Roji Intel Blog

Dave Halpert 0
25
Roji Health Intelligence Alternate Payment Model Performance Pathway APP
Alternative Payment Models (APM)APM Performance PathwayClinical Data RegistryPerformance Improvement
November 16, 2022

No Worries About ACO APP! It’s Your Pathway to Improvement

With the release of the 2023 Physician Fee Schedule Final Rule, CMS upheld its commitment to sunset its Web Interface for ACO quality reporting after 2024. Beginning in 2025, ACOs will be required to report through the Alternate Payment Model Performance Pathway, or APP. Some have expressed concerns about the APP. But this new reporting process actually has some significant advantages. It presents ACOs with a valuable trove of data to advance along the path toward better outcomes, health equity, and curtailed costs. In fact, the baseline for APP—data from provider systems, including their EHR data—is the foundation for data…
Read More
Robert McNutt, M.D. 0
31
Future of Health CareMedical Decision-MakingResearch
September 11, 2019

Fixing Clinical Science Requires a Moonshot

“We chose to go to the moon” President John Kennedy’s statement instigated a monumental marshaling of resources to achieve a remarkable goal. Those famous words also established a powerful metaphor for aiming high. We need an equally monumental shift in purpose and commitment of resources for how we conduct clinical science. Nothing less than our nation’s health is at stake. In my view, there are only three possible ways research efforts might proceed: First, the conduct of research might not change, but continue to rely on observational studies and non-generalizable randomized trials (RTs). If so, populations of subjects included in…
Read More
Dave Halpert 0
0
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)…
Read More
Dave Halpert 0
2
ACOsAdvanced Alternative Payment ModelsAlternative Payment Models (APM)MedicareMerit-Based Incentive Payment System (MIPS)Value-Based Health Care
June 13, 2018

Medicare Paths to Value-Based Health Care: Which Way is Up?

If you’re scratching your head about the direction of Value-Based Health Care (VBHC) in Medicare, you’re not alone. The current mix includes a swirl of separate initiatives, some new and others recently re-labled. As CMS pushes toward VBHC, providers may feel confused and frustrated as concepts emerge that will affect multiple programs. Within the last several months, the Patients Over Paperwork and Meaningful Measures initiatives have shaken up CMS value-based care programs, particularly: Merit-Based Incentive Payment System (MIPS) Medicare Shared Savings Program ACOs (MSSP ACOs) Direct Provider Contracting (DPC) Even more confounding, CMS is taking a non-linear development path for…
Read More
Theresa Hush 0
0
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…
Read More
Dave Halpert 0
0
Alternative Payment Models (APM)Clinical Data RegistryMerit-Based Incentive Payment System (MIPS)Qualified Clinical Data Registry ReportingValue-Based Health Care
June 28, 2017

10 Takeaways from the Proposed Rule for MIPS and APMs Year 2

We are already more than halfway through the initial year of Medicare’s new Quality Payment Program, which includes MIPS and APMs. Yet already we are seeing some changes from the new administration that will relax requirements for providers, eliminating the need for some to participate and making quality reporting, in particular, easier. Regardless of how Medicare plays these rules, top providers should maintain a strong strategic focus on Value-Based Health Care initiatives that emphasize performance improvement in cost and quality. Even as Medicare may step back from the leadership role it has taken in this arena, private insurance and employers…
Read More
Theresa Hush 0
0
Clinical Data RegistryFuture of Health CarePatient EmpowermentValue-Based Health Care
May 3, 2017

Health Care Providers Need Performance Data Audits to Market Trust

Health care systems once thought it was crude and undignified to use marketing to attract patients. No more. Now they use qualitative anecdotes to promote status at a time when data is king and consumers view comparative quality data on the Internet. Why not use quantitative evidence? Because their data doesn’t promote their cause—and even they don’t believe it. That avoidance behavior is a huge mistake. Health care organizations need to take steps now to turn performance data into valid indicators of both quality and cost. Otherwise they will risk losing control over their stories as providers of excellence. Consumers…
Read More
Thomas Dent, M.D. 0
0
Clinical Data RegistryMACRAMedical Decision-MakingMerit-Based Incentive Payment System (MIPS)Performance ImprovementQualified Clinical Data Registry ReportingRegistry ScienceResearch
July 19, 2016

MACRA Match-up: How EHR Source Data Will Benefit Registry Research

At the core of MACRA and MIPS requirements, Electronic Health Record (EHR) source data will soon become a key component for Registry research. Specifically, Clinical Performance Improvement Activities (CPIAs) are a required component of MIPS. Performance improvement efforts will no longer be optional. Quality data will be essential. EHRs present an excellent data resource, but the data is not flawless. Registries are well suited for validating data and assessing performance using a continuous improvement model—testing an idea by changing a practice and measuring its impact. When done on a small scale, testing performance improvement activities and the feasibility of population-based…
Read More
Dave Halpert 0
0
Alternative Payment Models (APM)Clinical Data RegistryMACRAMeaningful UseMerit-Based Incentive Payment System (MIPS)PQRS ReportingQualified Clinical Data Registry ReportingValue ModifierValue-Based Health Care
June 28, 2016

What’s the Score? Decoding the MIPS Scoring Methodology

CMS is calling MIPS the “First Step to a Fresh Start.” When it comes to scoring, that’s an understatement. Although MIPS’s foundations are rooted in existing programs, the MIPS algorithm is a significant departure from today’s quality, cost and health information technology scoring. Not only new, this scoring methodology is complex. Providers will receive one aggregated MIPS Composite Performance Score (CPS), but remember—this one score is going to account for three existing programs, plus a component for ongoing improvement. The real first step: learn how the scoring is done. With penalties starting at 4 percent the first year, growing to…
Read More
Theresa Hush 0
10
ACO ReportingClinical Data RegistryFuture of Health CarePerformance ImprovementRegistry ScienceResearchValue-Based Health Care
April 26, 2016

Your Health Care IT Investments: How to Purchase for Performance Improvement

Health care technology (HIT) is frequently oversold. That may be a surprising message coming from a Registry CEO, but it’s the truth. In the quest for answers, too many providers search for a system that can “do it all,” a dream technology that exists, well, only in your dreams. There is intense pressure on providers to prepare for undertaking the financial risk of patient care, while maintaining or improving patient quality and outcomes. Two factors are driving the push for HIT purchases to meet this demand: providers’ strong wish for easy and straightforward solutions that can mesh with existing technology,…
Read More