PQRS ReportingQualified Clinical Data Registry Reporting
December 16, 2014

Season’s Greetings from CMS: You Owe 1.5 Percent for a PQRS Reporting Failure

‘Tis the season to be jolly—unless your health care organization is one of many last week that received a letter from the Centers for Medicare and Medicaid Services (CMS) informing you that at least one of your providers was eligible to participate in PQRS in 2013, but failed to do so—and that a penalty is coming in 2015. Those who did not successfully report at least one PQRS measure in 2013 will only be reimbursed 98.5 percent on all allowable 2015 Medicare Part B charges—a 1.5 percent cut.   Ready or Not, the Penalties Were Based on 2013 PQRS Reporting…
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Population HealthPQRS Reporting
December 9, 2014

How to Energize Your Providers to Measure and Improve Outcomes

It’s no wonder that so many physicians feel threatened by the mention of outcomes measurement. All too often, outcomes are used as a club to punish providers who seem to weaken overall group performance. Or outcomes are packaged and applied in a way that doesn’t provide actionable information—which can seem like a waste of everyone’s time and resources. To engage your providers—and get the real benefit from this form of health care data analysis—try to link your efforts to measure and improve outcomes with an iterative process of inquiry into best practices. Why Outcomes Measurement Can Seem Misleading Measuring patient…
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Population HealthPQRS Reporting
December 2, 2014

No More Blame Game: How to Use Patient Outcomes Measurement to Boost Quality and Provider Performance

Fair or not, if your patients don’t do well, your physicians can be tagged as poorly performing providers. But there are ways to change the dynamic for your organization by effectively using patient outcomes measurement to structure and drive a quality program that benefits both patients and providers. Tracking the health and status of patients—“how patients do”—is the Holy Grail of quality measurement. Despite the fact that it is very difficult to identify a direct cause and effect between provider action and patient outcomes, quality programs are shifting the emphasis to patient outcomes and attributing performance to physicians. This is…
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Future of Health CareResearch
November 25, 2014

Health Care 2014: Where Do We Go from Here?

This week, many of us will sit around Thanksgiving tables, giving thanks for our families and friends, food and shelter, and living in this good land. We might also say, this land where we have access to some of the best health care on earth. So how interesting that we have spent the last several years waging war on every part of health care—the building of it, buying it, paying for it, measuring its value and delivering it. How did we get here? Have we lost trust in health care as we’ve lost trust in government? Or, perhaps there is…
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Population HealthPQRS ReportingValue-Based Payment Modifier
November 18, 2014

PQRS 2015: How Your Practice and Patients Can Benefit from New Population Health Measures

Good news for providers who have criticized PQRS as mundane and want to improve assessment of patient outcomes and reduce gaps in care: Medicare’s PQRS 2015 Rule is shifting away from rewarding fragmented quality services and toward population health. With the expansion of the related Value-Based Payment Modifier (VBPM), every group can turn population health into higher Medicare revenues, so long as you have strong, patient-centric processes—and data capture. If you don’t, you may suffer penalties. What’s a Cross-Cutting Measure and How Does It Work? CMS has established a set of Cross-Cutting Measures to provide a broader evaluation of care…
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PQRS ReportingQualified Clinical Data Registry ReportingValue-Based Payment Modifier
November 11, 2014

Specialists at Risk: How To Navigate Hazards in Medicare’s Value-Based Purchasing Programs

Heads up, specialty providers. The future of your practice may depend on three key components in Medicare’s Value-Based Purchasing program. Especially if you work in an independent practice with a higher proportion of Medicare patients than many primary care physicians, your income and practice survival are at risk if you don’t understand implications of the new Rule for 2015. This is certain: You must manage the new environment to avoid penalties and losses under these programs. Most important are PQRS 2015, Value-Based Payment Modifier (VBPM) and ACO Participation. That’s the foundation; with requirements getting tougher every year, you need to…
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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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