Roji Intel Blog

Theresa Hush 0
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ACO ReportingAlternative Payment Models (APM)MACRAMerit-Based Incentive Payment System (MIPS)PQRS ReportingValue-Based Health Care
May 31, 2016

Your MACRA Prep for APMs: Learn from ACO Failures

Many provider groups are suddenly realizing they need to understand how a Medicare risk model will impact their operations and revenues. With CMS pushing providers to embrace Alternative Payment Model (APM) risk models under Proposed MACRA Rules, they should be nervous. Although prior APMs such as ACOs did not approach the levels of risk under MACRA (most had zero risk in the first year), most were unsuccessful in reaching targeted savings. Lessons learned from ACOs will help groups make better decisions about how to manage costs, performance improvement, referrals outside the network and provider recruitment. Here are some key posts…
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Theresa Hush 0
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Merit-Based Incentive Payment System (MIPS)PQRS ReportingQualified Clinical Data Registry ReportingValue ModifierValue-Based Payment Modifier
May 24, 2016

Large Practice PQRS Reporting: Act Now Before GPRO Self-Nomination Deadline

If you’re still on the fence about reporting PQRS as a Group or Individual for 2016, it’s decision time. With the June 30 deadline for Group Reporting self-nomination just over a month away, you need to check out your options now or risk expensive reporting failures. These are your choices: Report for providers individually, which means that at least 50 percent of eligible professionals billing under one TIN must successfully meet PQRS reporting criteria; Report for providers using a Group Reporting Option (GRPO) in one of three ways: a. GPRO Registry option, by which you select a Registry to perform…
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Dave Halpert 0
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Alternative Payment Models (APM)MACRAMerit-Based Incentive Payment System (MIPS)Performance ImprovementPQRS ReportingQualified Clinical Data Registry ReportingValue ModifierValue-Based Health CareValue-Based Payment Modifier
May 3, 2016

Know the F.A.C.T.S.: 2016 Proposed MACRA Rule Highlights

Just over a year since the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) passed, the new Proposed MACRA Rule was released on April 27. Now we finally have some details on how Fee For Service will yield to reimbursement through value. There’s a lot to digest in this hefty rule and a great deal at stake, including hundreds of millions of dollars in penalties and incentives. Here’s what you need to know about the proposal and how it affects you. And if you have concerns, be sure to speak up during the 60-day comment period! As anticipated, Alternative…
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Dave Halpert 0
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ACO ReportingAlternative Payment Models (APM)Clinical Data RegistryPQRS ReportingValue ModifierValue-Based Health CareValue-Based Payment Modifier
April 5, 2016

If Your Solution to PQRS Reporting Is an ACO, Think Again

Problems with PQRS reporting this year? As a Registry that works with groups ranging from Academic Medical Centers to solo practitioners, we’ve seen the whole gamut of issues. While there are no quick and easy solutions (sorry), the biggest myth we’re hearing this year is that you can solve all your PQRS problems by forming an Accountable Care Organization (ACO). It’s certainly true that if your ACO reports successfully—and most do—you are not required also to report for PQRS. But before you take the huge organizational leap to forming or joining an ACO, you’d best read the fine print. For…
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Dave Halpert 0
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Future of Health CarePerformance ImprovementPQRS ReportingValue ModifierValue-Based Health CareValue-Based Payment Modifier
March 15, 2016

Still Not Sure of PQRS-VBPM? You Just Gave Your Competitor a Huge Bonus

If you still need a good reason to meet all PQRS requirements and improve your quality tiering under the Value-Based Payment Modifier (VBPM or Value Modifier), listen up: Failure to do so means your penalty will end up in your competitor’s pocket. Not only that—the 2016 Value Modifier Adjustment Factor (AF) for incentive payments has just been decided by CMS, and it’s an eye-popping 15.92 percent on all allowable Medicare Part B charges. Simply put, those groups whose Quality and Resource Use Reports (QRURs) showed 1.0 x AF will earn close to an additional 16 percent incentive payment, more than…
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Dave Halpert 0
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Performance ImprovementPQRS ReportingValue-Based Health CareValue-Based Payment Modifier
February 23, 2016

