Roji Intel Blog

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MACRAMerit-Based Incentive Payment System (MIPS)Performance ImprovementQualified Clinical Data Registry ReportingValue-Based Health Care
August 16, 2016

Can MACRA Help Patient-Centered Medical Homes Succeed?

The concept of a Patient-Centered Medical Home (PCMH) fits neatly into Value-Based Health Care: patients who are well should incur lower costs. And, if primary care providers help patients who are not well to manage chronic diseases and better navigate the system, outcomes and costs should also improve. But those results are not yet proven. Like any new delivery model, the solution can only work if providers have the commitment and tools to realize its potential. This is why MACRA’s new emphasis on the Patient-Centered Medical Home includes many incentives to engage providers. The PCMH features strongly under MACRA. Medicare’s…
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Dave Halpert 0
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Alternative Payment Models (APM)MACRAMeaningful UseMerit-Based Incentive Payment System (MIPS)Performance ImprovementPQRS ReportingQualified Clinical Data Registry ReportingValue ModifierValue-Based Health CareValue-Based Payment Modifier
July 26, 2016

Closing the Book on PQRS (and Opening the MACRA Sequel)

Did you receive your confirmation email from the Physician Value Help Desk that your TIN was successfully registered for Group Practice reporting? If you did, which method did you select? Whether Registry, QCDR, EHR-Direct or the CMS Web Interface, you are officially locked into that choice, and it’s too late to back out. If you didn’t register, and are not in an ACO or another program that excuses you from PQRS (beware—this does NOT include Meaningful Use!), you’re still on the hook for PQRS and are locked into reporting at an individual level. Now that the registration deadline has passed,…
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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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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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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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Dave Halpert 0
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Future of Health CarePerformance ImprovementPQRS ReportingValue ModifierValue-Based Health CareValue-Based Payment Modifier
March 15, 2016

Still Not Sure of PQRS-VBPM? You Just Gave Your Competitor a Huge Bonus

If you still need a good reason to meet all PQRS requirements and improve your quality tiering under the Value-Based Payment Modifier (VBPM or Value Modifier), listen up: Failure to do so means your penalty will end up in your competitor’s pocket. Not only that—the 2016 Value Modifier Adjustment Factor (AF) for incentive payments has just been decided by CMS, and it’s an eye-popping 15.92 percent on all allowable Medicare Part B charges. Simply put, those groups whose Quality and Resource Use Reports (QRURs) showed 1.0 x AF will earn close to an additional 16 percent incentive payment, more than…
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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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Dave Halpert 0
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Performance ImprovementPQRS ReportingValue-Based Health CareValue-Based Payment Modifier
February 23, 2016

Don’t Hit the Medicare Revenue Wall: What You Must Know About 2016 PQRS-VBPM Benchmarks

What will it take for health care providers actually to focus on improving patient outcomes, while keeping costs under control? CMS has structured quality reporting under the Value-Based Payment Modifier (VBPM) to reward providers who surpass PQRS measure benchmarks, and penalize those who lag behind. But inherent in the new quality tiering is a serious dilemma: a strong incentive to game the system, rather than to improve performance in any meaningful way. Here’s why: For three-quarters of the individual measures included in these benchmarks, it is statistically impossible to surpass your peers’ performance. The only way to differentiate performance is…
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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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