Roji Intel Blog

Dave Halpert 0
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Alternative Payment Models (APM)MACRAMeaningful UseMerit-Based Incentive Payment System (MIPS)Performance ImprovementPQRS ReportingQualified Clinical Data Registry ReportingValue ModifierValue-Based Health CareValue-Based Payment Modifier
July 26, 2016

Closing the Book on PQRS (and Opening the MACRA Sequel)

Did you receive your confirmation email from the Physician Value Help Desk that your TIN was successfully registered for Group Practice reporting? If you did, which method did you select? Whether Registry, QCDR, EHR-Direct or the CMS Web Interface, you are officially locked into that choice, and it’s too late to back out. If you didn’t register, and are not in an ACO or another program that excuses you from PQRS (beware—this does NOT include Meaningful Use!), you’re still on the hook for PQRS and are locked into reporting at an individual level. Now that the registration deadline has passed,…
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Theresa Hush 1
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ACO ReportingAlternative Payment Models (APM)MACRAMerit-Based Incentive Payment System (MIPS)Performance ImprovementQualified Clinical Data Registry ReportingValue-Based Health Care
July 12, 2016

MIPS v APM: Which Is Your Best Bet?

If you’ve been watching the signals from CMS, you undoubtedly know by now that the current reimbursement structure under Medicare will end, to be replaced by a Quality Payment Program (QPP) that holds providers at risk for resource use and quality. The ensuing choices, however, are confusing. Providers can select one of two QPP tracks: Continue Fee for Service (FFS) and fall under the Merit Incentive Payment System (MIPS) or participate in an Alternative Payment Model (APM), such as a risk-based ACO. So, how do you know if MIPS or APM is the best way to go, and on what…
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Theresa Hush 2
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Alternative Payment Models (APM)MACRAMerit-Based Incentive Payment System (MIPS)Qualified Clinical Data Registry ReportingValue-Based Health Care
July 5, 2016

Succeed Under MACRA Medicare: How to Meet CPIAs for Full Credit in MIPS

Although many parts of MACRA’s MIPS continue Medicare’s existing quality programs, Clinical Performance Improvement Activities (CPIAs) forge a new direction. CPIAs are one of four MIPS components that practices must meet in order to obtain full reimbursement from Medicare. Forward planning is essential. It takes time to strategize and implement performance improvements, including partnerships and technology. To make this happen in 2017—the base year for performance measurement—providers must prepare before the MACRA rules are finalized. CPIAs are a unique sign of Medicare’s intent to hold practices accountable for improving health care outcomes. That’s a significant step in Medicare’s evolving role…
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Dave Halpert 0
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Alternative Payment Models (APM)Clinical Data RegistryMACRAMeaningful UseMerit-Based Incentive Payment System (MIPS)PQRS ReportingQualified Clinical Data Registry ReportingValue ModifierValue-Based Health Care
June 28, 2016

What’s the Score? Decoding the MIPS Scoring Methodology

CMS is calling MIPS the “First Step to a Fresh Start.” When it comes to scoring, that’s an understatement. Although MIPS’s foundations are rooted in existing programs, the MIPS algorithm is a significant departure from today’s quality, cost and health information technology scoring. Not only new, this scoring methodology is complex. Providers will receive one aggregated MIPS Composite Performance Score (CPS), but remember—this one score is going to account for three existing programs, plus a component for ongoing improvement. The real first step: learn how the scoring is done. With penalties starting at 4 percent the first year, growing to…
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Theresa Hush 0
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ACO ReportingAlternative Payment Models (APM)Future of Health CareMACRAMeaningful UseMerit-Based Incentive Payment System (MIPS)Population HealthPQRS ReportingQualified Clinical Data Registry ReportingValue ModifierValue-Based Health Care
June 7, 2016

Proposed MACRA Rules: Your APM Strategy for Risk Readiness

If you chose not to participate in Medicare ACOs or Bundled Payments in recent years, CMS is planning to change your mind. Proposed MACRA Rules reveal a complex carrot-and-stick approach to inducing providers into risk models. Make no mistake: it’s just a matter of when, not if, you participate in one of the Alternative Payment Models (APMs). It will pay (literally) to begin planning your path to risk now. Here are five important provisions in the Proposed Rules that you need to understand: Full qualification as an Advanced APM earns a 5 percent lump sum bonus, exemption from participation in…
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Theresa Hush 0
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ACO ReportingAlternative Payment Models (APM)MACRAMerit-Based Incentive Payment System (MIPS)PQRS ReportingValue-Based Health Care
May 31, 2016

