AttributionPopulation HealthPQRS ReportingQualified Clinical Data Registry ReportingValue-Based Payment Modifier
May 12, 2015

Prove You’re a Top Tier Health Care Provider: Six Essentials for Your Value-Based Purchasing Game Plan

You know you need to shift your organization toward Value-Based Health Care. It’s a trend that’s here to stay, and you’re deep into planning your strategy. Question is, what’s the right game plan that will enable you to reap financial benefits by proving you’re a top-tier provider that offers quality, cost-effective health care? All too often, providers focus on adopting a reimbursement and delivery model that assumes risk without addressing fundamentals. Remember, this is not just about reorganizing to manage risk without engineering for improvement. While you must take steps to participate in the new Value-Based Health Care models, you…
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AttributionPQRS ReportingQualified Clinical Data Registry ReportingValue-Based Payment Modifier
May 5, 2015

Who Else Cares for Your Patients? How the Wrong Patient Attribution Can Skew Your VBPM

So, exactly who are your patients? Sounds like a silly question. But when it comes to Medicare’s patient attribution methodology, the answer is not obvious. Medicare attributes patients to providers and practices in order to calculate components of the Value-Based Payment Modifier (VBPM). Like it or not, certain patients can be attributed to your practice, even if their conditions are not under your clinical management, skewing your VBPM. If you don’t understand the rules, you risk significant penalties. This is true for all providers, but most apparent in specialty groups. As a Qualified Registry and QCDR that reports all measures…
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Population HealthPQRS ReportingQualified Clinical Data Registry ReportingRegistry ScienceResearchValue-Based Payment Modifier
April 28, 2015

Better Hypertension and Diabetes Outcomes: From Basic Measurement to a Plan for Improvement

Are you caught in a squeeze between avoiding penalties in both PQRS and the Value-Based Payment Modifier (VBPM)? Medicare’s move to Pay for Performance has created a Catch-22 for many groups:  you may have enough data to report enough PQRS measures, but if you choose to report measures where your performance is below the CMS mean of your peers, you risk penalties under the VBPM. As a CMS reporting registry that integrates VBPM Consultation Services, we commonly find at least one or two measures per client with scores that could negatively affect the VBPM if used in PQRS reporting—especially for…
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Population HealthPQRS ReportingQualified Clinical Data Registry ReportingValue-Based Payment Modifier
April 21, 2015

Your VBPM Incentive Payment Could Be Higher Than You Expect—If You Act Now

Here’s a lesson in budget neutrality, Medicare style: If you are penalized under PQRS for non-reporting or under the Value-Based Payment Modifier (VBPM) for poor performance, your money will be paid out to providers earning a VBPM incentive. That’s right—to your competition. If you’re on the losing end of this equation, you could lose up to 4 percent of your Medicare Revenues.  But if you’re on the winning side, you may be rewarded with a much higher net gain than an additional 4 percent. The Basic Arithmetic of PQRS and the VBPM The law creating the VBPM requires it to…
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Population HealthPQRS ReportingQualified Clinical Data Registry ReportingValue-Based Payment Modifier
April 14, 2015

How to Organize Your Academic Medical Center for PQRS 2015 Success

Take a deep breath. The last-minute flurry of adjustments and updates to last year’s PQRS reporting is over. And—brace yourselves. It’s time to dig into PQRS 2015, which, if you’ve been following our posts, requires a whole new level of rigor to avoid penalties under Pay for Performance. (Download our free eBook, Insider’s Guide to PQRS 2015 Reporting, if you need to catch up.) Nowhere are the new reporting complexities greater than for Academic Medical Centers (AMCs).  Everyone is scrambling to ensure that workflow adjustments sync with new reporting requirements and general measure changes, but AMCs must contend with additional…
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Future of Health CareMedical EducationPopulation HealthPQRS ReportingQualified Clinical Data Registry ReportingRegistry ScienceResearchValue-Based Payment Modifier
April 7, 2015

Academic Medical Centers at Risk: How to Survive Medicare and Medicaid Value-Based Health Care

Academic Medical Centers (AMCs) provide care to the most complicated patients and have surmounted some of the worst clinical challenges of all time. Yet the biggest issue to threaten survival of AMCs might well be Medicare and Medicaid Value-Based Purchasing. While AMCs incorporate the training of new physicians in both community and highly specialized care, the clinical complexity of their patient population is higher than other institutions. At the same time, AMCs are the most likely medical centers to offer trauma and burn care, new medical technology and clinical research. But with typically high volumes of Medicare and Medicaid patients,…
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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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