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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Medical EducationPopulation HealthResearch
October 28, 2014

The Missing Dimension of Residencies That Will Affect Your Program’s Future

Residency programs need to change. I write this as a former family medicine residency program director who spent much of my professional life teaching residents and medical students. Specifically, residency programs need to get on track in the value-based health care world. To fail to do so is to become obsolete. Here‘s the problem: Like most residency programs, our teaching focused on individual patients, in both the office or in the hospital. While we treated specific conditions and used protocols, however, we never evaluated performance of a patient population, particularly over an extended time frame. Quality Measurement is Now Central…
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Population HealthResearch
October 22, 2014

Research Revolution: Why Everyday Medical Decisions Need More Science

How can a physician know when a treatment actually works? Let’s examine the case of outcomes for patients with asymptomatic bacteriuria. In a recent study, patients with the diagnosis were randomized to receive either an antibiotic or a placebo; the outcome measure was the proportion who developed symptomatic bacteriuria. The findings? Both groups had nearly the same proportion of symptomatic bacteriuria at the end of the study. Clearly, the antibiotic made no difference in outcomes. But this can be a hard sell, not only for patients who expect their physicians to “do something,” but also for physicians, who believe that…
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Medical Education
October 15, 2014

Asset or Liability? How Your Residency Programs May Affect Your Competitive Standing

At its core, value-based medicine is all about aligning physician and hospital costs with the quality and effectiveness of care. But all too often, providers ignore the impact of one of their greatest workforce resources: residency programs. In many environments, residents deliver much of the front-line care in hospitals, emergency rooms and in employed primary care practices. But who is measuring your residents’ unique contribution to quality and costs? Can you assess how resident-delivered care affects your bottom line?  And here’s the kicker: Will subsidized medical education continue to be a given in the future, if residency programs fail to…
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Value-Based Payment Modifier
October 8, 2014

The “Avoidable Admissions” Pitfall: What Your Physicians Must Know to Avoid Medicare Penalties

Hospital and physician groups, take note: If you’re admitting patients to hospitals for complications that could have been prevented by better outpatient care, your Medicare revenues are in jeopardy. Under the 2014 Value Based Payment Modifier (VBPM) formula, groups that admit more patients for conditions classified as “avoidable” will risk penalties if their admissions are higher than similar sized groups, and reap rewards if admissions are lower. ACOs have similar reward structures associated with their hospital costs; in 2015, groups participating in ACOs will also bear risk under the VBPM. This is one of the ways that Medicare is instilling…
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PQRS Reporting
October 1, 2014

Is Your PQRS Program “Old School”? Shift Your Focus to Competitive Performance in 5 Key Steps

It used to be that CMS rewarded providers almost exclusively on the reporting of PQRS quality measures. Providers received a Medicare bonus even if they did not meet a measure’s performance. Medicare still requires PQRS reporting to avoid penalties and receive a bonus, but CMS has now made it the first step in a larger quality measurement process. Performance on measures is now critically important for practices or groups falling under Value-Based Payment Modifier (VBPM) quality tiering or who participate in an ACO. This includes the vast majority of all physicians. Bottom line: It’s no longer enough simply to report…
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PQRS ReportingQualified Clinical Data Registry Reporting
September 25, 2014

How to Integrate Strategic Quality Initiatives with PQRS Reporting: The QCDR Opportunity

For 2014 and beyond, CMS has created a new mechanism for PQRS reporting—the Qualified Clinical Data Registry. QCDR reporting requirements are the same as for a traditional Registry utilizing individual measures: A provider must report on at least nine measures. These measures must represent at least three National Quality and Strategy (NQS) Domains. Each of the nine measures must be completed for at least 50 percent of eligible patients or cases. However, a QCDR has features that can bring more to PQRS performance and reporting. QCDRs are designed to foster improvement in the quality of care provided to patients.  A…
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PQRS Reporting
September 15, 2014

Still Not Sure of Your PQRS 2014 Strategy? Delays Will Cost You

If your organization is just beginning to think about PQRS reporting for 2014, beware. End-of-year data collection is no longer enough to meet PQRS requirements. That’s because PQRS is no longer a quality “reporting” program; it’s now all about performance. In fact, waiting to determine your 2014 PQRS strategy until the last minute is actually very risky and could jeopardize both performance and future revenue. Although reporting through a qualified Registry extends your deadline (for 2014, CMS will not close its portal until March 31, 2015), the new Value-Based Payment Modifier (VBPM) requires more lead time to demonstrate good results.…
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