Roji Intel Blog

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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Dave Halpert 0
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ACO ReportingAlternative Payment Models (APM)AttributionPerformance ImprovementPQRS Reporting
December 15, 2015

Expanding Your ACO: The Best Recruiting Strategy for Bigger ACO Savings

Whether your ACO is in its infancy or is established and growing, you’ve probably had to make some difficult choices about which groups to include—and exclude. Your ACO’s success is almost entirely driven by your ACO network’s participating providers (and their patients). They provide the care and generate beneficiary costs, and help to ensure better patient outcomes. Developing that network intelligently is key to achieving shared savings. We’re here to help. Know this: one “free market” concept behind Alternate Payment Models is flawed—the assumption that providers who can demonstrate better results in quality and costs will be in higher demand.…
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Thomas Dent, M.D. 0
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ACO ReportingClinical Data RegistryMeaningful UsePerformance ImprovementPQRS ReportingRegistry ScienceValue-Based Payment Modifier
December 8, 2015

Want Real Performance and Outcomes Improvement? Track Interventions and Results Over Time

Time will explain it all. He is a talker, and needs no questioning before he speaks—Euripides For many providers, reviewing performance data is just another distraction from practicing medicine, rather than a valued tool for making better medical decisions. And who can blame them? Performance or outcome data reviewed in isolation, as static results, aren’t all that useful. The exercise is akin to looking at a single photograph of an event and inferring cause and effect without any corroborating evidence. To be an effective resource that leads to actual outcome improvements, data must be tracked over time. Most often, however,…
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Dave Halpert 0
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ACO ReportingAlternative Payment Models (APM)AttributionClinical Data RegistryPerformance Improvement
December 1, 2015

Don’t Let Wishful Thinking and Healthy Patients Harm Your ACO

Can healthy patients actually hinder your ACO’s ability to generate shared savings? Without a multi-layered strategy to improve continually over the course of the ACO agreement, the answer is yes. With the majority of ACOs failing to generate shared savings, a growing number of groups are beginning to realize that serving either the healthy or seriously ill end of the population health spectrum creates its own set of challenges. Compared to the Value-Based Payment Modifier program, ACOs are finding it nearly impossible to distinguish themselves through performance on quality measures. For ACOs to prove that they are more effectively coordinating…
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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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Robert McNutt, M.D. 0
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Future of Health CarePerformance ImprovementRegistry ScienceResearch
October 27, 2015

How to Harness Clinical Data Registry Power to Improve Outcomes

At the center of Medicare’s Value-Based Health Care, the Clinical Data Registry (CDR) is introducing new possibilities for outcomes improvement. Under this month’s final rules, Medicare expanded the role of Specialized Registry and Clinical Data Registry reporting in its future Meaningful Use program. Specifically, CMS initiated provider reporting to a “Specialized Registry” in 2015 as an option to meet Stage 2 requirements, while establishing the CDR as the future avenue for capturing outcome data over time. The question now is: How can we use a CDR to improve patient health? Some providers may “check the box” on Meaningful Use objectives…
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Dave Halpert 0
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ACO ReportingAlternative Payment Models (APM)Merit-Based Incentive Payment System (MIPS)Performance Improvement
October 20, 2015

Break the Barriers to ACO Shared Savings

The ACO performance results for 2014 are in, and they are troubling. While most ACOs were able to fulfill quality reporting requirements, only some reduced costs enough to qualify for shared savings. Many ACOs did cut costs—of the 353 ACOs, there were $411 million in total savings. But for most ACOs, it was not enough. How can ACOs break through the barrier to shared savings in the near future? Here are four lessons from analyzing the CMS data: The goal of Medicare’s performance-based reimbursement is to save money and improve outcomes, as illustrated by both the Merit-Based Incentive Payment System…
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Theresa Hush 0
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Future of Health CarePerformance ImprovementQualified Clinical Data Registry Reporting
September 29, 2015

Big Data Analytics v Clinical Data Registry: Which Is Best for Performance Improvement?

A few weeks ago, Epic announced that it would create an unidentified database of patient data for customer research, with a plan that the “Cosmos Research Network” will leverage data for better decisions. There’s been a flurry of activity in recent years to create Big Data in health care. The Clinical Data Registry (CDR) is a variation of the concept, soon to be populated by data from Meaningful Use public reporting requirements. The question: Can both these data engines help performance improvement? The answer depends on a key distinction between Big Data Analytics and the CDR, with important implications for…
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Dave Halpert 0
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Future of Health CareMerit-Based Incentive Payment System (MIPS)Performance ImprovementPQRS ReportingQualified Clinical Data Registry ReportingValue-Based Payment Modifier
September 22, 2015

Medicare’s MIPS: The Not-So New Face of Value-Based Care

Rumors that PQRS and VBPM have died may be wishful thinking, but are far from true. Value-Based Care is here to stay, even as Medicare’s programs evolve. You still have a chance to help shape those initiatives before they become law. So it’s well worth your time now to learn all about Medicare’s newest program, MIPS. In 2019, Medicare will phase in the Merit-Based Incentive Payment System (MIPS). The 2016 reporting year will form the basis for the final Value-Based Payment Modifier (VBPM) and PQRS payment adjustments, to be applied in 2018, with MIPS to begin the following year. But…
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