Roji Intel Blog

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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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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Dave Halpert 0
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PQRS ReportingQualified Clinical Data Registry Reporting
December 16, 2014

Season’s Greetings from CMS: You Owe 1.5 Percent for a PQRS Reporting Failure

‘Tis the season to be jolly—unless your health care organization is one of many last week that received a letter from the Centers for Medicare and Medicaid Services (CMS) informing you that at least one of your providers was eligible to participate in PQRS in 2013, but failed to do so—and that a penalty is coming in 2015. Those who did not successfully report at least one PQRS measure in 2013 will only be reimbursed 98.5 percent on all allowable 2015 Medicare Part B charges—a 1.5 percent cut.   Ready or Not, the Penalties Were Based on 2013 PQRS Reporting…
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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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Population HealthPQRS ReportingValue-Based Payment Modifier
November 18, 2014

PQRS 2015: How Your Practice and Patients Can Benefit from New Population Health Measures

Good news for providers who have criticized PQRS as mundane and want to improve assessment of patient outcomes and reduce gaps in care: Medicare’s PQRS 2015 Rule is shifting away from rewarding fragmented quality services and toward population health. With the expansion of the related Value-Based Payment Modifier (VBPM), every group can turn population health into higher Medicare revenues, so long as you have strong, patient-centric processes—and data capture. If you don’t, you may suffer penalties. What’s a Cross-Cutting Measure and How Does It Work? CMS has established a set of Cross-Cutting Measures to provide a broader evaluation of care…
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Theresa Hush 0
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PQRS ReportingQualified Clinical Data Registry ReportingValue-Based Payment Modifier
November 11, 2014

Specialists at Risk: How To Navigate Hazards in Medicare’s Value-Based Purchasing Programs

Heads up, specialty providers. The future of your practice may depend on three key components in Medicare’s Value-Based Purchasing program. Especially if you work in an independent practice with a higher proportion of Medicare patients than many primary care physicians, your income and practice survival are at risk if you don’t understand implications of the new Rule for 2015. This is certain: You must manage the new environment to avoid penalties and losses under these programs. Most important are PQRS 2015, Value-Based Payment Modifier (VBPM) and ACO Participation. That’s the foundation; with requirements getting tougher every year, you need to…
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Dave Halpert 0
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PQRS ReportingValue-Based Payment Modifier
November 6, 2014

Final PQRS 2015 Reporting Rule: Higher Penalties and Tougher Requirements

Looking for a good bedtime read? CMS has finalized its 1200-page Medicare Physician Payment System rule for 2015. While the full version is a sure cure for insomnia, buried within are two areas worth your attention: 2015 PQRS Reporting, and Medicare’s Value-Based Payment Modifier (VBPM). Central to Medicare’s value-based health care efforts, both impose stiffer penalty risks for physician groups in 2015. Here are key rule highlights for these two programs, modified slightly from the proposed rule.   Higher Penalties for PQRS Non-Reporting Failure to report PQRS triggers two penalties: a PQRS non-reporting penalty of 2 percent, plus a VBPM non-reporting penalty…
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