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 […]
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 […]
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 […]
Expanding Your ACO: The Best Recruiting Strategy for Bigger ACO Savings
Whether your ACO is in its infancy or is established and growing, you’ve probably had to make some difficult choices about which groups to include—and exclude. Your ACO’s success is almost entirely driven by your ACO network’s participating providers (and their patients). They provide the care and generate beneficiary costs, and help to ensure better […]
Don’t Let Wishful Thinking and Healthy Patients Harm Your ACO
Can healthy patients actually hinder your ACO’s ability to generate shared savings? Without a multi-layered strategy to improve continually over the course of the ACO agreement, the answer is yes. With the majority of ACOs failing to generate shared savings, a growing number of groups are beginning to realize that serving either the healthy or […]
2016 Medicare Final Physician Payment Rule: What You Must Know
CMS’s push toward value-based care and performance improvement leaves no more room for doubt. In a hefty 1,358 pages, the 2016 Medicare Final Rule expands the role of Qualified Clinical Data Registries for PQRS reporting, dovetailing with the Specialized/Clinical Data Registry component in the Meaningful Use Rules. Both methods place the focus squarely on how […]
Break the Barriers to ACO Shared Savings
The ACO performance results for 2014 are in, and they are troubling. While most ACOs were able to fulfill quality reporting requirements, only some reduced costs enough to qualify for shared savings. Many ACOs did cut costs—of the 353 ACOs, there were $411 million in total savings. But for most ACOs, it was not enough. […]
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 […]
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, […]
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, […]