Roji Intel Blog

Theresa Hush 0
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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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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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Dave Halpert 0
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Alternative Payment Models (APM)Meaningful UseMerit-Based Incentive Payment System (MIPS)PQRS ReportingQualified Clinical Data Registry ReportingValue Modifier
February 28, 2017

How to Turn 2016 PQRS Success into Better Care (and a MIPS Win)

March has arrived. The submission window for PQRS shuts on March 31. It’s the moment of truth for providers, practices and Registries. Are you ready to report, ready to panic or somewhere in-between? It’s probably too late to implement an initiative designed to improve your PQRS measures, but with the right Registry partner, there is still a path to 2016 PQRS success, even if you aren’t “PQRS Ready.” More importantly, if you follow these three steps, you’ll also create a pathway to success in the Quality Payment Program (either through MIPS or an APM)—both by avoiding penalties, as well as…
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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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Future of Health CareMerit-Based Incentive Payment System (MIPS)Value-Based Health Care
December 20, 2016

New Year’s Prediction: More Cost Sharing for Patients Means Problems for Providers

A year ago we reported on the trend in shifting health care costs to the consumer through higher deductibles, copayments and premium sharing. Fast forward to 2017: expect to see “financial accountability” for patients vastly increase, as health care costs continue their relentless rise and the public policies that support premium subsidies, Obamacare, Medicare and Medicaid expansion, research and innovative provider-based models are weakened or reversed. In general, the politics of the moment are ushering in simple economic concepts: Reduce the complexity, cap costs, minimize bureaucracy. When government or employers contemplate giving patients a fixed contribution for health care, possibly through…
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Future of Health CareRoji Health Intelligence
December 13, 2016

ICLOPS is Changing Its Name to Roji Health Intelligence

We all know that health care is at a crossroads. Regardless of any new directions that national policy will take, providers will be under even greater pressure to reduce costs. We expect that providers will be under financial risk, and patients will bear more costs. What remains constant is the need for guidance and data to navigate a successful path to better health. ICLOPS is reinforcing its commitment to help providers to succeed on this path, through its strategic consultation and technology. To reflect what lies ahead, ICLOPS is also changing its name on January 1, 2017, to Roji Health…
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Dave Halpert 0
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Alternative Payment Models (APM)Merit-Based Incentive Payment System (MIPS)PQRS ReportingQualified Clinical Data Registry ReportingValue ModifierValue-Based Payment Modifier
November 29, 2016

PQRS Homestretch: Finish Line In Sight (But You Haven’t Crossed It Yet)

It’s almost time to bid farewell to PQRS (formerly PQRI), and say hello to the Merit-based Incentive Payment System (MIPS). But PQRS hasn’t ended yet; even when it does, financial implications will not be felt until 2018. Those who do not report PQRS are at risk of being penalized twice, once for PQRS and once for the Value Modifier (VM). Those who do report may earn incentives, penalties or be held neutral, depending on cost and quality results. Ideally, you are already using PQRS as a stepping-stone to succeed in the Quality Payment Program, but even if you haven’t, there…
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Dave Halpert 0
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PQRS ReportingQualified Clinical Data Registry ReportingValue ModifierValue-Based Health CareValue-Based Payment Modifier
November 22, 2016

Improve MAV Audit Success with Expert Data

There are 198 measures available for PQRS Registry Reporting in 2016—seems like there should be enough options to select the most advantageous measures for providers. Unfortunately, however, that’s not the case. Even though there are a whopping 21 measures that could be skipped for each 1 reported, and twice as many National Quality Strategy (NQS) Domains as needed, not everyone will be able to report on 9 measures across 3 Domains (including a cross-cutting measure!). Why is there difficulty in meeting basic reporting requirements? Because measures do not apply to specialties in equal amounts, nor are they evenly distributed within…
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Dave Halpert 0
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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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