Roji Intel Blog

Dave Halpert 0
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PQRS ReportingQualified Clinical Data Registry ReportingValue-Based Payment Modifier
August 11, 2015

Medicare’s 2016 Proposed Rule: What Do You Need to Know?

Is PQRS dead? That’s the question we’ve been hearing, in the wake of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), which outlined a new program for merit-based payments. With the release of the 2016 Proposed Rule, the answer is a resounding “No.” The Proposed Rule is exactly that—proposed, rather than final. Nevertheless, historically speaking, there is little deviation between the Proposed Rule and the Final Rule, and so those with a stake in the matter (which presumably includes you, if you’re reading this), should begin digesting these 813 pages to see the direction the program will take…
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Theresa Hush 0
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ACO ReportingFuture of Health CarePopulation HealthQualified Clinical Data Registry ReportingRegistry ScienceResearchValue-Based Payment Modifier
August 4, 2015

ACOs and the Referral Revolution Part 2: How to Align Objectives and Referral Practices

There’s no getting around it. Disruption in referrals under new Value-Based Health Care programs will upset both primary care and specialty practices under any change scenario. Physicians with historical relationships will undoubtedly resent an edict to redirect referrals, if they don’t understand or believe comparative data on cost and quality. On the other side of the equation, physicians who accept that aligning referrals with outcome data is part of being in an ACO will object if they see that referrals are driven, instead, by physician employment status. Every participant in an ACO must eventually accept that achieving shared savings will…
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Thomas Dent, M.D. 0
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ACO ReportingFuture of Health CareValue-Based Payment Modifier
July 28, 2015

Are Your Specialists and ACO Ready for the Referral Revolution? Part 1

The practice of physician-determined referrals to specialists is deeply embedded in the culture of medicine. But it no longer works under Value-Based Health Care. A revolution in referrals is underway, one that will dramatically change physician alignment and engagement in ACOs and other Pay for Performance models. Outcome measures can distinguish the performance of one specialist versus another—and this performance data is available to both health systems and physicians. We all know that pure comparative performance data has a lot of flaws. But Medicare is publishing provider-specific performance for PQRS and group performance for ACOs, and calculating comparative scores under the…
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Robert McNutt, M.D. 0
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Registry ScienceResearch
July 21, 2015

Are You Measuring Effectiveness of Your ACO’s Population Health Interventions?

It’s time to reboot your method of deploying population health initiatives, if you really want a return from your ACO efforts. Despite the intense focus on data and analytics in health care, most start-up ACOs adopt identical population health initiatives, such as intensive case management for high cost patients. The choice is not made because of proven outcomes and lowered costs from these initiatives, but because everyone else is doing the same thing. It’s ironic that we adopt evidence-based performance measures, but rely on anecdotal results in population health. With a research-capable Registry and reliable data, we can be smarter…
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Theresa Hush 0
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ACO ReportingPQRS ReportingQualified Clinical Data Registry ReportingValue-Based Payment Modifier
July 14, 2015

Will Medicare’s Published Physician Quality Data Push Your Patients Away?

CMS isn’t the only group scrutinizing your quality and cost data any more. As the next step toward value-based health care, Medicare has begun publishing provider performance data for PQRS under “Physician Compare.” Now patients and their families can make their own data-driven choices about health care providers with an online search. The website is a game-changer. Performance variation between providers is startling. There are 50 provider groups with performance at or lower than 65 percent for at least one published measure. By contrast, a handful of groups show all four measures over 95 percent. The 2013 data are limited and do…
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Dave Halpert 0
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ACO ReportingPQRS ReportingValue-Based Payment Modifier
July 7, 2015

Anesthesiologists’ Best Practices: How to Succeed with Medicare PQRS and VBPM

Anesthesiologists across the country are coping with a unique PQRS challenge. Different procedures and settings may mean that some practices do not have the requisite number of measures to meet requirements. Other groups will have enough measures, but the choices may not be obvious. When you have up to 6 percent of your Medicare Part B revenues at risk, you cannot afford to take that chance. Read on to learn how to make the best reporting decisions for your anesthesiology group and avoid Medicare penalties. Like Orthopedists, your specialty focus inherently limits your relevant PQRS measures—except that for Anesthesia, the options are…
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Dave Halpert 0
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ACO ReportingPQRS ReportingQualified Clinical Data Registry ReportingValue-Based Payment Modifier
June 30, 2015

Orthopedists’ Survival Kit: How to Succeed with Medicare PQRS and VBPM

Pay for Performance success takes careful thought and management, particularly for specialty practices. Under Medicare’s PQRS and Value-Based Payment Modifier (VBPM), specialties have fewer measures available, which narrows reporting options—making it harder for you to meet PQRS and compare well against your peers. For Orthopedics, this is especially true. Nearly 200 PQRS measures have a Registry reporting option, but many orthopedic surgeons still have a difficult time finding nine measures across three National Quality Strategy (NQS) Domains (including one cross-cutting measure), where performance is good enough to report. All too often, orthopedic surgeons get trapped, reporting on measures where performance…
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Dave Halpert 0
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ACO ReportingPopulation HealthQualified Clinical Data Registry ReportingValue-Based Payment Modifier
June 23, 2015

How to Get Paid for Your Population Health Program: Part 2

If you’ve written off population health initiatives as too expensive, think again. Pay for Performance means just what it says: you need to demonstrate better outcomes than your peers if you expect to reap benefits from Medicare. And, if you fall behind, you’ll risk ACO losses or Value-Based Payment Modifier (VBPM) penalties. As we discussed last week, by focusing on Medicare’s programs and reimbursable Medicare Wellness Visits, your organization can build a solid foundation for your population health program—and get paid for it. Medicare’s new Chronic Care Management Services offer another cost-effective way to build out your population health program.…
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Dave Halpert 0
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ACO ReportingPopulation HealthQualified Clinical Data Registry ReportingValue-Based Payment Modifier
June 16, 2015

How to Get Paid for Your Population Health Program: Part 1

How can you succeed in Pay for Performance if you can’t risk revenues on a program that may not produce results? Especially if your competitors have made the investment and can prove better outcomes, raising the bar for everyone? It’s not enough simply to tighten existing procedures or to focus on maintaining high standards To stay competitive, you need to improve patients’ outcomes and reduce costs over your own history and against other organizations, even without a lot of cash on hand.  If you don’t, you’ll face even greater financial risks under ACO participation or independently through VBPM penalties. But…
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Theresa Hush 0
0
PQRS ReportingQualified Clinical Data Registry ReportingValue-Based Payment Modifier
June 9, 2015

Does Your EMR Tell Medicare the Right Story About Your Patient Quality?

Reporting physician quality to Medicare through an EMR is an easy and affordable approach—at least on the surface. But be careful when using EHR Direct Reporting for PQRS 2015, so you don’t cost your organization as much as 4 percent in Medicare penalties or create an unappealing profile of your quality in Medicare’s public reporting. Navigating successfully through the maze of Medicare’s new Value-Based Purchasing requires a thorough understanding of how all the different reporting and performance programs interact. Unless you have a good grasp of how your EMR reports your quality data, you risk setting yourself up for costly…
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