Roji Intel Blog

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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Thomas Dent, M.D. 0
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Population HealthRegistry ScienceResearch
March 17, 2015

Placebo v Nocebo: How to Test Methods of Physician Engagement in Population Health

The Holy Grail for value-based health care is to improve patient quality and cost outcomes, while stabilizing or reducing annual aggregate payouts for insurance and government benefits. By holding physicians and health systems accountable, the theory goes, providers will engage with patients in a process leading to better status and lower costs. The key word here is “engage,” because none of this happens in a vacuum. Provider engagement is essential for making change happen. But if engagement is the key, how do physicians’ mindsets, attitudes and language play into outcomes?  Providers are not a homogenous group, any more than patients…
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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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Robert McNutt, M.D. 0
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Population HealthRegistry ScienceResearch
February 24, 2015

Population Health: What Should It Really Mean?

A long time ago, on my first day of an Oncology fellowship, my soon-to-be-mentors asked me if I had a research interest. “Yes,” I said, “I want to cure breast cancer.” Their kind smiles belied their recognition of my naïveté. In retrospect, thinking too broadly leaves one adrift. To navigate to your goal, you need to chart a specific, systematic course. Talking without specificity about “population health” can lead to thinking as murky as my claim to cure breast cancer. Population health is sometimes defined so broadly that it becomes meaningless.  Unfortunately, population health has also become synonymous, for some people, with…
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Thomas Dent, M.D. 0
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Future of Health CareMedical Decision-MakingPopulation HealthResearch
February 17, 2015

Should Wearable Tech Be Tied to Patient Outcomes? Benefits and Risks of Sharing Personal Digital Data

How many steps did you take today? If you’re a Fitbit fan, you know precisely, and you’re not alone. Digital health devices were a $5 billion-plus growth industry last year, and the range of gadgets is expanding rapidly, from ear devices that measure blood pressure, respiration rate and oxygenation level, to iPhone cases that record your ECG. While wearable tech is a popular means to track your personal health and fitness, the data you collect is also a valuable commodity for ACOs, Health Systems and employers, who are looking for new ways to achieve meaningful savings under Value-Based Health Care.…
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Thomas Dent, M.D. 0
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Future of Health CarePopulation HealthPQRS ReportingValue-Based Payment Modifier
January 27, 2015

How Medicare is Moving from PQRS Basics into Value-Based Care: Improving Outcomes with Plan of Care

For a number of PQRS measures, Medicare requires that the provider document a Follow-up Plan or Plan of Care to demonstrate that appropriate interventions have been made to reduce risk. This has caused confusion and consternation among some of our clients who may not have clearly documented the follow-up plan or may disagree with Medicare on the plan’s criteria. Nonetheless, documentation of risk-reduction interventions is in keeping with CMS plans to transition all reimbursement into Value-Based Care, so it’s essential to understand how to manage this process. In fact, just this past Monday, January 26, Health and Human Services Secretary…
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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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Thomas Dent, M.D. 0
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Population HealthPQRS Reporting
December 9, 2014

How to Energize Your Providers to Measure and Improve Outcomes

It’s no wonder that so many physicians feel threatened by the mention of outcomes measurement. All too often, outcomes are used as a club to punish providers who seem to weaken overall group performance. Or outcomes are packaged and applied in a way that doesn’t provide actionable information—which can seem like a waste of everyone’s time and resources. To engage your providers—and get the real benefit from this form of health care data analysis—try to link your efforts to measure and improve outcomes with an iterative process of inquiry into best practices. Why Outcomes Measurement Can Seem Misleading Measuring patient…
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Thomas Dent, M.D. 0
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Population HealthPQRS Reporting
December 2, 2014

No More Blame Game: How to Use Patient Outcomes Measurement to Boost Quality and Provider Performance

Fair or not, if your patients don’t do well, your physicians can be tagged as poorly performing providers. But there are ways to change the dynamic for your organization by effectively using patient outcomes measurement to structure and drive a quality program that benefits both patients and providers. Tracking the health and status of patients—“how patients do”—is the Holy Grail of quality measurement. Despite the fact that it is very difficult to identify a direct cause and effect between provider action and patient outcomes, quality programs are shifting the emphasis to patient outcomes and attributing performance to physicians. This is…
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Theresa Hush 0
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Future of Health CareResearch
November 25, 2014

Health Care 2014: Where Do We Go from Here?

This week, many of us will sit around Thanksgiving tables, giving thanks for our families and friends, food and shelter, and living in this good land. We might also say, this land where we have access to some of the best health care on earth. So how interesting that we have spent the last several years waging war on every part of health care—the building of it, buying it, paying for it, measuring its value and delivering it. How did we get here? Have we lost trust in health care as we’ve lost trust in government? Or, perhaps there is…
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