators for hands-on, personalized support.

Through QPP, MACRA’s aim is to help transition health care providers from fee-for-service to value-based care. To advance this effort, the Merit-based Incentive Payment System (MIPS) payment track combines legacy-quality reporting programs and an improvement category into a single new composite scoring and reporting system. Under MIPS, clinicians can receive positive, neutral, or negative adjustments to future Medicare payments based on their final score. 

For small, rural practices operating on slim margins, the ability to proactively manage Medicare payments is crucial. To help these practices report information accurately and achieve their highest possible MIPS score, Altarum created MIPScast®, a user-friendly Qualified Registry tool. We provided the tool at no cost to all SURS-eligible clinicians, enabling them to track their MIPS measures and improvement activities, compare their performance to national benchmarks and their peers, and directly submit program data to CMS. 


Over the course of the five-year program, Altarum’s practice facilitators engaged 31,664 health care providers across 16,640 practices to support their QPP success. To educate the broader health care community and raise awareness of the resource center, we presented at more than 30 national and regional conferences and hosted more than 60 educational webinars. Over 2,100 clinicians registered for the QPP Resource Center portal, where we maintained a dedicated help desk to provide direct education, guidance, and real-time support. The results were affirming: Participants reported a 99 percent satisfaction rate with Altarum’s services. 

On February 15, 2022, CMS officially ended QPP-SURS. Altarum — having a deep understanding of the compliance difficulties faced by small, rural, and underserved practices, who have relied on exceptions offered by the Extreme and Uncontrollable Circumstances (EUC) hardship applications in the wake of the Covid-19 public health emergency — continues to advocate for the extension of QPP-SURS. Such an extension would continue to provide the necessary tools and support to ensure the success of these practices in the MIPS program.

Altarum continues to offer health care providers technical assistance around QPP and MIPS, as well as perform on-site and remote security risk analyses to protect patient information through our commercial services program. We also produce a quarterly newsletter to keep practices up to date on the latest QPP and MIPS news and information. Additionally, our practice facilitators continue to offer no-cost, direct support to clinicians through various quality improvement programs; Reframing Optimal Management of Pain and Opioids in Older Adults (ROMPO), for instance, helps primary care providers (PCPs) effectively manage pain in older adults, and Healthy Hearts for Michigan assists rural PCPs in evaluating current workflows and establishing screening and treatment protocols for cardiovascular disease (CVD).


Carrie Frye
Project Manager, Delivery Systems Transformation
Anya Day
Vice President, Proposal and Opportunity Management