Date of Award


Document Type


Degree Name

Doctor of Health Administration


College of Health Professions

First Advisor

Annie N. Simpson

Second Advisor

Jillian Harvey

Third Advisor

Kit N. Simpson


The purpose of this study is to identify trends in participation, clinician performance, program scores, and payment adjustments received for rural and urban providers during the MIPS 2018 Performance Year. Five contiguous states in the southeastern US were selected for this study due to their significant rural population: Alabama, Georgia, South Carolina, North Carolina, and Tennessee. Descriptive statistics were used to summarize participation and performance data for rural and urban providers in the Southeastern US, as reported in the 2018 QPP Experience Report Public Use File and made publically available by CMS. The study findings extend prior evidence that has shown that value-based payment programs disproportionately penalize rural healthcare providers when compared to their urban counterparts (Johnston, 2020; Khuller, 2020; Navathe, 2019). It will be vital for CMS to identify and appropriately address barriers to participation and performance faced by rural healthcare providers to ensure the success of the MIPS program.


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