Roji Intel Blog

Dave Halpert 0
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Future of Health CarePerformance ImprovementPQRS ReportingValue ModifierValue-Based Health CareValue-Based Payment Modifier
March 15, 2016

Still Not Sure of PQRS-VBPM? You Just Gave Your Competitor a Huge Bonus

If you still need a good reason to meet all PQRS requirements and improve your quality tiering under the Value-Based Payment Modifier (VBPM or Value Modifier), listen up: Failure to do so means your penalty will end up in your competitor’s pocket. Not only that—the 2016 Value Modifier Adjustment Factor (AF) for incentive payments has just been decided by CMS, and it’s an eye-popping 15.92 percent on all allowable Medicare Part B charges. Simply put, those groups whose Quality and Resource Use Reports (QRURs) showed 1.0 x AF will earn close to an additional 16 percent incentive payment, more than…
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Dave Halpert 0
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ACO ReportingAlternative Payment Models (APM)Clinical Data RegistryFuture of Health CareMerit-Based Incentive Payment System (MIPS)Value-Based Health CareValue-Based Payment Modifier
March 8, 2016

APMs Are Here and MIPS Is Coming Sooner Than You Think: How to Plan for the Unknown

How do you prepare for a program with yet-to-be-defined rules that will involve larger potential penalties (or incentives)—but requires long term planning? It’s a real quandary, but the time is now to begin thinking strategically about the upcoming Merit-Based Incentive Payment System, or MIPS. MIPS Fundamentals MIPS was created from the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). The Act succeeded in expunging the looming but flawed “Sustainable Growth Rate” formula, replacing impending cuts with reimbursement tied to Value-Based Health Care. MIPS details may be lacking, but the overall MIPS framework is taking shape. Scheduled to begin on…
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Robert McNutt, M.D. 0
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Clinical Data RegistryFuture of Health CareMedical Decision-MakingPerformance ImprovementRegistry ScienceResearchValue-Based Health Care
March 1, 2016

First, Ask Questions: How to Harness CDR Data for Better Patient Outcomes

As more and better clinical data becomes available and demand grows for better outcomes, the Clinical Data Registry is positioned to fulfill the role of data manager—a vital mechanism for improving care. The CDR is the engine driving a smoothly running system toward better outcomes. This involves much more than data collection. A high quality management function for CDR data requires making inferences from the data it collects. But drawing inferences from present data sources presents significant challenges, no matter how big the data source. As a medical journal editor, I have reviewed many papers from countries with massive data…
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Thomas Dent, M.D. 0
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ACO ReportingAlternative Payment Models (APM)Clinical Data RegistryFuture of Health CareMeaningful UseMerit-Based Incentive Payment System (MIPS)Performance ImprovementRegistry ScienceResearchValue-Based Health Care
February 2, 2016

All Together, Now: Why Specialists Need the CDR Edge for Bundled Payments

With the advent of Bundled Payments for selected procedures and conditions, providers and institutions must collaborate to meet both cost and quality targets. No longer will each provider bill and receive payment separately for services when these bundles become mandatory—as most experts believe will happen. All providers participating in a set “bundled” price must focus on coordinated performance improvement or face penalties. Key to that effort: a Clinical Data Registry (CDR) that tracks patient outcome data over time and pinpoints success or failure of interventions. CDR Performance Improvement Tools Are Essential for Bundled Payments Success The CDR fulfills two fundamental…
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Theresa Hush 0
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ACO ReportingClinical Data RegistryFuture of Health CarePerformance ImprovementRegistry ScienceResearchValue-Based Health Care
January 26, 2016

Why Traditional VBHC Trouble Shooting Will Get You in Trouble with Performance Improvement

