Roji Intel Blog

Theresa Hush 0
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ACO ReportingAlternative Payment Models (APM)Clinical Data RegistryMeaningful UseMerit-Based Incentive Payment System (MIPS)Performance ImprovementValue-Based Health Care
March 22, 2016

Ready for Risk? How to Foster Physician Alignment with Your Health System’s APMs

We’ve seen unprecedented consolidation among hospitals, hospital systems and physician groups in recent years, sparked by the drive for greater market share. As systems organize competitively to participate in risk models such as ACOs and bundled payments, however, the dramatic surge in hospital employment of physicians hasn’t helped ACO success. In fact, most Medicare ACOs have not met cost targets needed to generate revenue. All too often, hospitals or health systems and their physicians clash over goals, expectations, outcomes and basic communication regarding Alternate Payment Models (APMs). As a Registry helping large systems take steps toward clinical integration, ACOs and performance…
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Dave Halpert 0
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Future of Health CarePerformance ImprovementPQRS ReportingValue ModifierValue-Based Health CareValue-Based Payment Modifier
March 15, 2016

Still Not Sure of PQRS-VBPM? You Just Gave Your Competitor a Huge Bonus

If you still need a good reason to meet all PQRS requirements and improve your quality tiering under the Value-Based Payment Modifier (VBPM or Value Modifier), listen up: Failure to do so means your penalty will end up in your competitor’s pocket. Not only that—the 2016 Value Modifier Adjustment Factor (AF) for incentive payments has just been decided by CMS, and it’s an eye-popping 15.92 percent on all allowable Medicare Part B charges. Simply put, those groups whose Quality and Resource Use Reports (QRURs) showed 1.0 x AF will earn close to an additional 16 percent incentive payment, more than…
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Dave Halpert 0
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ACO ReportingAlternative Payment Models (APM)Clinical Data RegistryFuture of Health CareMerit-Based Incentive Payment System (MIPS)Value-Based Health CareValue-Based Payment Modifier
March 8, 2016

APMs Are Here and MIPS Is Coming Sooner Than You Think: How to Plan for the Unknown

How do you prepare for a program with yet-to-be-defined rules that will involve larger potential penalties (or incentives)—but requires long term planning? It’s a real quandary, but the time is now to begin thinking strategically about the upcoming Merit-Based Incentive Payment System, or MIPS. MIPS Fundamentals MIPS was created from the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). The Act succeeded in expunging the looming but flawed “Sustainable Growth Rate” formula, replacing impending cuts with reimbursement tied to Value-Based Health Care. MIPS details may be lacking, but the overall MIPS framework is taking shape. Scheduled to begin on…
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Dave Halpert 0
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Performance ImprovementPQRS ReportingValue-Based Health CareValue-Based Payment Modifier
February 23, 2016

Don’t Hit the Medicare Revenue Wall: What You Must Know About 2016 PQRS-VBPM Benchmarks

What will it take for health care providers actually to focus on improving patient outcomes, while keeping costs under control? CMS has structured quality reporting under the Value-Based Payment Modifier (VBPM) to reward providers who surpass PQRS measure benchmarks, and penalize those who lag behind. But inherent in the new quality tiering is a serious dilemma: a strong incentive to game the system, rather than to improve performance in any meaningful way. Here’s why: For three-quarters of the individual measures included in these benchmarks, it is statistically impossible to surpass your peers’ performance. The only way to differentiate performance is…
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Theresa Hush 0
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ACO ReportingClinical Data RegistryMeaningful UseQualified Clinical Data Registry ReportingSpecialized RegistryValue-Based Health Care
February 15, 2016

ICLOPS Specialized Registry Now Open: Don’t Miss 2-29 Deadline for Active Engagement in 2016 MU Public Health Reporting

Attention, Eligible Providers and Hospitals looking for a Specialized Registry to meet public health reporting requirements in Modified Stage 2 of Meaningful Use: ICLOPS is open for business. ICLOPS Specialized Registry services will support both Eligible Providers, regardless of specialty, and Eligible Hospitals, plus all eCQMs. Since CMS finalized the modifications to the Meaningful Use program in October 2015, providers have been scrambling to find information on public health reporting options. While some providers are already connected to their specialty registries or to state and local immunization registries, many Eligible Providers have been without options for meeting this requirement. There is…
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Thomas Dent, M.D. 0
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ACO ReportingClinical Data RegistryMeaningful UsePerformance ImprovementPQRS ReportingRegistry ScienceValue-Based Payment Modifier
December 8, 2015

