Roji Intel Blog

Theresa Hush 1
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ACO ReportingAlternative Payment Models (APM)MACRAMerit-Based Incentive Payment System (MIPS)Performance ImprovementQualified Clinical Data Registry ReportingValue-Based Health Care
July 12, 2016

MIPS v APM: Which Is Your Best Bet?

If you’ve been watching the signals from CMS, you undoubtedly know by now that the current reimbursement structure under Medicare will end, to be replaced by a Quality Payment Program (QPP) that holds providers at risk for resource use and quality. The ensuing choices, however, are confusing. Providers can select one of two QPP tracks: Continue Fee for Service (FFS) and fall under the Merit Incentive Payment System (MIPS) or participate in an Alternative Payment Model (APM), such as a risk-based ACO. So, how do you know if MIPS or APM is the best way to go, and on what…
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Theresa Hush 2
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Alternative Payment Models (APM)MACRAMerit-Based Incentive Payment System (MIPS)Qualified Clinical Data Registry ReportingValue-Based Health Care
July 5, 2016

Succeed Under MACRA Medicare: How to Meet CPIAs for Full Credit in MIPS

Although many parts of MACRA’s MIPS continue Medicare’s existing quality programs, Clinical Performance Improvement Activities (CPIAs) forge a new direction. CPIAs are one of four MIPS components that practices must meet in order to obtain full reimbursement from Medicare. Forward planning is essential. It takes time to strategize and implement performance improvements, including partnerships and technology. To make this happen in 2017—the base year for performance measurement—providers must prepare before the MACRA rules are finalized. CPIAs are a unique sign of Medicare’s intent to hold practices accountable for improving health care outcomes. That’s a significant step in Medicare’s evolving role…
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Dave Halpert 0
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Alternative Payment Models (APM)Clinical Data RegistryMACRAMeaningful UseMerit-Based Incentive Payment System (MIPS)PQRS ReportingQualified Clinical Data Registry ReportingValue ModifierValue-Based Health Care
June 28, 2016

What’s the Score? Decoding the MIPS Scoring Methodology

CMS is calling MIPS the “First Step to a Fresh Start.” When it comes to scoring, that’s an understatement. Although MIPS’s foundations are rooted in existing programs, the MIPS algorithm is a significant departure from today’s quality, cost and health information technology scoring. Not only new, this scoring methodology is complex. Providers will receive one aggregated MIPS Composite Performance Score (CPS), but remember—this one score is going to account for three existing programs, plus a component for ongoing improvement. The real first step: learn how the scoring is done. With penalties starting at 4 percent the first year, growing to…
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Dave Halpert 0
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MACRAMerit-Based Incentive Payment System (MIPS)PQRS ReportingQualified Clinical Data Registry ReportingValue Modifier
June 14, 2016

Don’t Miss GPRO Deadline: Choose (and Register) by June 30

For many, June 30 means the fiscal year is coming to its end. It also means the deadline for self-nominating for the Group Practice Reporting Option for PQRS looms near. Why does it matter? Because your selection (or lack thereof) has the potential to substantially impact your budget in 2018, and the GPRO registration deadline is June 30. Millions of dollars are at stake. Failing to report for PQRS means that CMS will hold back 6 percent of all Medicare Part B reimbursements in 2018—a 2 percent penalty for not reporting PQRS, plus a 4 percent penalty for the Value…
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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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Theresa Hush 0
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Alternative Payment Models (APM)Clinical IntegrationFuture of Health CareMACRAMerit-Based Incentive Payment System (MIPS)Performance ImprovementValue-Based Health Care
May 17, 2016

3 Ways Proposed MACRA Rules Revive Health Systems’ Clinical Integration Programs

Clinical Integration in medium to large Health Systems just received a nice push from the federal government’s Proposed Rules for MACRA. Health Systems trying to market quality-based physician and hospital networks systems— especially those with both employed and private physicians—should take note. This opportunity for Health Systems to bridge Medicare and private health plan quality is one of the best features of MACRA. Why? Look at this triple play of provisions woven through both MIPS and APMs: “Other-Payer” Advanced APMs will be allowed in the program’s third year to meet Advanced APM status by participating in both Health Plan and Medicare…
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Dave Halpert 0
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Alternative Payment Models (APM)MACRAMerit-Based Incentive Payment System (MIPS)Performance ImprovementPQRS ReportingQualified Clinical Data Registry ReportingValue ModifierValue-Based Health CareValue-Based Payment Modifier
May 3, 2016

Know the F.A.C.T.S.: 2016 Proposed MACRA Rule Highlights

Just over a year since the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) passed, the new Proposed MACRA Rule was released on April 27. Now we finally have some details on how Fee For Service will yield to reimbursement through value. There’s a lot to digest in this hefty rule and a great deal at stake, including hundreds of millions of dollars in penalties and incentives. Here’s what you need to know about the proposal and how it affects you. And if you have concerns, be sure to speak up during the 60-day comment period! As anticipated, Alternative…
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Theresa Hush 0
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ACO ReportingClinical Data RegistryFuture of Health CarePerformance ImprovementRegistry ScienceResearchValue-Based Health Care
April 26, 2016

Your Health Care IT Investments: How to Purchase for Performance Improvement

Health care technology (HIT) is frequently oversold. That may be a surprising message coming from a Registry CEO, but it’s the truth. In the quest for answers, too many providers search for a system that can “do it all,” a dream technology that exists, well, only in your dreams. There is intense pressure on providers to prepare for undertaking the financial risk of patient care, while maintaining or improving patient quality and outcomes. Two factors are driving the push for HIT purchases to meet this demand: providers’ strong wish for easy and straightforward solutions that can mesh with existing technology,…
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Robert McNutt, M.D. 0
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Clinical Data RegistryRegistry ScienceResearch
April 19, 2016

Does Data Say All You Need to Improve Health Care Performance?

Can data lie? In a word, yes. The answer also depends on whom you ask. That goes for all forms of data analysis, including how we evaluate health care. This presents a tough dilemma for providers, patients and other stakeholders at a time when the industry and government are heavily invested in using data to compare provider performance, attach payment to “good” providers and penalties for the others. The fact is that the health care data “revolution” is in its infancy, and it is not so easy to identify two key facts: what causes outcomes, and what fixes them. Situations…
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Thomas Dent, M.D. 0
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Alternative Payment Models (APM)Future of Health CarePerformance ImprovementSpecialized RegistryValue-Based Health Care
April 12, 2016

Boutique Medicine’s Quality Challenge: Can Specialized Registries Aid Consumer Choice?

Many physicians—especially those in primary care—are angry about the practice of medicine. Dogged by high administrative overhead, they feel the pressure of shorter visit times to meet the practice’s income needs. In some geographic areas, PCPs are opting out of Medicare assignment in large numbers and establishing boutique medicine practices (including “concierge medicine”). Indeed, as CMS pushes providers toward risk under Alternative Payment Mechanisms (APMs) and away from the traditional fee-for-service, concierge medicine has become an attractive alternative for physicians who are fed up with the system. What does this trend mean for access and quality of care, especially when…
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