Roji Intel Blog

Dave Halpert 0
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2025 CMS PFS Final Rule
ACOsAPP ReportingCMS RulesMerit-Based Incentive Payment System (MIPS)Value-Based Health Care
November 6, 2024

The 2025 CMS PFS Final Rule: The Five-Pronged Strategy Towards Comprehensive Accountable Care

The 2025 CMS PFS Rule landed with a bang, and it’s not just the weight of the 3,088 pages. We’re one year closer to 2030, the year that CMS intends to have all Traditional Medicare patients in a relationship with a clinician who is accountable for total cost of care. The push to the finish line is the primary driver behind each of the QPP-related policies in this Rule. For CMS to accomplish its goal within its stated time-frame, accountable care programs must promote equity, expand into rural and underserved areas, and align to reduce administrative burden. A slew of…
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Theresa Hush 0
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Roji Health Intelligence Terry Hush ACOs Need a Strategic Map for Cost Control
ACOsData AggregationMedicareValue-Based Health Care
June 5, 2024

ACOs Need a Strategic Map for Cost Control

For ACOs to remain relevant and viable under risk payment models, they must step up now to generate more cost savings for Medicare patient care. Medicare’s budget cuts are once again under consideration as political pressure mounts to lower governmental spending. CMS is expanding risk through Medicare value-based payment models, such as the new ACO PC Flex model, which is designed to create per-patient reimbursement for small ACOs in trade for higher reimbursements and funding for infrastructure. Most newer CMS payment models are now incorporating per-patient payments designed to lower the total cost of care. As the provider-driven vanguard in…
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Dave Halpert 0
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2022 QPP Performance Report
ACOsAlternative Payment Models (APM)Merit-Based Incentive Payment System (MIPS)Quality Payment Program
May 23, 2024

2022 QPP Experience Report: Address 3 Key Findings Now to Avoid Future Penalties

At first glance, CMS’s recently released 2022 QPP Experience Report (PDF) seems reassuring, because the majority of clinicians avoided financial penalties under MIPS. Don’t be fooled! While overall success and failure rates in the report may lead you to conclude that merely participating in the QPP (either in MIPS or as an APM) is enough to do well, trends in the report tell a very different story: Without a concerted and cohesive strategy to simultaneously improve efficiency and demonstrably improve quality, providers will begin to see their consistent results fall short of minimum performance thresholds. The QPP Experience Report details participation…
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Roji Health Intelligence 0
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ACOsAPP ReportingCMS RulesMedicareValue-Based Health Care
December 12, 2023

How Your ACO Can Optimize APP Reporting Using Medicare CQMs

ACOs just gained a reprieve from implementing all-patient APP quality reporting in 2024. A provision in CMS’s Physician Fee Schedule Final Rule, which goes into effect on January 1, 2024, enables ACOs to report on Medicare patients only, based on CMS provision of eligible patient lists for three APP measures. If your ACO decides to delay aggregation of practice data for now, you need to consider how to optimize APP Reporting of Medicare CQMs. Choose a qualified registry for APP Reporting that can reduce your workload for reporting Medicare CQM Measures. Using CMS’s list of patients eligible for measures will…
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Dave Halpert 0
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The 2024 CMS PFS Final Rule: Post-PHE, Value-Based Care Returns to the Forefront, Roji Health Intelligence, Dave Halpert
ACOsCMS RulesData AggregationMIPS Value PathwaysValue-Based Health Care
November 9, 2023

The 2024 CMS PFS Final Rule: Post-PHE, Value-Based Care Returns to the Forefront

The 2024 Physician Fee Schedule Final Rule—all 2,709 pages worth—was released on November 3, and the significance of the “Post-COVID” rule cannot be understated. With the Public Health Emergency expiring earlier this year, these finalized policies are intended to get the proverbial train back on its tracks, following the massive derailment in March 2020. Although many policies were finalized as proposed, there are plenty of exceptions and caveats, and providers and practices need to be keenly aware of the details. CMS is using this rule to advance its value-based care goals through data aggregation and attention to health equity. Those…
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Theresa Hush 0
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ACOsAlternative Payment Models (APM)Future of Health CareHealth EquityValue-Based Health Care
April 5, 2023

Jumpstart ACO Health Equity with Data-Based Collaborative Initiatives

Ever since the first pandemic data revealed the enormous cost of health inequities, the pressing question of how to rectify unfair access to quality health care has become a major policy discussion. Now the debate is turning to action, as the first Value-based Payment Model to address health equity comes online. ACO REACH is Medicare's response to blending several key values in its most advanced payment model to date. In addition to traditional ACO quality and cost values, ACO REACH also includes population-based payments (including global payments), rather than Fee-for-Service, and promotes health equity as a central goal. If your…
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Theresa Hush 0
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ACOsCMS RulesCorporate Health CareEpisodes of CareFuture of Health CareValue-Based Health Care
December 13, 2022

5 Key Health Care Trends to Watch for in 2023

After an intense few years in health care, will 2023 deliver more punches? While 2022 was dubbed a COVID “recovery” year, as patient volume rebounded, health care staffing shortages festered. Burnout prompted physicians to retire, sell practices to corporate owners, or leave traditional health care for other employment. Simply put, 2022 was short on recovery and stability. Even still, 2022 fostered important new trends and discoveries. Despite inflation and recession fears, corporate health care continued its growth undaunted, with new startups and equity-backed practice expansion. Value-Based Care spurred corporate territorial reach into legacy health care preserves. Optum, ACO enablers like…
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Dave Halpert 0
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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…
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Dave Halpert 0
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ACOsCMS RulesFuture of Health CareMIPS Value Pathways
November 7, 2022

2023 PFS Final Rule: 8 Key Strategies that Boost New ACOs and Increase Health Care Access

It’s here. The 2023 CMS Physician Fee Schedule Final Rule has been released, and in a mere 3,304 pages, CMS has largely finalized its proposals from over the summer. To save you from pouring through all the minutiae, here’s what you need to know. Overall, in this Final Rule, CMS has codified principles to fulfill the goals outlined in the Innovation Center’s Strategic Refresh of October 2021. Most notably, CMS has committed to having all Traditional Medicare beneficiaries in an accountable care program by 2030, and to prioritize health equity. To make this happen, CMS needs to shake up the…
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Dave Halpert 0
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ACOsAlternative Payment Models (APM)MIPS Value PathwaysValue-Based Health Care
July 12, 2022

CMS 2023 Proposed Rule Accelerates ACOs, MVPs

CMS just set off summer fireworks, amping up incentives to adopt Value-Based Care in its just-released, 2,066-page 2023 Proposed Physician Fee Schedule Rule. By encouraging formation of new ACOs, the Proposed Rule establishes a pathway to expand beneficiaries' access to accountable care. Last year, CMS committed that every Medicare beneficiary will be in an accountable care relationship by 2030, to ensure quality and total cost control. Its October 2021 Innovation Center’s Strategic Refresh identified issues with provider adoption of accountable care networks and alternative payment models (APMs). It also identified two objectives: to drive providers into Accountable Care Networks, and…
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