Now that Value-Based Health Care defines the landscape, reporting for revenue is on its way out. Value-based quality is in. Medicare’s transition to Pay for Performance gives providers just three options—and no out—for participating in reimbursement models that reward for higher quality and lower cost: Build or participate in an Accountable Care Organization; Report PQRS […]
Placebo v Nocebo: How to Test Methods of Physician Engagement in Population Health
The Holy Grail for value-based health care is to improve patient quality and cost outcomes, while stabilizing or reducing annual aggregate payouts for insurance and government benefits. By holding physicians and health systems accountable, the theory goes, providers will engage with patients in a process leading to better status and lower costs. The key word […]
Population Health: What Should It Really Mean?
A long time ago, on my first day of an Oncology fellowship, my soon-to-be-mentors asked me if I had a research interest. “Yes,” I said, “I want to cure breast cancer.” Their kind smiles belied their recognition of my naïveté. In retrospect, thinking too broadly leaves one adrift. To navigate to your goal, you need […]
Navigating the ACO Labyrinth to Success: How to Find Your Way to Quality and Shared Savings
Last year, less than one quarter of Medicare MSSP ACOs achieved success in generating shared savings. Not a good report card, given that Accountable Care Organizations form for the explicit purpose of delivering high quality, coordinated care, with shared savings as in incentive to avoid duplication of services. But ACOs are complex endeavors, both administratively […]
How Medicare is Moving from PQRS Basics into Value-Based Care: Improving Outcomes with Plan of Care
For a number of PQRS measures, Medicare requires that the provider document a Follow-up Plan or Plan of Care to demonstrate that appropriate interventions have been made to reduce risk. This has caused confusion and consternation among some of our clients who may not have clearly documented the follow-up plan or may disagree with Medicare […]
Avoid PQRS and VBPM Penalties and Achieve Long Term Revenues: How to Choose the Right QCDR
Can you optimize your Value-Based Payment Modifier (VBPM) quality and cost profile to demonstrate better outcomes than others and avoid both PQRS and VBPM penalties at the same time? Yes: Use a Qualified Clinical Data Registry (QCDR) to do both. In 2014, the initial year of QCDR reporting, providers had the opportunity to report non-PQRS […]
Are “Flat-Line” Outcomes the Kiss of Death? How to Use a Registry for Outcomes Improvement Research
Despite a huge investment in health care, we have yet to demonstrate real progress in improving outcomes. A major study of patient outcomes last year revealed disappointing “flat-line” results for patient-centered medical home services, which means no difference in outcomes over time, regardless of significant expenditures. And that’s just the beginning. Assessments of cancer outcomes, preventive […]
How to Energize Your Providers to Measure and Improve Outcomes
It’s no wonder that so many physicians feel threatened by the mention of outcomes measurement. All too often, outcomes are used as a club to punish providers who seem to weaken overall group performance. Or outcomes are packaged and applied in a way that doesn’t provide actionable information—which can seem like a waste of everyone’s […]
No More Blame Game: How to Use Patient Outcomes Measurement to Boost Quality and Provider Performance
Fair or not, if your patients don’t do well, your physicians can be tagged as poorly performing providers. But there are ways to change the dynamic for your organization by effectively using patient outcomes measurement to structure and drive a quality program that benefits both patients and providers. Tracking the health and status of patients—“how […]
PQRS 2015: How Your Practice and Patients Can Benefit from New Population Health Measures
Good news for providers who have criticized PQRS as mundane and want to improve assessment of patient outcomes and reduce gaps in care: Medicare’s PQRS 2015 Rule is shifting away from rewarding fragmented quality services and toward population health. With the expansion of the related Value-Based Payment Modifier (VBPM), every group can turn population health […]