Want Real Performance and Outcomes Improvement? Track Interventions and Results Over Time

Time will explain it all. He is a talker, and needs no questioning before he speaks—Euripides For many providers, reviewing performance data is just another distraction from practicing medicine, rather than a valued tool for making better medical decisions. And who can blame them? Performance or outcome data reviewed in isolation, as static results, aren’t all that useful. The exercise is akin to looking at a single photograph of an event and inferring cause and effect without any corroborating evidence. To be an effective resource that leads to actual outcome improvements, data must be tracked over time. Most often, however,…
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Theresa Hush 0
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Clinical Data RegistryFuture of Health CareMeaningful UseMedical Decision-MakingPerformance Improvement
November 24, 2015

Putting the “Meaning” in MU Public Health Reporting: 
How to Move Beyond “Check the Box”

Can Medicare influence health care delivery via the “public health” reporting requirements of the EHR Incentive Program? That question is central to the updated EHR Incentive Program (more commonly known as Meaningful Use, or “MU”). The answer boils down to a fundamental choice: whether providers view the external reporting Objective as just one more compliance effort, or an opportunity to improve. Apart from governmental reporting, Modified Stage 2 of MU requires eligible providers to submit data reporting to one of three types of “public health” registries: immunization, syndromic surveillance and Specialized Registries. This is reporting for the public good, and…
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Dave Halpert 0
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ACO ReportingAttributionClinical Data RegistryMeaningful UsePQRS ReportingQualified Clinical Data Registry ReportingValue-Based Payment Modifier
November 17, 2015

2016 Medicare Final Physician Payment Rule: What You Must Know

CMS’s push toward value-based care and performance improvement leaves no more room for doubt. In a hefty 1,358 pages, the 2016 Medicare Final Rule  expands the role of Qualified Clinical Data Registries for PQRS reporting, dovetailing with the Specialized/Clinical Data Registry component in the Meaningful Use Rules. Both methods place the focus squarely on how outcomes change over time, across all patients. Tracking outcomes and measuring improvement are no longer optional. Here’s what you need to know: QCDRs Get GPRO Submission Status As expected, the differentiation between the Final Rule and the Proposed Rule is minor; the most important change for…
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Dave Halpert 0
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PQRS ReportingQualified Clinical Data Registry ReportingValue-Based Payment Modifier
October 13, 2015

ICLOPS Case Study: VBPM Consultation Lifts Specialty Group’s Quality Tier and Medicare Revenues

Medicare’s Value-Based Health Care programs aren’t just about penalties. You can also earn a reward. Case in point—an ICLOPS orthopedic client recently asked The Big Question: Are there really incentives to be earned through Medicare’s Value-Based Care? With the release on September 9 of the Annual Quality and Resource Use Reports (QRURs), the answer is a resounding “Yes.” At its core, the Value-Based Payment Modifier (VBPM) is a simple proposition: Those who are able to demonstrate higher quality care at a lower cost than other groups are rewarded, while those who can’t are penalized. The rewards come from the pool of…
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Theresa Hush 0
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ACO ReportingFuture of Health CarePQRS ReportingQualified Clinical Data Registry ReportingRegistry ScienceValue-Based Payment Modifier
September 15, 2015

No More Status Quo: How the New CDR Will Change Health Care

As CMS streamlines its Value-Based Reimbursement programs, the pressure is on for providers to participate. A better foundation is needed to support those changes, so providers can actually succeed. And Medicare’s expansion of Clinical Data Registries (CDRs) may just be the answer. CDRs could be the tipping point for transforming health care. Here’s why: With better capabilities for performance measurement, more comprehensive databases, and expertise for more advanced outcomes analyses and research, CDRs can provide tools that have been missing for all stakeholders—providers, health plans and consumers. What’s a CDR and Why Is It Different? The Clinical Data Registry has…
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