Roji Intel Blog

Dave Halpert 0
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PQRS ReportingQualified Clinical Data Registry ReportingValue-Based Payment Modifier
October 13, 2015

ICLOPS Case Study: VBPM Consultation Lifts Specialty Group’s Quality Tier and Medicare Revenues

Medicare’s Value-Based Health Care programs aren’t just about penalties. You can also earn a reward. Case in point—an ICLOPS orthopedic client recently asked The Big Question: Are there really incentives to be earned through Medicare’s Value-Based Care? With the release on September 9 of the Annual Quality and Resource Use Reports (QRURs), the answer is a resounding “Yes.” At its core, the Value-Based Payment Modifier (VBPM) is a simple proposition: Those who are able to demonstrate higher quality care at a lower cost than other groups are rewarded, while those who can’t are penalized. The rewards come from the pool of…
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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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Dave Halpert 0
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Future of Health CareMerit-Based Incentive Payment System (MIPS)Performance ImprovementPQRS ReportingQualified Clinical Data Registry ReportingValue-Based Payment Modifier
September 22, 2015

Medicare’s MIPS: The Not-So New Face of Value-Based Care

Rumors that PQRS and VBPM have died may be wishful thinking, but are far from true. Value-Based Care is here to stay, even as Medicare’s programs evolve. You still have a chance to help shape those initiatives before they become law. So it’s well worth your time now to learn all about Medicare’s newest program, MIPS. In 2019, Medicare will phase in the Merit-Based Incentive Payment System (MIPS). The 2016 reporting year will form the basis for the final Value-Based Payment Modifier (VBPM) and PQRS payment adjustments, to be applied in 2018, with MIPS to begin the following year. But…
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Theresa Hush 0
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ACO ReportingFuture of Health CarePQRS ReportingQualified Clinical Data Registry ReportingRegistry ScienceValue-Based Payment Modifier
September 15, 2015

No More Status Quo: How the New CDR Will Change Health Care

As CMS streamlines its Value-Based Reimbursement programs, the pressure is on for providers to participate. A better foundation is needed to support those changes, so providers can actually succeed. And Medicare’s expansion of Clinical Data Registries (CDRs) may just be the answer. CDRs could be the tipping point for transforming health care. Here’s why: With better capabilities for performance measurement, more comprehensive databases, and expertise for more advanced outcomes analyses and research, CDRs can provide tools that have been missing for all stakeholders—providers, health plans and consumers. What’s a CDR and Why Is It Different? The Clinical Data Registry has…
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Dave Halpert 0
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Alternative Payment Models (APM)AttributionMerit-Based Incentive Payment System (MIPS)Qualified Clinical Data Registry ReportingValue-Based Payment Modifier
September 1, 2015

Mastering MSPB: How “Episode” Care Calculations Make or Break Your Revenues

The whole may be greater than the sum of its parts—but how those parts each contribute to the whole is key to a new Medicare calculation of episode costs. If you aren’t paying attention to the total cost of an entire “episode” of care for your patients—including that rendered by others—your future revenues may take a hit. Enter Medicare Spending Per Beneficiary (MSPB), a component of CMS’s Value-Based Payment Modifier (VBPM) calculations that is crucial to your bottom line. MSPB is a measure of charges per episode of care that looks at costs immediately prior to, during and following a hospital…
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Dave Halpert 0
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AttributionPQRS ReportingValue-Based Payment Modifier
August 25, 2015

How to Boost Your VBPM with ICD-10

With five weeks until ICD-10 becomes official, take note: Your transition strategy must include PQRS and the Value-Based Payment Modifier (VBPM). Neglecting VBPM in your short-term plan may lead to long-term penalties. That now goes for everybody, whether you helm an Academic Medical Center or run a small practice. October 1, 2015, marks the starting date of the new coding set for diagnoses and inpatient procedures. ICD-10’s increased specificity dovetails with how medicine is practiced today, versus the 36-year-old ICD-9 coding. Given a choice between implementation and lost revenues, practices will have no option but to make the transition. As…
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Dave Halpert 0
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ACO ReportingPQRS ReportingQualified Clinical Data Registry ReportingValue-Based Payment Modifier
August 18, 2015

Radiologists’ Tool Kit: How to Succeed in PQRS and VBPM

When it comes to PQRS reporting, it’s not easy being a radiologist. How can you fulfill PQRS reporting requirements and avoid jeopardizing future value-based payments? Many radiologists have found themselves backed into a PQRS corner—not enough measures to report, and those measures that can be reported have some tricky requirements. Similar to anesthesiologists, radiologists practice in a variety of settings and perform different types of procedures, according to sub-specialty. Depending on the procedures you perform, the vast majority of PQRS measures may not be applicable to you—not only are they clinically irrelevant, but you couldn’t report them even if you…
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Theresa Hush 0
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ACO ReportingFuture of Health CarePopulation HealthQualified Clinical Data Registry ReportingRegistry ScienceResearchValue-Based Payment Modifier
August 4, 2015

ACOs and the Referral Revolution Part 2: How to Align Objectives and Referral Practices

There’s no getting around it. Disruption in referrals under new Value-Based Health Care programs will upset both primary care and specialty practices under any change scenario. Physicians with historical relationships will undoubtedly resent an edict to redirect referrals, if they don’t understand or believe comparative data on cost and quality. On the other side of the equation, physicians who accept that aligning referrals with outcome data is part of being in an ACO will object if they see that referrals are driven, instead, by physician employment status. Every participant in an ACO must eventually accept that achieving shared savings will…
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Thomas Dent, M.D. 0
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ACO ReportingFuture of Health CareValue-Based Payment Modifier
July 28, 2015

Are Your Specialists and ACO Ready for the Referral Revolution? Part 1

The practice of physician-determined referrals to specialists is deeply embedded in the culture of medicine. But it no longer works under Value-Based Health Care. A revolution in referrals is underway, one that will dramatically change physician alignment and engagement in ACOs and other Pay for Performance models. Outcome measures can distinguish the performance of one specialist versus another—and this performance data is available to both health systems and physicians. We all know that pure comparative performance data has a lot of flaws. But Medicare is publishing provider-specific performance for PQRS and group performance for ACOs, and calculating comparative scores under the…
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Theresa Hush 0
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ACO ReportingPQRS ReportingQualified Clinical Data Registry ReportingValue-Based Payment Modifier
July 14, 2015

Will Medicare’s Published Physician Quality Data Push Your Patients Away?

CMS isn’t the only group scrutinizing your quality and cost data any more. As the next step toward value-based health care, Medicare has begun publishing provider performance data for PQRS under “Physician Compare.” Now patients and their families can make their own data-driven choices about health care providers with an online search. The website is a game-changer. Performance variation between providers is startling. There are 50 provider groups with performance at or lower than 65 percent for at least one published measure. By contrast, a handful of groups show all four measures over 95 percent. The 2013 data are limited and do…
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