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 […]
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 […]
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 […]
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 […]
Be Prepared for Medicare’s Transition to Bundled Payments—or Risk Future Revenues
As specialists face increasing pressure to lower costs, particularly by Medicare, so-called Bundled Payments are becoming an increasingly significant—and preferred—method of reimbursement. Although this form of Alternative Payment Method (APM) is not yet mandatory, most industry experts believe that bundled payments will form the basis of how Medicare will pay specialty services in the future, […]
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, […]
No More Status Quo: How the New CDR Will Change Health Care
As CMS streamlines its Value-Based Reimbursement programs, the pressure is on for providers to participate. A better foundation is needed to support those changes, so providers can actually succeed. And Medicare’s expansion of Clinical Data Registries (CDRs) may just be the answer. CDRs could be the tipping point for transforming health care. Here’s why: With […]
Know Your Risk Under VBPM: Your Medicare Revenues Are at Stake
Although Medicare has been increasing the pressure on providers to prepare for value-based health care, we still encounter many providers who are unaware or confused. Big clue: we see all too many large provider organizations that are developing RFPs for PQRS reporting without also including an evaluation of their risk under the Value-Based Payment Modifier […]
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 […]
How to Boost Your VBPM with ICD-10
With five weeks until ICD-10 becomes official, take note: Your transition strategy must include PQRS and the Value-Based Payment Modifier (VBPM). Neglecting VBPM in your short-term plan may lead to long-term penalties. That now goes for everybody, whether you helm an Academic Medical Center or run a small practice. October 1, 2015, marks the starting […]