Roji Intel Blog

Theresa Hush 0
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Future of Health CareMACRAMerit-Based Incentive Payment System (MIPS)Patient EmpowermentPerformance ImprovementValue-Based Health Care
April 20, 2017

Can Value-Based Health Care Help Consumers Choose Doctors? 
12 Questions to Ask

Do consumers and other health care purchasers have the ability to choose providers based on quality and cost? That’s the assumption beneath attempts by Medicare and health plans to reimburse providers based on their ability to deliver better quality while constraining costs. Value-Based Health Care also includes programs by commercial insurance to offer “narrow” provider networks that select physicians and hospitals by performance. Choosing value presumes that consumers and employers have the right knowledge and information to select providers who deliver the best clinical results at lower cost. The need to provide that information has fueled efforts over the past…
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Theresa Hush 0
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Alternative Payment Models (APM)Future of Health CareMACRAMerit-Based Incentive Payment System (MIPS)Patient Empowerment
April 12, 2017

Why MACRA MIPS Cost Episodes Make Good Products for Health Care Consumers

Here’s a radical idea: What if providers re-envisioned MIPS as a patient marketing initiative, not a regulatory response? Yes, I’m serious. From the beginning of PQRS and Meaningful Use to MACRA, health systems considered these efforts to be merely “compliance” with regulations and not market initiatives. But this view is shortsighted. As outlined in MACRA rules, all of the MIPS initiatives parallel changes that consumers, employers and health plans have been demanding: lower costs, quality, improvement and value. Analyzing the MIPS component of Cost provides a good way to evaluate how providers could use Medicare data to help remap their…
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Theresa Hush 0
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MACRAMerit-Based Incentive Payment System (MIPS)Qualified Clinical Data Registry Reporting
April 5, 2017

Do Centers of Excellence Lose Under New MACRA MIPS Episodic Cost Measures?

Health systems’ Centers of Excellence that attract patients through clinical prowess may be heading for an upset. Under the MACRA MIPS program now entering its first year, physicians will be scored for cost performance in some of the same clinical areas that they have promoted to distinguish their care—and compared against their peers. Since Centers of Excellence are likely to be higher cost in comparison with other providers, associated episodic cost measures may possibly be used to penalize their providers. The impact won’t be felt immediately, however; in 2017 the MIPS Cost component is scored but not calculated in the…
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Theresa Hush 0
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Future of Health CareMACRAPatient EmpowermentPerformance ImprovementValue-Based Health Care
March 29, 2017

Why Bundled Payments Are a Win-Win for Specialists and Health Care Consumers

Bundled payments, a health care payment innovation that has been widely praised for controlling costs, recently got a bad rap. Secretary of Health and Human Services Tom Price  has delayed implementation of the final Medicare rule for several bundled payment programs that were set to start this year. He has criticized the bundled payments initiative for moving too fast and “experimenting with patients’ health.” Other industry experts disagree. They strongly favor the concept for both improving care and cutting costs. Bundled payments reimburse physicians and hospitals according to a set fee that includes all care associated with a procedure or…
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Theresa Hush 1
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Future of Health CareMedical Decision-MakingPatient Empowerment
March 22, 2017

Health Care Price Transparency for Consumers Starts with Provider Action

“Consumer choice” is at the heart of the national health care debate. This presumes access to accurate information about costs. While consumers woke up to health care costs a few years ago as their share began to rise, they lack the necessary facts to make intelligent decisions about the quantity and quality of what they are purchasing. As costs continue skyward, this crucial information, especially price transparency, is what consumers are now demanding. But health care pricing remains a mystery that can’t be solved by consumers, on their own. While “pricing” to consumers includes insurance premiums and payments to providers, only…
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Theresa Hush 0
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Future of Health CareMedical Decision-MakingPatient Empowerment
March 14, 2017

Fast Forward: Why Patients Should Own Their Medical Records

Up to now, who owns patient medical records hasn’t been a big issue. In fact, the “who owns” question has been largely confined to provider purchasing discussions regarding health care data analytics or other sharing of patient records, when providers want to assert their ownership of the data. Patients have had no voice in this conversation. Few people question the provider’s ownership of a patient’s record, which is supported by state statutes (only one state grants ownership to patients) as well as the rare case of litigation. All that changes going forward. Why? Because big revisions in health insurance will…
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Theresa Hush 0
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Future of Health CareMACRAMedical Decision-MakingPatient Empowerment
March 7, 2017

The Problematic “A” in the ACA Repeal and Replace

Last week, my sister sent me a copy of an email that she had sent to her inner circle. It began, “I am writing you today as a metastatic breast cancer patient . . . and also as your friend or relative who wants you to have the best resources and care if this disease ever affects your life or loved ones.” It was a plea for women to understand what would happen to breast cancer patients if the Affordable Care Act (ACA) was repealed, linked to an article. She was hoping to reach across a divide to raise consciousness about…
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Dave Halpert 0
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Alternative Payment Models (APM)Meaningful UseMerit-Based Incentive Payment System (MIPS)PQRS ReportingQualified Clinical Data Registry ReportingValue Modifier
February 28, 2017

How to Turn 2016 PQRS Success into Better Care (and a MIPS Win)

March has arrived. The submission window for PQRS shuts on March 31. It’s the moment of truth for providers, practices and Registries. Are you ready to report, ready to panic or somewhere in-between? It’s probably too late to implement an initiative designed to improve your PQRS measures, but with the right Registry partner, there is still a path to 2016 PQRS success, even if you aren’t “PQRS Ready.” More importantly, if you follow these three steps, you’ll also create a pathway to success in the Quality Payment Program (either through MIPS or an APM)—both by avoiding penalties, as well as…
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Robert McNutt, M.D. 0
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Future of Health CareMedical Decision-MakingPatient EmpowermentResearch
February 21, 2017

For Patients, “Trust Me” Is No Longer Good Enough for Medical Decision-Making

It’s time to rethink ideologies of medical care that no longer make sense. The following may sound revolutionary, but are nonetheless true: Patients are the future leaders in medical care. Patients must and can make their own medical decisions after being informed. Patients can and must learn to discern useless from useful information. Science must improve to match the increasing abilities of patients. At present, none of these concepts are fully embraced by the business of medicine and, in fact, may be a 180-degree reversal from the way things work now. So, why are these statements important? Because getting the…
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Theresa Hush 0
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Future of Health CareMedical Decision-MakingPatient EmpowermentPerformance Improvement
February 14, 2017

Turning Patients into Health Care Consumers—For Economic Survival

If we want to help people take better charge of their health—both physically and financially—we should start by treating them as real consumers, instead of patients. While that may seem like a simple change in terminology, it is anything but. A Patient Is a Recipient of Services, Not the Actor Health care organizations often work hard to welcome patients and provide as many services as needed. They design facilities to be comfortable, and there are often superb training programs for staff to be courteous, communicative, and to make patients comfortable. But let’s be honest. Health care is a business concern,…
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