Don’t Hit the Medicare Revenue Wall: What You Must Know About 2016 PQRS-VBPM Benchmarks

What will it take for health care providers actually to focus on improving patient outcomes, while keeping costs under control? CMS has structured quality reporting under the Value-Based Payment Modifier (VBPM) to reward providers who surpass PQRS measure benchmarks, and penalize those who lag behind. But inherent in the new quality tiering is a serious dilemma: a strong incentive to game the system, rather than to improve performance in any meaningful way. Here’s why: For three-quarters of the individual measures included in these benchmarks, it is statistically impossible to surpass your peers’ performance. The only way to differentiate performance is…
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Dave Halpert 0
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ACO ReportingAlternative Payment Models (APM)AttributionPerformance ImprovementPQRS Reporting
December 15, 2015

Expanding Your ACO: The Best Recruiting Strategy for Bigger ACO Savings

Whether your ACO is in its infancy or is established and growing, you’ve probably had to make some difficult choices about which groups to include—and exclude. Your ACO’s success is almost entirely driven by your ACO network’s participating providers (and their patients). They provide the care and generate beneficiary costs, and help to ensure better patient outcomes. Developing that network intelligently is key to achieving shared savings. We’re here to help. Know this: one “free market” concept behind Alternate Payment Models is flawed—the assumption that providers who can demonstrate better results in quality and costs will be in higher demand.…
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Thomas Dent, M.D. 0
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ACO ReportingClinical Data RegistryMeaningful UsePerformance ImprovementPQRS ReportingRegistry ScienceValue-Based Payment Modifier
December 8, 2015

Want Real Performance and Outcomes Improvement? Track Interventions and Results Over Time

Time will explain it all. He is a talker, and needs no questioning before he speaks—Euripides For many providers, reviewing performance data is just another distraction from practicing medicine, rather than a valued tool for making better medical decisions. And who can blame them? Performance or outcome data reviewed in isolation, as static results, aren’t all that useful. The exercise is akin to looking at a single photograph of an event and inferring cause and effect without any corroborating evidence. To be an effective resource that leads to actual outcome improvements, data must be tracked over time. Most often, however,…
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Dave Halpert 0
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ACO ReportingAttributionClinical Data RegistryMeaningful UsePQRS ReportingQualified Clinical Data Registry ReportingValue-Based Payment Modifier
November 17, 2015

2016 Medicare Final Physician Payment Rule: What You Must Know

CMS’s push toward value-based care and performance improvement leaves no more room for doubt. In a hefty 1,358 pages, the 2016 Medicare Final Rule  expands the role of Qualified Clinical Data Registries for PQRS reporting, dovetailing with the Specialized/Clinical Data Registry component in the Meaningful Use Rules. Both methods place the focus squarely on how outcomes change over time, across all patients. Tracking outcomes and measuring improvement are no longer optional. Here’s what you need to know: QCDRs Get GPRO Submission Status As expected, the differentiation between the Final Rule and the Proposed Rule is minor; the most important change for…
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Dave Halpert 0
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PQRS ReportingQualified Clinical Data Registry ReportingValue-Based Payment Modifier
October 13, 2015

ICLOPS Case Study: VBPM Consultation Lifts Specialty Group’s Quality Tier and Medicare Revenues

Medicare’s Value-Based Health Care programs aren’t just about penalties. You can also earn a reward. Case in point—an ICLOPS orthopedic client recently asked The Big Question: Are there really incentives to be earned through Medicare’s Value-Based Care? With the release on September 9 of the Annual Quality and Resource Use Reports (QRURs), the answer is a resounding “Yes.” At its core, the Value-Based Payment Modifier (VBPM) is a simple proposition: Those who are able to demonstrate higher quality care at a lower cost than other groups are rewarded, while those who can’t are penalized. The rewards come from the pool of…
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