ACO ReportingAlternative Payment Models (APM)Merit-Based Incentive Payment System (MIPS)Performance Improvement
October 20, 2015

Break the Barriers to ACO Shared Savings

The ACO performance results for 2014 are in, and they are troubling. While most ACOs were able to fulfill quality reporting requirements, only some reduced costs enough to qualify for shared savings. Many ACOs did cut costs—of the 353 ACOs, there were $411 million in total savings. But for most ACOs, it was not enough. How can ACOs break through the barrier to shared savings in the near future? Here are four lessons from analyzing the CMS data: The goal of Medicare’s performance-based reimbursement is to save money and improve outcomes, as illustrated by both the Merit-Based Incentive Payment System…
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ACO ReportingFuture of Health CareValue-Based Payment Modifier
July 28, 2015

Are Your Specialists and ACO Ready for the Referral Revolution? Part 1

The practice of physician-determined referrals to specialists is deeply embedded in the culture of medicine. But it no longer works under Value-Based Health Care. A revolution in referrals is underway, one that will dramatically change physician alignment and engagement in ACOs and other Pay for Performance models. Outcome measures can distinguish the performance of one specialist versus another—and this performance data is available to both health systems and physicians. We all know that pure comparative performance data has a lot of flaws. But Medicare is publishing provider-specific performance for PQRS and group performance for ACOs, and calculating comparative scores under the…
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ACO ReportingPQRS ReportingQualified Clinical Data Registry ReportingValue-Based Payment Modifier
June 30, 2015

Orthopedists’ Survival Kit: How to Succeed with Medicare PQRS and VBPM

Pay for Performance success takes careful thought and management, particularly for specialty practices. Under Medicare’s PQRS and Value-Based Payment Modifier (VBPM), specialties have fewer measures available, which narrows reporting options—making it harder for you to meet PQRS and compare well against your peers. For Orthopedics, this is especially true. Nearly 200 PQRS measures have a Registry reporting option, but many orthopedic surgeons still have a difficult time finding nine measures across three National Quality Strategy (NQS) Domains (including one cross-cutting measure), where performance is good enough to report. All too often, orthopedic surgeons get trapped, reporting on measures where performance…
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ACO ReportingPopulation HealthQualified Clinical Data Registry ReportingValue-Based Payment Modifier
June 16, 2015

How to Get Paid for Your Population Health Program: Part 1

How can you succeed in Pay for Performance if you can’t risk revenues on a program that may not produce results? Especially if your competitors have made the investment and can prove better outcomes, raising the bar for everyone? It’s not enough simply to tighten existing procedures or to focus on maintaining high standards To stay competitive, you need to improve patients’ outcomes and reduce costs over your own history and against other organizations, even without a lot of cash on hand.  If you don’t, you’ll face even greater financial risks under ACO participation or independently through VBPM penalties. But…
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PQRS ReportingQualified Clinical Data Registry ReportingValue-Based Payment Modifier
June 9, 2015

Does Your EMR Tell Medicare the Right Story About Your Patient Quality?

Reporting physician quality to Medicare through an EMR is an easy and affordable approach—at least on the surface. But be careful when using EHR Direct Reporting for PQRS 2015, so you don’t cost your organization as much as 4 percent in Medicare penalties or create an unappealing profile of your quality in Medicare’s public reporting. Navigating successfully through the maze of Medicare’s new Value-Based Purchasing requires a thorough understanding of how all the different reporting and performance programs interact. Unless you have a good grasp of how your EMR reports your quality data, you risk setting yourself up for costly…
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PQRS ReportingQualified Clinical Data Registry ReportingValue-Based Payment Modifier
June 2, 2015

GPRO Registration Ends June 30—Don’t Lose Your PQRS Reporting Advantage!

The clock is winding down—have you registered your practice for the Group Practice Reporting Option (GPRO) for PQRS?  To report as one collective unit, you must register with Medicare by June 30. If you don’t complete this step, you’ll still have to participate in PQRS, but your group’s providers will need to report on a person-by-person basis, which can be an administrative nightmare and make it much more challenging to succeed under the Value-Based Payment Modifier (VBPM). Tick-tock! GPRO registration is only the first administrative step. There’s a lot more to know in order to avoid penalties, either from failure…
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AttributionPQRS ReportingValue-Based Payment Modifier
May 26, 2015

Provider Network Growth? How to Avoid Unanticipated Medicare VBPM Penalties

Mergers and acquisitions, joint ventures and affiliations—this is the new face of health care, and the trend shows no signs of slackening. If your group has grown and changed significantly through consolidation, you’d best take a second look at your 2013 Quality and Resource Use Report (QRUR). Chances are, it no longer applies to your organization, putting your at risk for significant penalties under the Value-Based Payment Modifier (VBPM). The good news is that CMS has released its Mid-Year 2014 QRURs to all providers, regardless of how many providers are billed under your group’s Tax Identification Number (TIN). Why bother…
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Population HealthPQRS ReportingQualified Clinical Data Registry ReportingRegistry ScienceResearchValue-Based Payment Modifier
April 28, 2015

Better Hypertension and Diabetes Outcomes: From Basic Measurement to a Plan for Improvement

Are you caught in a squeeze between avoiding penalties in both PQRS and the Value-Based Payment Modifier (VBPM)? Medicare’s move to Pay for Performance has created a Catch-22 for many groups:  you may have enough data to report enough PQRS measures, but if you choose to report measures where your performance is below the CMS mean of your peers, you risk penalties under the VBPM. As a CMS reporting registry that integrates VBPM Consultation Services, we commonly find at least one or two measures per client with scores that could negatively affect the VBPM if used in PQRS reporting—especially for…
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Population HealthPQRS ReportingQualified Clinical Data Registry ReportingValue-Based Payment Modifier
April 21, 2015

Your VBPM Incentive Payment Could Be Higher Than You Expect—If You Act Now

Here’s a lesson in budget neutrality, Medicare style: If you are penalized under PQRS for non-reporting or under the Value-Based Payment Modifier (VBPM) for poor performance, your money will be paid out to providers earning a VBPM incentive. That’s right—to your competition. If you’re on the losing end of this equation, you could lose up to 4 percent of your Medicare Revenues.  But if you’re on the winning side, you may be rewarded with a much higher net gain than an additional 4 percent. The Basic Arithmetic of PQRS and the VBPM The law creating the VBPM requires it to…
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