Roji Intel Blog

Theresa Hush 0
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Future of Health CareMedical EducationPopulation HealthPQRS ReportingQualified Clinical Data Registry ReportingRegistry ScienceResearchValue-Based Payment Modifier
April 7, 2015

Academic Medical Centers at Risk: How to Survive Medicare and Medicaid Value-Based Health Care

Academic Medical Centers (AMCs) provide care to the most complicated patients and have surmounted some of the worst clinical challenges of all time. Yet the biggest issue to threaten survival of AMCs might well be Medicare and Medicaid Value-Based Purchasing. While AMCs incorporate the training of new physicians in both community and highly specialized care, the clinical complexity of their patient population is higher than other institutions. At the same time, AMCs are the most likely medical centers to offer trauma and burn care, new medical technology and clinical research. But with typically high volumes of Medicare and Medicaid patients,…
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Dave Halpert 0
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Population HealthPQRS ReportingQualified Clinical Data Registry ReportingValue-Based Payment Modifier
March 31, 2015

ACO v Group Practice P4P: How Medicare Costs and Quality Calculations Affect Your Bottom Line

Now that Value-Based Health Care defines the landscape, reporting for revenue is on its way out. Value-based quality is in. Medicare’s transition to Pay for Performance gives providers just three options—and no out—for participating in reimbursement models that reward for higher quality and lower cost: Build or participate in an Accountable Care Organization; Report PQRS and submit to the risk of the practice-based Value-Based Payment Modifier; Receive automatic financial penalties. Given that the last option is not really viable, which way should providers participate in Medicare’s Value-Based Health Care? An Accountable Care Organization (ACO) is a network-based model for managing…
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Theresa Hush 0
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Population HealthPQRS ReportingQualified Clinical Data Registry ReportingValue-Based Payment Modifier
March 24, 2015

PQRS 2014 Last Minute Checklist: What You Can and Can’t Do Now

  With just a few days to go before the final reporting deadline, it’s time to cross the t’s and dot the i’s on PQRS 2014. There may be a few practices still trying to put together a reporting program, but almost everyone using a Registry and who has done the work is ready to report. Here are the top five things you can and should do before your Registry is ready to hit “Submit”: Check again that your Tax Identification Number (TIN) is correct. Yes, you may have already verified it electronically, but numbers sometimes get transposed. Please do it…
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Theresa Hush 0
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PQRS ReportingQualified Clinical Data Registry ReportingValue-Based Payment Modifier
March 10, 2015

Tales from the PQRS Trenches: How to Avoid Harm to Your Practice and Patients

With less than three weeks until the final deadline of PQRS Registry Reporting for 2014 services, many providers are still scrambling to figure out their reporting strategy. They will have few—if any—options for success. It’s 2015, the requirements for PQRS reporting are entering their seventh year, and non-reporting penalties have been applied for two years. If your organization wants to avoid a 4 percent penalty on Medicare revenues, this year you must make an early start a top priority. But in the real world, both large and small groups often get sidetracked because there are so many changes in health…
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Theresa Hush 0
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Population HealthPQRS ReportingQualified Clinical Data Registry ReportingValue-Based Payment Modifier
February 10, 2015

Navigating the ACO Labyrinth to Success: How to Find Your Way to Quality and Shared Savings

Last year, less than one quarter of Medicare MSSP ACOs achieved success in generating shared savings. Not a good report card, given that Accountable Care Organizations form for the explicit purpose of delivering high quality, coordinated care, with shared savings as in incentive to avoid duplication of services. But ACOs are complex endeavors, both administratively and clinically. Better coordination of patient care does not guarantee success. Your efforts must be complemented by a solid understanding of Medicare’s basic rules for quality reporting and methods of attributing patients to the ACO, so that you can keep your patients within the network.…
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Dave Halpert 0
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PQRS ReportingQualified Clinical Data Registry ReportingValue-Based Payment Modifier
February 3, 2015

PQRS Catch-22 for Specialists: How Medicare’s Division of Measures Can Put You at Risk for Penalties

If you are a specialist, maintaining your Medicare revenues just became more challenging. As of 2015, CMS now requires nine measures instead of three for PQRS reporting. They provided a partial reprieve by reducing the completion rate from 80 percent to only 50 percent. However, successful PQRS reporting is all or nothing—failure to report all nine measures within three domains will result in a penalty for both PQRS and the Value-Based Payment Modifier (VBPM) of 6 percent total in 2017. With more than 200 measures to choose from, you may wonder what’s the problem; surely you can find nine that…
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Dave Halpert 0
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Population HealthPQRS ReportingQualified Clinical Data Registry ReportingRegistry ScienceValue-Based Payment Modifier
January 20, 2015

Avoid PQRS and VBPM Penalties and Achieve Long Term Revenues: How to Choose the Right QCDR

Can you optimize your Value-Based Payment Modifier (VBPM) quality and cost profile to demonstrate better outcomes than others and avoid both PQRS and VBPM penalties at the same time? Yes: Use a Qualified Clinical Data Registry (QCDR) to do both. In 2014, the initial year of QCDR reporting, providers had the opportunity to report non-PQRS measures, but still get credit for participating in PQRS. This year, Medicare has provided additional freedom by giving QCDRs the chance to report 30 non-PQRS measures for PQRS, up from last year’s 20. Providers are required to report an additional outcome measure this year (two,…
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Robert McNutt, M.D. 0
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Medical Decision-MakingPopulation HealthQualified Clinical Data Registry ReportingRegistry ScienceResearch
January 13, 2015

Are “Flat-Line” Outcomes the Kiss of Death? How to Use a Registry for Outcomes Improvement Research

Despite a huge investment in health care, we have yet to demonstrate real progress in improving outcomes. A major study of patient outcomes last year revealed disappointing “flat-line” results for patient-centered medical home services, which means no difference in outcomes over time, regardless of significant expenditures. And that’s just the beginning.  Assessments of cancer outcomes, preventive screenings and chronic disease indicators show similar, disappointing results. It’s hard to accept that we have failed to improve mortality or morbidity in a way that can be attributed to medical management and treatment, rather than to lifestyle and nutrition. In most cases, however, that’s where…
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Dave Halpert 0
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PQRS ReportingQualified Clinical Data Registry ReportingValue-Based Payment Modifier
January 6, 2015

Medicare Is Playing by 2015 Rules—Are You?

Does it feel like 2015 yet? While we may fill out paperwork that reads “2014 2015” for the next few weeks, 2015 is here—and it’s different. Do you need evidence? The 2015 Medicare Physician Fee Schedule is officially in effect.  Several hundred pages within the 1200-page “Final Rule” describe the rules for the 2015 Physician Quality Reporting System (PQRS) and the 2017 Value-Based Payment Modifier (VBPM). Make no mistake—there is no transition period; these rules are in place today whether you’re ready or not. So, now that we’re playing by 2015 rules, what do you need to know? PQRS 2015 Is…
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Dave Halpert 0
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PQRS ReportingQualified Clinical Data Registry ReportingValue-Based Payment Modifier
December 30, 2014

New Year’s Resolution: Know the Difference Between PQRS and Meaningful Use

No one wants another CMS penalty letter this coming year. Especially after the past two weeks, when many providers from coast to coast learned that their Medicare Part B reimbursements in 2015 will be cut by 1.5 percent, since they were eligible but did not participate in PQRS 2013. Caught by surprise, some providers were shocked to discover that their successful participation in Meaningful Use (MU) did not fulfill PQRS requirements—and they were hit with the penalty. It certainly pays to understand the difference between these two Medicare initiatives. Both MU and PQRS are intended to improve the level of care…
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