Population HealthPQRS ReportingQualified Clinical Data Registry ReportingValue-Based Payment Modifier
April 14, 2015

How to Organize Your Academic Medical Center for PQRS 2015 Success

Take a deep breath. The last-minute flurry of adjustments and updates to last year’s PQRS reporting is over. And—brace yourselves. It’s time to dig into PQRS 2015, which, if you’ve been following our posts, requires a whole new level of rigor to avoid penalties under Pay for Performance. (Download our free eBook, Insider’s Guide to PQRS 2015 Reporting, if you need to catch up.) Nowhere are the new reporting complexities greater than for Academic Medical Centers (AMCs).  Everyone is scrambling to ensure that workflow adjustments sync with new reporting requirements and general measure changes, but AMCs must contend with additional…
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Future of Health CareMedical EducationPopulation HealthPQRS ReportingQualified Clinical Data Registry ReportingRegistry ScienceResearchValue-Based Payment Modifier
April 7, 2015

Academic Medical Centers at Risk: How to Survive Medicare and Medicaid Value-Based Health Care

Academic Medical Centers (AMCs) provide care to the most complicated patients and have surmounted some of the worst clinical challenges of all time. Yet the biggest issue to threaten survival of AMCs might well be Medicare and Medicaid Value-Based Purchasing. While AMCs incorporate the training of new physicians in both community and highly specialized care, the clinical complexity of their patient population is higher than other institutions. At the same time, AMCs are the most likely medical centers to offer trauma and burn care, new medical technology and clinical research. But with typically high volumes of Medicare and Medicaid patients,…
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Population HealthPQRS ReportingQualified Clinical Data Registry ReportingValue-Based Payment Modifier
March 31, 2015

ACO v Group Practice P4P: How Medicare Costs and Quality Calculations Affect Your Bottom Line

Now that Value-Based Health Care defines the landscape, reporting for revenue is on its way out. Value-based quality is in. Medicare’s transition to Pay for Performance gives providers just three options—and no out—for participating in reimbursement models that reward for higher quality and lower cost: Build or participate in an Accountable Care Organization; Report PQRS and submit to the risk of the practice-based Value-Based Payment Modifier; Receive automatic financial penalties. Given that the last option is not really viable, which way should providers participate in Medicare’s Value-Based Health Care? An Accountable Care Organization (ACO) is a network-based model for managing…
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Population HealthPQRS ReportingQualified Clinical Data Registry ReportingValue-Based Payment Modifier
March 24, 2015

PQRS 2014 Last Minute Checklist: What You Can and Can’t Do Now

  With just a few days to go before the final reporting deadline, it’s time to cross the t’s and dot the i’s on PQRS 2014. There may be a few practices still trying to put together a reporting program, but almost everyone using a Registry and who has done the work is ready to report. Here are the top five things you can and should do before your Registry is ready to hit “Submit”: Check again that your Tax Identification Number (TIN) is correct. Yes, you may have already verified it electronically, but numbers sometimes get transposed. Please do it…
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Population HealthRegistry ScienceResearch
March 17, 2015

Placebo v Nocebo: How to Test Methods of Physician Engagement in Population Health

The Holy Grail for value-based health care is to improve patient quality and cost outcomes, while stabilizing or reducing annual aggregate payouts for insurance and government benefits. By holding physicians and health systems accountable, the theory goes, providers will engage with patients in a process leading to better status and lower costs. The key word here is “engage,” because none of this happens in a vacuum. Provider engagement is essential for making change happen. But if engagement is the key, how do physicians’ mindsets, attitudes and language play into outcomes?  Providers are not a homogenous group, any more than patients…
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PQRS ReportingQualified Clinical Data Registry ReportingValue-Based Payment Modifier
March 10, 2015

Tales from the PQRS Trenches: How to Avoid Harm to Your Practice and Patients

With less than three weeks until the final deadline of PQRS Registry Reporting for 2014 services, many providers are still scrambling to figure out their reporting strategy. They will have few—if any—options for success. It’s 2015, the requirements for PQRS reporting are entering their seventh year, and non-reporting penalties have been applied for two years. If your organization wants to avoid a 4 percent penalty on Medicare revenues, this year you must make an early start a top priority. But in the real world, both large and small groups often get sidetracked because there are so many changes in health…
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PQRS ReportingValue-Based Payment Modifier
March 3, 2015

PQRS 2015 Reporting: How to Go Beyond Basics to Improve Outcomes

Chances are you don’t have time to read through all 1,200 pages of Medicare’s Final Reporting Rule. But if you don’t understand how CMS is moving the Medicare program, and the health care system at large, toward rewarding providers for quality rather than quantity of care, your organization is in for a rude awakening. In 2015, PQRS is now mandatory; you must meet full reporting requirements to avoid a penalty. No more safety nets. Successful reporting means you need to understand the interplay between PQRS and the Value-Based Payment Modifier (VBPM), which rewards only those practices that outperform their competition…
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Population HealthRegistry ScienceResearch
February 24, 2015

Population Health: What Should It Really Mean?

A long time ago, on my first day of an Oncology fellowship, my soon-to-be-mentors asked me if I had a research interest. “Yes,” I said, “I want to cure breast cancer.” Their kind smiles belied their recognition of my naïveté. In retrospect, thinking too broadly leaves one adrift. To navigate to your goal, you need to chart a specific, systematic course. Talking without specificity about “population health” can lead to thinking as murky as my claim to cure breast cancer. Population health is sometimes defined so broadly that it becomes meaningless.  Unfortunately, population health has also become synonymous, for some people, with…
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Future of Health CareMedical Decision-MakingPopulation HealthResearch
February 17, 2015

Should Wearable Tech Be Tied to Patient Outcomes? Benefits and Risks of Sharing Personal Digital Data

How many steps did you take today? If you’re a Fitbit fan, you know precisely, and you’re not alone. Digital health devices were a $5 billion-plus growth industry last year, and the range of gadgets is expanding rapidly, from ear devices that measure blood pressure, respiration rate and oxygenation level, to iPhone cases that record your ECG. While wearable tech is a popular means to track your personal health and fitness, the data you collect is also a valuable commodity for ACOs, Health Systems and employers, who are looking for new ways to achieve meaningful savings under Value-Based Health Care.…
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Population HealthPQRS ReportingQualified Clinical Data Registry ReportingValue-Based Payment Modifier
February 10, 2015

Navigating the ACO Labyrinth to Success: How to Find Your Way to Quality and Shared Savings

Last year, less than one quarter of Medicare MSSP ACOs achieved success in generating shared savings. Not a good report card, given that Accountable Care Organizations form for the explicit purpose of delivering high quality, coordinated care, with shared savings as in incentive to avoid duplication of services. But ACOs are complex endeavors, both administratively and clinically. Better coordination of patient care does not guarantee success. Your efforts must be complemented by a solid understanding of Medicare’s basic rules for quality reporting and methods of attributing patients to the ACO, so that you can keep your patients within the network.…
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