Your MACRA Prep for APMs: Learn from ACO Failures

Many provider groups are suddenly realizing they need to understand how a Medicare risk model will impact their operations and revenues. With CMS pushing providers to embrace Alternative Payment Model (APM) risk models under Proposed MACRA Rules, they should be nervous. Although prior APMs such as ACOs did not approach the levels of risk under MACRA (most had zero risk in the first year), most were unsuccessful in reaching targeted savings. Lessons learned from ACOs will help groups make better decisions about how to manage costs, performance improvement, referrals outside the network and provider recruitment. Here are some key posts…
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Theresa Hush 0
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Alternative Payment Models (APM)Clinical IntegrationFuture of Health CareMACRAMerit-Based Incentive Payment System (MIPS)Performance ImprovementValue-Based Health Care
May 17, 2016

3 Ways Proposed MACRA Rules Revive Health Systems’ Clinical Integration Programs

Clinical Integration in medium to large Health Systems just received a nice push from the federal government’s Proposed Rules for MACRA. Health Systems trying to market quality-based physician and hospital networks systems— especially those with both employed and private physicians—should take note. This opportunity for Health Systems to bridge Medicare and private health plan quality is one of the best features of MACRA. Why? Look at this triple play of provisions woven through both MIPS and APMs: “Other-Payer” Advanced APMs will be allowed in the program’s third year to meet Advanced APM status by participating in both Health Plan and Medicare…
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Theresa Hush 0
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Alternative Payment Models (APM)MACRAMerit-Based Incentive Payment System (MIPS)Qualified Clinical Data Registry ReportingValue-Based Health Care
May 10, 2016

Proposed MACRA Rules Boost QCDR Development

One of the promises fulfilled by the new Proposed MACRA Rules, released April 27, is to position the Qualified Clinical Data Registry (QCDR) front and center. In fact, the Rules place the QCDR on par with the EHR in the spectrum of Health Care Information Technology (HIT) and give it special emphasis in Performance Improvement. Yet the QCDR is mysterious to most providers. While providers and heath systems try to sort through all of MACRA recalculations for provider gain or loss under the new Quality Payment Programs, it can be easy to miss the simultaneous revolution in HIT to support…
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Dave Halpert 0
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Alternative Payment Models (APM)MACRAMerit-Based Incentive Payment System (MIPS)Performance ImprovementPQRS ReportingQualified Clinical Data Registry ReportingValue ModifierValue-Based Health CareValue-Based Payment Modifier
May 3, 2016

Know the F.A.C.T.S.: 2016 Proposed MACRA Rule Highlights

Just over a year since the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) passed, the new Proposed MACRA Rule was released on April 27. Now we finally have some details on how Fee For Service will yield to reimbursement through value. There’s a lot to digest in this hefty rule and a great deal at stake, including hundreds of millions of dollars in penalties and incentives. Here’s what you need to know about the proposal and how it affects you. And if you have concerns, be sure to speak up during the 60-day comment period! As anticipated, Alternative…
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Thomas Dent, M.D. 0
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Alternative Payment Models (APM)Future of Health CarePerformance ImprovementSpecialized RegistryValue-Based Health Care
April 12, 2016

Boutique Medicine’s Quality Challenge: Can Specialized Registries Aid Consumer Choice?

Many physicians—especially those in primary care—are angry about the practice of medicine. Dogged by high administrative overhead, they feel the pressure of shorter visit times to meet the practice’s income needs. In some geographic areas, PCPs are opting out of Medicare assignment in large numbers and establishing boutique medicine practices (including “concierge medicine”). Indeed, as CMS pushes providers toward risk under Alternative Payment Mechanisms (APMs) and away from the traditional fee-for-service, concierge medicine has become an attractive alternative for physicians who are fed up with the system. What does this trend mean for access and quality of care, especially when…
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