Future of Health CareMedical EducationPerformance Improvement
December 19, 2018

There’s More to be Learned from Good Results than Bad—and Why It Matters

Becoming a physician requires passing many tests, beginning with premed studies, all the way through residency and, ultimately, board certification. You spend countless hours focused on passing examinations or rotations and learning to avoid pitfalls. As a residency program director, I and my colleagues invested considerable effort to determine which residents were struggling and to develop strategies to help them. We focused on finding deficiencies that would impede them from being excellent physicians. A fellow faculty member ran a Morbidity and Mortality conference that he nicknamed the “boo-boo” conference. This process of identifying and analyzing medical errors produced competitive physicians,…
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ACOsFuture of Health CarePerformance ImprovementValue-Based Health Care
September 19, 2018

ACOs Under Risk: Select Specialists Based on Collaborative Audit Process

ACOs have tiptoed into developing a physician network based on value. Building a full lineup of primary and specialty physicians to serve their patient population presents a daunting challenge. Even more relevant, until downside financial risk arrangements become mandatory, ACOs have been able to keep their physician networks inclusive; managing cost of care has been a lower priority than maintaining volume of patients or physician relationships. All that is poised to change as ACOs come under downside financial risk. The threat of budgeted expense levels that mandate repayment to Medicare or forfeiture of revenues to health plans will change traditional…
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ACOsClinical Data RegistryMerit-Based Incentive Payment System (MIPS)Performance ImprovementValue-Based Health Care
July 18, 2018

No More MIPS Cost Score Details? 5 Ways Providers Can Still Take Control of Costs

CMS is urging providers to participate in ACOs with downside risk, but they might be eliminating one of the keys that providers need to prepare. It couldn’t come at a worse time, when providers already stand to lose under risk-based models if they can’t identify where their cost issues lie. That data is only available from claims data made available by payers. Up until now, practices have had access to indispensable data on costs that are attributed to their providers, showing specifics of where they are above the norm. These were previously part of Quality and Resource Use Reports (QRURs)…
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ACOsConsumers & PatientsPerformance ImprovementValue-Based Health Care
April 25, 2018

Four ACO Development Decisions That Will Impact Return on Investment 

“It’s not how you start, but how you finish” might be the way some ACOs must navigate a difficult path to success.  But for organizations planning a new ACO venture, that rocky path may be avoidable. The early days of ACO development are behind us, and ACO models to take on financial risk are now underway. Achieving a return on ACO investment has proven to be elusive for most providers. There is progress, but no victory yet in sight. So ACOs and industry watchers are searching for the keys that allow some ACOs to experience more success than others. Whether…
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Alternative Payment Models (APM)Bundled PaymentsFuture of Health CarePerformance ImprovementValue-Based Health Care
January 24, 2018

BPCI Advanced Means Financial Risk Is Coming for Specialists

In case you missed Medicare’s messages about its reimbursement direction in recent years, CMS just reminded us that financial risk is well on its way. If you’re developing strategies that assume the status quo, it’s time to reassess your organization’s financial footing. CMS has already stated its intention to shift 50 percent of Medicare provider reimbursement into Alternative Payment Models (APMs) by the end of this calendar year. And those APMs are quickly transitioning toward putting providers at financial risk, because CMS is rewarding them to do so. CMS’s goal to impose financial risk was front and center again this…
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Future of Health CareMedical Decision-MakingPerformance ImprovementQualified Clinical Data Registry ReportingValue-Based Health Care
January 17, 2018

Time Out! How Strategic Pauses Can Enhance Medical Decision-Making to Improve Outcomes 

Health care providers are under increasing pressure to improve outcomes for patients with chronic conditions. There is pressure to meet quality measures, to establish programs that improve outcomes, to decrease costs for these conditions (utilization as an outcome)—or a combination of goals. At issue: what works, what is affordable, what is acceptable to patients and clinicians. The answers are elusive because there are many factors involved in the care of patients who have numerous chronic conditions, co-morbidities and medications, as well as multiple healthcare professionals providing their care. Adding to this complexity, any outcomes improvement for patients with chronic conditions…
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Future of Health CareMedical Decision-MakingPatient EmpowermentPerformance Improvement
December 14, 2017

Is Shared Decision-Making the Path to Improved Provider Performance?

As an escalating percentage of Americans (including children) are diagnosed with diabetes and hypertension, the health care system is straining to control costs and demonstrate good clinical outcomes. No surprise that providers blame patients for lack of compliance with therapies or lifestyle changes that will improve their health status. Hence the uptick—some say warranted—in incentives or penalties assessed by insurers or employers on patients who don’t “behave.” But this punitive finger pointing is neither equitable nor productive. Just as it’s unfair to hold physicians, alone, to be fully accountable for patient outcomes in quality reporting and cost, without giving them…
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Merit-Based Incentive Payment System (MIPS)Performance ImprovementQualified Clinical Data Registry ReportingValue-Based Health Care
November 29, 2017

Convention Lesson: MIPS Improvement Activities Are Woefully Misunderstood

With only a month left of 2017, practices should be wrapping up their Improvement Activities. MIPS requires at least 90 consecutive days of participation in order for a group or clinician to attest that an Improvement Activity is complete—meaning that the last day to start was October 2. The Improvement Activity portion of MIPS is the only component that is not a direct descendant of a previous program, increasing the challenge of implementation. Recently, we attended a national conference for those in healthcare practice and administration; one of our goals was to learn more about how practices were adapting to…
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Future of Health CareMACRANarrow NetworksPerformance ImprovementValue-Based Health Care
November 1, 2017

Providers Should Believe in Health Care Cost Control Now—If They Want to Stay in Business

Despite MACRA and other Value-Based Health Care efforts, many health care providers believe that controlling health care costs is impossible to do. They cite lack of comprehensive data about their patients and where they obtain services, and lack of control of patients’ decisions. But the real issue that providers have with cost control is much simpler: Why give up revenues under Fee for Service by reducing volume of services? That system has rewarded them well, fueling the growth of consolidated health systems, technology expansion and purchase of physician practices by ensuring a patient base. Controlling costs is now a relatively…
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Patient EmpowermentPerformance Improvement
October 18, 2017

What the Dog Show Taught Me: Performance Improvement Is Not Just Science, But Art

Last week I attended the Bearded Collie Club of America National with my two highly energetic and driven dogs, along with about two hundred other competitors. A calm vacation it was not. My dog athletes enjoyed multiple days of performance competition, capped off by show competition. For people who believe dogs are pets and don’t have emotional lives, let me introduce you to my beardies. They have goals. It’s my job to help them achieve those goals. To do that I need to understand how to get performance, and to improve it. I have learned a lot about meeting goals…
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