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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PQRS ReportingQualified Clinical Data Registry ReportingValue-Based Payment Modifier
February 3, 2015

PQRS Catch-22 for Specialists: How Medicare’s Division of Measures Can Put You at Risk for Penalties

If you are a specialist, maintaining your Medicare revenues just became more challenging. As of 2015, CMS now requires nine measures instead of three for PQRS reporting. They provided a partial reprieve by reducing the completion rate from 80 percent to only 50 percent. However, successful PQRS reporting is all or nothing—failure to report all nine measures within three domains will result in a penalty for both PQRS and the Value-Based Payment Modifier (VBPM) of 6 percent total in 2017. With more than 200 measures to choose from, you may wonder what’s the problem; surely you can find nine that…
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Future of Health CarePopulation HealthPQRS ReportingValue-Based Payment Modifier
January 27, 2015

How Medicare is Moving from PQRS Basics into Value-Based Care: Improving Outcomes with Plan of Care

For a number of PQRS measures, Medicare requires that the provider document a Follow-up Plan or Plan of Care to demonstrate that appropriate interventions have been made to reduce risk. This has caused confusion and consternation among some of our clients who may not have clearly documented the follow-up plan or may disagree with Medicare on the plan’s criteria. Nonetheless, documentation of risk-reduction interventions is in keeping with CMS plans to transition all reimbursement into Value-Based Care, so it’s essential to understand how to manage this process. In fact, just this past Monday, January 26, Health and Human Services Secretary…
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