Roji Intel Blog

Theresa Hush 0
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ACO ReportingAlternative Payment Models (APM)Clinical Data RegistryMeaningful UseMerit-Based Incentive Payment System (MIPS)Performance ImprovementValue-Based Health Care
March 22, 2016

Ready for Risk? How to Foster Physician Alignment with Your Health System’s APMs

We’ve seen unprecedented consolidation among hospitals, hospital systems and physician groups in recent years, sparked by the drive for greater market share. As systems organize competitively to participate in risk models such as ACOs and bundled payments, however, the dramatic surge in hospital employment of physicians hasn’t helped ACO success. In fact, most Medicare ACOs have not met cost targets needed to generate revenue. All too often, hospitals or health systems and their physicians clash over goals, expectations, outcomes and basic communication regarding Alternate Payment Models (APMs). As a Registry helping large systems take steps toward clinical integration, ACOs and performance…
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Dave Halpert 0
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ACO ReportingAlternative Payment Models (APM)Clinical Data RegistryFuture of Health CareMerit-Based Incentive Payment System (MIPS)Value-Based Health CareValue-Based Payment Modifier
March 8, 2016

APMs Are Here and MIPS Is Coming Sooner Than You Think: How to Plan for the Unknown

How do you prepare for a program with yet-to-be-defined rules that will involve larger potential penalties (or incentives)—but requires long term planning? It’s a real quandary, but the time is now to begin thinking strategically about the upcoming Merit-Based Incentive Payment System, or MIPS. MIPS Fundamentals MIPS was created from the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). The Act succeeded in expunging the looming but flawed “Sustainable Growth Rate” formula, replacing impending cuts with reimbursement tied to Value-Based Health Care. MIPS details may be lacking, but the overall MIPS framework is taking shape. Scheduled to begin on…
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Thomas Dent, M.D. 0
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ACO ReportingAlternative Payment Models (APM)Clinical Data RegistryFuture of Health CareMeaningful UseMerit-Based Incentive Payment System (MIPS)Performance ImprovementRegistry ScienceResearchValue-Based Health Care
February 2, 2016

All Together, Now: Why Specialists Need the CDR Edge for Bundled Payments

With the advent of Bundled Payments for selected procedures and conditions, providers and institutions must collaborate to meet both cost and quality targets. No longer will each provider bill and receive payment separately for services when these bundles become mandatory—as most experts believe will happen. All providers participating in a set “bundled” price must focus on coordinated performance improvement or face penalties. Key to that effort: a Clinical Data Registry (CDR) that tracks patient outcome data over time and pinpoints success or failure of interventions. CDR Performance Improvement Tools Are Essential for Bundled Payments Success The CDR fulfills two fundamental…
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Theresa Hush 0
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ACO ReportingClinical Data RegistryFuture of Health CareMeaningful UseMerit-Based Incentive Payment System (MIPS)
November 10, 2015

Questions You Should Ask (or Should Have) About Medicare’s Alternative Payment Models

Are you prepared for your risk or reward under Medicare payment reforms? It’s hard to give up current revenues that reward volume, sooner than absolutely necessary. That’s the dilemma facing all providers who realize that Medicare is serious about moving 50 percent of its provider reimbursement to Alternative Payment Models (APMs) by the end of 2018. While some providers have rushed into the new system while Medicare still allows for failure to meet targets, others are waiting (including many higher cost academic medical centers). Here’s what to ask before plunging in—and if you’re already in, how to right the ship.…
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Thomas Dent, M.D. 0
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Clinical Data RegistryMeaningful UseMerit-Based Incentive Payment System (MIPS)
November 3, 2015

Making the Most of Meaningful Use: How the “Specialized Registry” Can Secure Your Future in MIPS

Good health care requires insight. That’s the message under Medicare’s new Medicare Meaningful Use rules for 2015 through 2017, giving providers the option to use a Specialized Registry to meet the Public Health Reporting Objective. The new rule also lays out how a Clinical Data Registry (CDR) will fit into this and other MU objectives in the future. Both the Specialized Registry and the CDR reflect a significant opportunity. Why? Because as these Registries collect, analyze and show data from providers who will need to report in order to be in compliance with Medicare, there will be a lot of…
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Dave Halpert 0
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ACO ReportingAlternative Payment Models (APM)Merit-Based Incentive Payment System (MIPS)Performance Improvement
October 20, 2015

Break the Barriers to ACO Shared Savings

The ACO performance results for 2014 are in, and they are troubling. While most ACOs were able to fulfill quality reporting requirements, only some reduced costs enough to qualify for shared savings. Many ACOs did cut costs—of the 353 ACOs, there were $411 million in total savings. But for most ACOs, it was not enough. How can ACOs break through the barrier to shared savings in the near future? Here are four lessons from analyzing the CMS data: The goal of Medicare’s performance-based reimbursement is to save money and improve outcomes, as illustrated by both the Merit-Based Incentive Payment System…
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Dave Halpert 0
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Future of Health CareMerit-Based Incentive Payment System (MIPS)Performance ImprovementPQRS ReportingQualified Clinical Data Registry ReportingValue-Based Payment Modifier
September 22, 2015

Medicare’s MIPS: The Not-So New Face of Value-Based Care

Rumors that PQRS and VBPM have died may be wishful thinking, but are far from true. Value-Based Care is here to stay, even as Medicare’s programs evolve. You still have a chance to help shape those initiatives before they become law. So it’s well worth your time now to learn all about Medicare’s newest program, MIPS. In 2019, Medicare will phase in the Merit-Based Incentive Payment System (MIPS). The 2016 reporting year will form the basis for the final Value-Based Payment Modifier (VBPM) and PQRS payment adjustments, to be applied in 2018, with MIPS to begin the following year. But…
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Dave Halpert 0
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Alternative Payment Models (APM)AttributionMerit-Based Incentive Payment System (MIPS)Qualified Clinical Data Registry ReportingValue-Based Payment Modifier
September 1, 2015

Mastering MSPB: How “Episode” Care Calculations Make or Break Your Revenues

The whole may be greater than the sum of its parts—but how those parts each contribute to the whole is key to a new Medicare calculation of episode costs. If you aren’t paying attention to the total cost of an entire “episode” of care for your patients—including that rendered by others—your future revenues may take a hit. Enter Medicare Spending Per Beneficiary (MSPB), a component of CMS’s Value-Based Payment Modifier (VBPM) calculations that is crucial to your bottom line. MSPB is a measure of charges per episode of care that looks at costs immediately prior to, during and following a hospital…
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