Mergers and acquisitions, joint ventures and affiliations—this is the new face of health care, and the trend shows no signs of slackening. If your group has grown and changed significantly through consolidation, you’d best take a second look at your 2013 Quality and Resource Use Report (QRUR). Chances are, it no longer applies to your […]
Who Else Cares for Your Patients? How the Wrong Patient Attribution Can Skew Your VBPM
So, exactly who are your patients? Sounds like a silly question. But when it comes to Medicare’s patient attribution methodology, the answer is not obvious. Medicare attributes patients to providers and practices in order to calculate components of the Value-Based Payment Modifier (VBPM). Like it or not, certain patients can be attributed to your practice, […]
Better Hypertension and Diabetes Outcomes: From Basic Measurement to a Plan for Improvement
Are you caught in a squeeze between avoiding penalties in both PQRS and the Value-Based Payment Modifier (VBPM)? Medicare’s move to Pay for Performance has created a Catch-22 for many groups: you may have enough data to report enough PQRS measures, but if you choose to report measures where your performance is below the CMS […]
Your VBPM Incentive Payment Could Be Higher Than You Expect—If You Act Now
Here’s a lesson in budget neutrality, Medicare style: If you are penalized under PQRS for non-reporting or under the Value-Based Payment Modifier (VBPM) for poor performance, your money will be paid out to providers earning a VBPM incentive. That’s right—to your competition. If you’re on the losing end of this equation, you could lose up […]
How to Organize Your Academic Medical Center for PQRS 2015 Success
Take a deep breath. The last-minute flurry of adjustments and updates to last year’s PQRS reporting is over. And—brace yourselves. It’s time to dig into PQRS 2015, which, if you’ve been following our posts, requires a whole new level of rigor to avoid penalties under Pay for Performance. (Download our free eBook, Insider’s Guide to […]
Academic Medical Centers at Risk: How to Survive Medicare and Medicaid Value-Based Health Care
Academic Medical Centers (AMCs) provide care to the most complicated patients and have surmounted some of the worst clinical challenges of all time. Yet the biggest issue to threaten survival of AMCs might well be Medicare and Medicaid Value-Based Purchasing. While AMCs incorporate the training of new physicians in both community and highly specialized care, […]
ACO v Group Practice P4P: How Medicare Costs and Quality Calculations Affect Your Bottom Line
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 […]
Tales from the PQRS Trenches: How to Avoid Harm to Your Practice and Patients
With less than three weeks until the final deadline of PQRS Registry Reporting for 2014 services, many providers are still scrambling to figure out their reporting strategy. They will have few—if any—options for success. It’s 2015, the requirements for PQRS reporting are entering their seventh year, and non-reporting penalties have been applied for two years. […]
PQRS 2015 Reporting: How to Go Beyond Basics to Improve Outcomes
Chances are you don’t have time to read through all 1,200 pages of Medicare’s Final Reporting Rule. But if you don’t understand how CMS is moving the Medicare program, and the health care system at large, toward rewarding providers for quality rather than quantity of care, your organization is in for a rude awakening. In […]