You’ve heard the phrase. You know it’s a key goal in Value-Based Health Care. But many providers don’t understand the full meaning of performance improvement. All too often, health care systems rely on piecemeal, troubleshooting approaches that emphasize short-term gains over meaningful, improved outcomes. Here’s a common example: Almost every hospital has adjusted its discharge process to avoid readmissions. But unless they can explain why patients were readmitted—few actually can—gains will diminish. New patients presenting with the same high-risk conditions will challenge reduction of readmissions because efforts addressed the symptom but not the root cause. Improving performance means more than…
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Robert McNutt, M.D. 0
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Clinical Data RegistryFuture of Health CarePerformance ImprovementRegistry ScienceResearch
January 19, 2016

The CDR Advantage: Why Registry Research Minimizes Study Bias for Performance Improvement

The Clinical Data Registry is a powerful research tool for improving patient health. But what makes Registry-based study design better than pre-post study design? The answer has far-reaching implications for how we will use data to determine treatment effectiveness in the future, as well as how we will meet the challenge of improving health outcomes. Research can be built on the case-control study, observational study designs, N-of-1 study designs, randomized trials or the N-of-1 population study. Most of these approaches—except those facilitated by a Registry—will be limited by small patient samples due to the patient selection process. But that’s a…
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Thomas Dent, M.D. 0
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AttributionClinical Data RegistryFuture of Health CareMeaningful UsePerformance ImprovementValue-Based Health Care
January 12, 2016

Public Health Reporting for Specialists: Avoiding Penalties Isn’t the Only Reason to Comply

At the heart of CMS’s Public Health Reporting Requirements for Meaningful Use is a basic premise: EMR technology must facilitate tracking of public health trends and long-term outcomes improvement. That is why all providers in the Meaningful Use program, regardless of specialty, are now being required to engage in public health reporting to avoid a penalty. Many specialists don’t see the point of reporting for public health reasons or find it too difficult. While it’s true that specialists face some specific challenges that require dedicated reporting to fit their clinical operations and to avoid professional and financial risks, there are…
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Dave Halpert 0
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ACO ReportingAlternative Payment Models (APM)AttributionClinical Data RegistryFuture of Health CarePerformance ImprovementValue-Based Health Care
January 5, 2016

Bundled Payments Aren’t Mandatory for Everyone (Yet): Is Your Group Ready?

It’s taken more than a half-century, but the Medicare Final Rule on Comprehensive Care for Joint Replacement (CCJR) has set in motion utilization reporting that will shift the focus from static data about diagnoses, services and days in hospital to meaningful information about care transitions and outcomes. It’s taken a long time. But now that we’re here, the train is leaving the station. The big question facing providers: with Medicare’s push to ensure that compensation from Alternative Payment Models (APMs) accounts for half of reimbursements by 2018, is a Bundled Payment the best APM for you and your group? A…
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Theresa Hush 0
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Clinical Data RegistryFuture of Health CarePerformance ImprovementValue-Based Health Care
December 22, 2015

Happy New Year: Higher Patient Financial Responsibility Risks More Provider Debt

A few weeks ago, we learned that the rate of health care spending has escalated, with a 5.3 percent gain in 2014—accounting for 17.5 per cent of the U.S. Gross Domestic Product. And, according to the Kaiser Foundation, this predicted upward trend shows no signs of abating anytime soon. At some point, this cost burden on the economy is unsustainable. So where is the outcry? The relative silence around the trend, compared with prior decades, reveals a shift in financial responsibility from employers to individuals, which just might crack the foundations of the health care system. Consumers are Paying More…
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Theresa Hush 0
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Clinical Data RegistryFuture of Health CareMeaningful UseMedical Decision-MakingPerformance Improvement
November 24, 2015

Putting the “Meaning” in MU Public Health Reporting: 
How to Move Beyond “Check the Box”

Can Medicare influence health care delivery via the “public health” reporting requirements of the EHR Incentive Program? That question is central to the updated EHR Incentive Program (more commonly known as Meaningful Use, or “MU”). The answer boils down to a fundamental choice: whether providers view the external reporting Objective as just one more compliance effort, or an opportunity to improve. Apart from governmental reporting, Modified Stage 2 of MU requires eligible providers to submit data reporting to one of three types of “public health” registries: immunization, syndromic surveillance and Specialized Registries. This is reporting for the public good, and…
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