Roji Intel Blog

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Future of Health CareMACRAMerit-Based Incentive Payment System (MIPS)Patient EmpowermentPerformance ImprovementValue-Based Health Care
April 20, 2017

Can Value-Based Health Care Help Consumers Choose Doctors? 
12 Questions to Ask

Do consumers and other health care purchasers have the ability to choose providers based on quality and cost? That’s the assumption beneath attempts by Medicare and health plans to reimburse providers based on their ability to deliver better quality while constraining costs. Value-Based Health Care also includes programs by commercial insurance to offer “narrow” provider networks that select physicians and hospitals by performance. Choosing value presumes that consumers and employers have the right knowledge and information to select providers who deliver the best clinical results at lower cost. The need to provide that information has fueled efforts over the past…
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MACRAMerit-Based Incentive Payment System (MIPS)Qualified Clinical Data Registry Reporting
April 5, 2017

Do Centers of Excellence Lose Under New MACRA MIPS Episodic Cost Measures?

Health systems’ Centers of Excellence that attract patients through clinical prowess may be heading for an upset. Under the MACRA MIPS program now entering its first year, physicians will be scored for cost performance in some of the same clinical areas that they have promoted to distinguish their care—and compared against their peers. Since Centers of Excellence are likely to be higher cost in comparison with other providers, associated episodic cost measures may possibly be used to penalize their providers. The impact won’t be felt immediately, however; in 2017 the MIPS Cost component is scored but not calculated in the…
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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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Future of Health CareMedical Decision-MakingPatient EmpowermentPerformance Improvement
February 14, 2017

Turning Patients into Health Care Consumers—For Economic Survival

If we want to help people take better charge of their health—both physically and financially—we should start by treating them as real consumers, instead of patients. While that may seem like a simple change in terminology, it is anything but. A Patient Is a Recipient of Services, Not the Actor Health care organizations often work hard to welcome patients and provide as many services as needed. They design facilities to be comfortable, and there are often superb training programs for staff to be courteous, communicative, and to make patients comfortable. But let’s be honest. Health care is a business concern,…
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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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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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ACO ReportingFuture of Health CareMACRAMerit-Based Incentive Payment System (MIPS)Performance ImprovementValue-Based Health Care
January 10, 2017

Can Health Care Stay the Course of Reform Amidst Uncertainty?

With the new year finally here, health care organizations need to know: How should you proceed amidst uncertainty about Medicare policy, including Value-Based and Risk programs initiated by the Obama administration? In the crosshairs are the new, complex Quality Payment Programs under MACRA, including both MIPS and Alternative Payment Models (APMs) such as ACOs. Although MACRA had bipartisan support in the 114th Congress, it was the Affordable Care Act (ACA) that created the foundation for ACOs and other Value-Based programs. As the new Congress hurtles toward ACA repeal, the landscape for all of health care is murkier than ever. The…
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Future of Health CareMACRAValue-Based Health Care
January 3, 2017

Onward to 2017 as Roji Health Intelligence

  It’s been a momentous year in health care, with significant changes on the way for 2017. “Patient Empowerment” and cost shifting to the consumer are gaining political currency in Washington. MACRA is looming on the horizon, with the coming year being the first under the Final Rule for measuring performance. Health care organizations have significant strategic decisions to make as we move more intensively through an era of Value-Based Health Care and into Risk. Patients, too, will face serious questions about health care coverage and how to find accurate, comparative information for making choices about providers and networks. It…
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MACRAMerit-Based Incentive Payment System (MIPS)Qualified Clinical Data Registry ReportingValue ModifierValue-Based Health Care
November 8, 2016

Risky Business: How to Make Risk Adjustment Fair and Accurate for Quality Measurement

No two patients are the same. Some are much sicker than others. Obvious? Yes. But this is the fundamental challenge of quality measurement. As public scrutiny of physician performance intensifies via the CMS Physician Compare website, and as outcome comparisons become ever more crucial to Medicare and private insurance reimbursement strategies, finding a fair and accurate way to adjust for risk is critical. Each patient population has its own challenges. Academic medical centers may get the most difficult cases, but solo practitioners see the entire community, and without the infrastructure available elsewhere. For health care to improve for all patients,…
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Dave Halpert 0
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Alternative Payment Models (APM)MACRAMerit-Based Incentive Payment System (MIPS)Qualified Clinical Data Registry ReportingValue-Based Health Care
October 28, 2016

The MACRA Final Rule: On Your Mark, Get Set . . . Transition!

The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) has (among other things) repealed the Sustainable Growth Rate and incorporated quality measurement into payment, steering away from traditional Fee for Service payments. In other words, revenues are being tied to quality, rather than volume. The Quality Payment Program (QPP) defined within MACRA offers two methods of participation: Merit-Based Incentive Payment System (MIPS) Advanced Alternate Payment Models (Advanced APMs) The Final Rule (CMS-5517-FC: “Medicare Program; Merit-based Incentive Payment System (MIPS) and Alternative Payment Model (APM) Incentive under the Physician Fee Schedule, and Criteria for Physician-Focused Payment Models”), released on October…
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