Roji Intel Blog

Robert McNutt, M.D. 0
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Future of Health CareMedical Decision-MakingPatient Empowerment
July 26, 2017

It’s Not What We Don’t Know That Hurts Us: It‘s What We “Know” That Isn’t So

Making a decision is a—or really—“the” fundamental activity of life. The decisions we make, the consequences of those decisions, our feelings about the consequences, our interpretation of whether we made a good or bad decision based on those consequences, in total, form the basis of our life’s experiences, and, often, how we decide the next time. My children used to say, “Duh,” to my muttering an obvious observance like, “It sure is hot today,” because the temperature just hit 100 degrees. The opening sentence of this blog may seem so obvious that it may trigger a similar response. Making a…
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Theresa Hush 0
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Future of Health CareMACRAMerit-Based Incentive Payment System (MIPS)Value-Based Health Care
July 19, 2017

The Future of MACRA: Will MIPS Survive?

Will MIPS survive as Medicare’s overarching performance measurement and improvement program for physicians? That’s the question as providers finalize their plans for meeting requirements in 2017 and beyond. MIPS Is in Adjustment Mode MIPS is undergoing a significant transition. How do we know? First, the ink is hardly dry on the huge rewrite of various Medicare Value-Based Health Care programs combined and streamlined through the MACRA Final Rule in October 2016. That rewrite replaced PQRS, the Value-Based Payment Modifier and Meaningful Use with a Merit Incentive Pay System (MIPS) for physicians. Yet, while MIPS is still in its initial implementation…
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Theresa Hush 0
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Future of Health CareMedical Decision-MakingNarrow NetworksPatient Empowerment
July 12, 2017

Narrow Networks and Rationed Health Care, Version 2017

For decades, our nation’s health care system has been highly valued for its bounty. Access to the most advanced technology, surgery and expertise has been a point of pride. The concept of rationing health care, by contrast, has been taboo. We accused the British of rationing in their universal health system when people had to wait for care or couldn’t get specialty services. We proudly counted the number of Canadians crossing the border to get cardiac surgery in this country. Oregon was accused of rationing when it released a list of prioritized health services under its health system, and the…
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Theresa Hush 0
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Future of Health CareMACRAPatient EmpowermentValue-Based Health Care
July 5, 2017

Who Will Fill the Leadership Void in Health Care Reform if MACRA Rolls Back?

Amidst the political cacophony over health care coverage for American consumers, a fundamental question has been relegated to a soundbite: How can we control cost? Everyone (in the industry or participating in the debate) knows that cost drives our health care system problems, including affordable insurance coverage. The fallacy at the heart of all the wrangling is that we can address coverage affordability without confronting cost. But doing something about cost in a de-regulation environment is exceptionally difficult. That is why we are finding ourselves in the midst of both a MACRA implementation and a likely MACRA Rollback. And no…
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Dave Halpert 0
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Alternative Payment Models (APM)Clinical Data RegistryMerit-Based Incentive Payment System (MIPS)Qualified Clinical Data Registry ReportingValue-Based Health Care
June 28, 2017

10 Takeaways from the Proposed Rule for MIPS and APMs Year 2

We are already more than halfway through the initial year of Medicare’s new Quality Payment Program, which includes MIPS and APMs. Yet already we are seeing some changes from the new administration that will relax requirements for providers, eliminating the need for some to participate and making quality reporting, in particular, easier. Regardless of how Medicare plays these rules, top providers should maintain a strong strategic focus on Value-Based Health Care initiatives that emphasize performance improvement in cost and quality. Even as Medicare may step back from the leadership role it has taken in this arena, private insurance and employers…
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Theresa Hush 0
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Future of Health CareMedical Decision-MakingPatient EmpowermentValue-Based Health Care
June 21, 2017

The Doctor Will See You Now, But Don’t Stay Long or Ask Too Much

Something has been happening with physician medical visits. Maybe I’m just noticing it because my doctor quit and I had to find a new one, which put me on a treadmill of repeat appointments—because, as my new physician told me, she was out of time for our visit. But here’s the rub: Apart from seasonal allergies, there is nothing wrong with me. I am, thankfully, extraordinarily healthy. I have no hypertension, diabetes, cardiac issues or auto-immune diseases. My lipids are normal and my weight hasn’t changed since I was 21. The only meds I take are for allergies. Yet so…
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Dave Halpert 1
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Merit-Based Incentive Payment System (MIPS)Qualified Clinical Data Registry ReportingValue-Based Health Care
June 14, 2017

Best Practice MIPS Quality Reporting: QCDR Group with Individual Accountability

The “transition” phase of the Merit-Based Payment System (MIPS) is half over, and so, too, is the time needed to prepare for the full rollout in 2018. Yet during the 2017 MIPS “transition” year, many providers are still trying to pigeonhole MACRA’s MIPS into the previous quality program, PQRS. That choice may have worked for simple quality reporting, but it doesn’t work for MACRA’s more comprehensive approach. Among other things, it overlooks a key decision—whether to base quality reporting on group practice or individual provider results. The problem is this: MIPS is not PQRS. It is a full-fledged Value-Based Health…
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Robert McNutt, M.D. 0
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Future of Health CareMedical Decision-MakingPatient EmpowermentResearch
June 7, 2017

Physician Comparisons Based on Performance Don’t Tell the Right Story

Medical decision-making requires a comparison. There is, most often, more than a single option for your care. New tests and treatments are constantly being added to the medical portfolio by scientific inquiry. The only way to advance care, in fact, is by comparing options. Comparing incites a difficult task, however: the compared option that is best for your disease-related outcome may be worse for your test- or treatment-related outcomes. For example, for men with early stage prostate cancer, surgery may reduce the chance of dying of prostate cancer from 8 to 6 percent over 10 years, but surgery increases, simultaneously,…
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Dave Halpert 0
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MACRAPerformance ImprovementQualified Clinical Data Registry Reporting
May 31, 2017

How to Improve Patient Outcomes with a Multi-Specialty QCDR

Care coordination and HIT interoperability are touted throughout the healthcare world as “must haves” for any provider, practice or health system. The reason is simple: information from multiple sources helps providers and patients to make informed clinical decisions and provide better care. A key pillar in any program that quantifies whether providers are “meaningfully using” their EHRs is the ability to send and receive information on a specific patient. If that’s true at the point of care, doesn’t it make sense that performance measurement and improvement would benefit from the same treatment? Qualified Clinical Data Registries (QCDRs) were created specifically…
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Theresa Hush 0
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Future of Health CareMedical Decision-MakingPatient Empowerment
May 24, 2017

Can Consumers Help Reduce Rising Costs of Medical Technology?

In years to come, the current health care financial scene may seem like the “good old days” of health care for middle class Americans. Despite escalating consumer costs, proposed cuts in coverage, and an ever-rising cost of care, most Americans can still access health care services. They believe health care will be there for them, even if not everyone can get it. But the affordability of health care, regardless of coverage source, will soon be everyone’s problem. Medicare is projected to run out of money in only 10 years (some say less), and each year the cost of health care…
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