The whole may be greater than the sum of its parts—but how those parts each contribute to the whole is key to a new Medicare calculation of episode costs. If you aren’t paying attention to the total cost of an entire “episode” of care for your patients—including that rendered by others—your future revenues may take a […]
How to Boost Your VBPM with ICD-10
With five weeks until ICD-10 becomes official, take note: Your transition strategy must include PQRS and the Value-Based Payment Modifier (VBPM). Neglecting VBPM in your short-term plan may lead to long-term penalties. That now goes for everybody, whether you helm an Academic Medical Center or run a small practice. October 1, 2015, marks the starting […]
Radiologists’ Tool Kit: How to Succeed in PQRS and VBPM
When it comes to PQRS reporting, it’s not easy being a radiologist. How can you fulfill PQRS reporting requirements and avoid jeopardizing future value-based payments? Many radiologists have found themselves backed into a PQRS corner—not enough measures to report, and those measures that can be reported have some tricky requirements. Similar to anesthesiologists, radiologists practice […]
ACOs and the Referral Revolution Part 2: How to Align Objectives and Referral Practices
There’s no getting around it. Disruption in referrals under new Value-Based Health Care programs will upset both primary care and specialty practices under any change scenario. Physicians with historical relationships will undoubtedly resent an edict to redirect referrals, if they don’t understand or believe comparative data on cost and quality. On the other side of […]
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 […]
Will Medicare’s Published Physician Quality Data Push Your Patients Away?
CMS isn’t the only group scrutinizing your quality and cost data any more. As the next step toward value-based health care, Medicare has begun publishing provider performance data for PQRS under “Physician Compare.” Now patients and their families can make their own data-driven choices about health care providers with an online search. The website is a game-changer. […]
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 […]
How to Get Paid for Your Population Health Program: Part 2
If you’ve written off population health initiatives as too expensive, think again. Pay for Performance means just what it says: you need to demonstrate better outcomes than your peers if you expect to reap benefits from Medicare. And, if you fall behind, you’ll risk ACO losses or Value-Based Payment Modifier (VBPM) penalties. As we discussed […]
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 […]
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. […]