Roji Intel Blog

Theresa Hush 0
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Alternative Payment Models (APM)Future of Health CareMACRAMerit-Based Incentive Payment System (MIPS)Patient Empowerment
April 12, 2017

Why MACRA MIPS Cost Episodes Make Good Products for Health Care Consumers

Here’s a radical idea: What if providers re-envisioned MIPS as a patient marketing initiative, not a regulatory response? Yes, I’m serious. From the beginning of PQRS and Meaningful Use to MACRA, health systems considered these efforts to be merely “compliance” with regulations and not market initiatives. But this view is shortsighted. As outlined in MACRA rules, all of the MIPS initiatives parallel changes that consumers, employers and health plans have been demanding: lower costs, quality, improvement and value. Analyzing the MIPS component of Cost provides a good way to evaluate how providers could use Medicare data to help remap their…
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Theresa Hush 0
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Future of Health CareMACRAPatient EmpowermentPerformance ImprovementValue-Based Health Care
March 29, 2017

Why Bundled Payments Are a Win-Win for Specialists and Health Care Consumers

Bundled payments, a health care payment innovation that has been widely praised for controlling costs, recently got a bad rap. Secretary of Health and Human Services Tom Price  has delayed implementation of the final Medicare rule for several bundled payment programs that were set to start this year. He has criticized the bundled payments initiative for moving too fast and “experimenting with patients’ health.” Other industry experts disagree. They strongly favor the concept for both improving care and cutting costs. Bundled payments reimburse physicians and hospitals according to a set fee that includes all care associated with a procedure or…
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Theresa Hush 0
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ACO ReportingAlternative Payment Models (APM)Future of Health CareMACRAMeaningful UseMerit-Based Incentive Payment System (MIPS)Population HealthPQRS ReportingQualified Clinical Data Registry ReportingValue ModifierValue-Based Health Care
June 7, 2016

Proposed MACRA Rules: Your APM Strategy for Risk Readiness

If you chose not to participate in Medicare ACOs or Bundled Payments in recent years, CMS is planning to change your mind. Proposed MACRA Rules reveal a complex carrot-and-stick approach to inducing providers into risk models. Make no mistake: it’s just a matter of when, not if, you participate in one of the Alternative Payment Models (APMs). It will pay (literally) to begin planning your path to risk now. Here are five important provisions in the Proposed Rules that you need to understand: Full qualification as an Advanced APM earns a 5 percent lump sum bonus, exemption from participation in…
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Dave Halpert 0
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ACO ReportingAlternative Payment Models (APM)Clinical Data RegistryPQRS ReportingValue ModifierValue-Based Health CareValue-Based Payment Modifier
April 5, 2016

If Your Solution to PQRS Reporting Is an ACO, Think Again

Problems with PQRS reporting this year? As a Registry that works with groups ranging from Academic Medical Centers to solo practitioners, we’ve seen the whole gamut of issues. While there are no quick and easy solutions (sorry), the biggest myth we’re hearing this year is that you can solve all your PQRS problems by forming an Accountable Care Organization (ACO). It’s certainly true that if your ACO reports successfully—and most do—you are not required also to report for PQRS. But before you take the huge organizational leap to forming or joining an ACO, you’d best read the fine print. For…
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Theresa Hush 0
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ACO ReportingAlternative Payment Models (APM)Clinical Data RegistryMeaningful UseMerit-Based Incentive Payment System (MIPS)Performance ImprovementValue-Based Health Care
March 22, 2016

Ready for Risk? How to Foster Physician Alignment with Your Health System’s APMs

We’ve seen unprecedented consolidation among hospitals, hospital systems and physician groups in recent years, sparked by the drive for greater market share. As systems organize competitively to participate in risk models such as ACOs and bundled payments, however, the dramatic surge in hospital employment of physicians hasn’t helped ACO success. In fact, most Medicare ACOs have not met cost targets needed to generate revenue. All too often, hospitals or health systems and their physicians clash over goals, expectations, outcomes and basic communication regarding Alternate Payment Models (APMs). As a Registry helping large systems take steps toward clinical integration, ACOs and performance…
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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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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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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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ACO ReportingClinical Data RegistryFuture of Health CareMeaningful UseMerit-Based Incentive Payment System (MIPS)
November 10, 2015

Questions You Should Ask (or Should Have) About Medicare’s Alternative Payment Models

Are you prepared for your risk or reward under Medicare payment reforms? It’s hard to give up current revenues that reward volume, sooner than absolutely necessary. That’s the dilemma facing all providers who realize that Medicare is serious about moving 50 percent of its provider reimbursement to Alternative Payment Models (APMs) by the end of 2018. While some providers have rushed into the new system while Medicare still allows for failure to meet targets, others are waiting (including many higher cost academic medical centers). Here’s what to ask before plunging in—and if you’re already in, how to right the ship.…
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Dave Halpert 0
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Alternative Payment Models (APM)Future of Health CareValue-Based Payment Modifier
October 6, 2015

Be Prepared for Medicare’s Transition to Bundled Payments—or Risk Future Revenues

As specialists face increasing pressure to lower costs, particularly by Medicare, so-called Bundled Payments are becoming an increasingly significant—and preferred—method of reimbursement. Although this form of Alternative Payment Method (APM) is not yet mandatory, most industry experts believe that bundled payments will form the basis of how Medicare will pay specialty services in the future, especially regarding inpatient care. Develop your strategy now, or you risk economic fallout. From a fledgling pilot initiative, Medicare’s Bundled Payments for Care Improvement Initiative (BCPI) has grown to 2,100 provider groups with initiatives in one or more of 48 unique procedure or diagnosis “bundles.”…
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