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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