Roji Intel Blog

Theresa Hush 0
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Future of Health CareMACRAPatient EmpowermentPerformance ImprovementValue-Based Health Care
March 29, 2017

Why Bundled Payments Are a Win-Win for Specialists and Health Care Consumers

Bundled payments, a health care payment innovation that has been widely praised for controlling costs, recently got a bad rap. Secretary of Health and Human Services Tom Price  has delayed implementation of the final Medicare rule for several bundled payment programs that were set to start this year. He has criticized the bundled payments initiative for moving too fast and “experimenting with patients’ health.” Other industry experts disagree. They strongly favor the concept for both improving care and cutting costs. Bundled payments reimburse physicians and hospitals according to a set fee that includes all care associated with a procedure or…
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Robert McNutt, M.D. 0
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Future of Health CareMedical Decision-MakingPatient EmpowermentResearch
February 21, 2017

For Patients, “Trust Me” Is No Longer Good Enough for Medical Decision-Making

It’s time to rethink ideologies of medical care that no longer make sense. The following may sound revolutionary, but are nonetheless true: Patients are the future leaders in medical care. Patients must and can make their own medical decisions after being informed. Patients can and must learn to discern useless from useful information. Science must improve to match the increasing abilities of patients. At present, none of these concepts are fully embraced by the business of medicine and, in fact, may be a 180-degree reversal from the way things work now. So, why are these statements important? Because getting the…
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Theresa Hush 0
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Future of Health CarePerformance Improvement
January 31, 2017

The Dirty Little Secret About Performance Measurement Data

“The data just hooks up.” That was an opening remark from a competitor applauding his company’s scoring system for physician quality. He went on to explain how this data produced reliable scores on quality. The idea that data hooks up and produces a true scoring system for quality is a fantasy. Not only is data itself flawed, but it doesn’t always tell the exact truth. Treating data casually amounts to an off-hand dismissal of the complexity and inherent biases of performance measurement. But here’s the kicker: we need to measure performance, anyway. In fact, it’s more critical than ever to…
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Theresa Hush 0
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Future of Health CarePatient EmpowermentPerformance Improvement
January 24, 2017

Real Patient Empowerment Depends on Real Performance Measurement

“Patient empowerment” is a new term to watch. It’s a banner for some health care reform initiatives being proposed in lieu of the Affordable Care Act (ACA). In fact, “Empowering Patients First” is the title of legislation introduced by Congressman Tom Price (nominee for Secretary of the Department of Health & Human Services, which oversees Medicare and Medicaid) to replace the ACA. Empowering patients can be very positive, if they have the appropriate tools to make the health care system work to improve their health status. What Exactly Is Patient Empowerment? But what does “patient empowerment” actually mean within the current…
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Thomas Dent, M.D. 0
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Future of Health CareMedical Decision-MakingPerformance ImprovementRegistry ScienceResearchValue-Based Health Care
October 11, 2016

Physician Culture Must Transition from Defensiveness to Performance Improvement

Physicians undergo long and arduous training, with good reason. Lives are at stake. Learning to make the correct diagnosis, to expertly perform the appropriate procedure and to properly treat conditions is essential. Mistakes or flaws are scrutinized and not tolerated. Being wrong may cause greater harm to the patient—and lead to malpractice litigation. In short, physician culture places a premium on individual performance and responsibility. Steeped in those values, most physicians take great pride in the quality of care they deliver to patients, in the examination room or the surgical suite. Teams who provide specialized services, such as Emergency Departments,…
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Theresa Hush 0
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Alternative Payment Models (APM)Future of Health CareMACRAMerit-Based Incentive Payment System (MIPS)Performance ImprovementValue-Based Health Care
October 4, 2016

Improve Your Risk Readiness With Physician-Driven MACRA CPIA Innovation

CMS is pushing providers to accept Risk under Alternative Payment Models (APMs), and they’re sweetening the pot with incentives. But for the vast number of providers who will participate in MIPS because they don’t participate in risk-based APMs, the path to reward is murky. That’s because many Health Systems have a hard time visualizing how Performance Improvement with CPIAs can create savings under ACOs, the biggest APM model. Here’s the key: innovation that engages physicians. Historical Performance Improvement Often Leaves Out Physicians For most Health Systems, it’s rare for physicians to actively participate in Performance Improvement initiatives. There are two…
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Theresa Hush 0
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Alternative Payment Models (APM)MACRAPerformance ImprovementValue-Based Health Care
September 20, 2016

MACRA APM Risk: 5 Keys for Redefining Performance Improvement

Whatever relief providers felt after the recent CMS MACRA Pick Your Pace announcement, don’t be fooled. CMS has not, it seems, backed off its goals of pushing providers toward Risk, nor the interim and final quotas for participation. To the contrary—the announcement pointedly suggested that providers consider joining a risk-based Alternative Payment Model (APM) in 2017. But here’s the bigger issue: most existing ACOs have failed to meet cost targets, and the risk of losses for risk-based APMs will fall back on the participating providers. MACRA Pick your Pace should not be a time of rest. You should run, not…
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Dave Halpert 0
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Alternative Payment Models (APM)MACRAMerit-Based Incentive Payment System (MIPS)Performance ImprovementQualified Clinical Data Registry ReportingValue-Based Health Care
September 7, 2016

Back to School: Your Post-MACRA Study Guide for QPP Success

Back to school. That phrase prompts memories of making new friends (and catching up with old friends); carts full of notebooks, binders and pens; new classes; and, of course, abject terror. As the summer sun sets on PQRS, the Value Modifier (VM) and Meaningful Use (MU), it’s time for all of us to get into back-to-school mode, take the lessons we’ve learned and build on them for future success. Unfortunately, however, there’s an added challenge. Rather than having a season off to rest, regroup and ease into the new fall schedule, the transition from old programs to new is immediate…
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Robert McNutt, M.D. 0
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Performance ImprovementPersonalized MedicinePopulation HealthRegistry ScienceResearch
August 30, 2016

Personalized Medicine v Population Health: Opposites or Complements?

If personalized medical care is the goal, how does that fit with the concept of “population health,” the darling of the health care industry’s drive toward better results and lower costs? Are these two concepts really at odds, or do they work in tandem? This is not a rhetorical question; in the current environment of keeping costs under control, lives are at stake. How Personalized Medicine Should Work We know that best outcomes occur when individuals are appropriately assessed and allowed to make choices based on their personal characteristics. Personalized medicine is not a concept of averages; it is a…
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Theresa Hush 0
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Future of Health CareMACRAMerit-Based Incentive Payment System (MIPS)Performance ImprovementPQRS ReportingQualified Clinical Data Registry ReportingValue ModifierValue-Based Health CareValue-Based Payment Modifier
August 2, 2016

Use PQRS 2016 Reporting to Prepare for MACRA MIPS

In the last year of PQRS reporting, you may be tempted to take it easy and complete the bare minimum of reporting requirements. But don’t stick your head in the sand. First, PQRS and Value Modifier (VM) penalties are still alive and strong in 2016 and will affect your revenues in 2018. Second, if you’ve only been meeting reporting requirements and have yet to evaluate your performance, you stand to lose more under the tougher requirements of MACRA MIPS next year. We cannot stress this enough: 2016 should be the year to seriously evaluate your performance and create your strategy.…
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