Thought Leadership Webinar: Exploring the MIPS Quality Measure

It’s been well over a year since MACRA of 2015 was passed by Congress and signed into law but according to according to Deloitte’s 2016 Survey of U.S. Physicians, only about 50 percent of practicing physicians have heard of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). Interestingly of those 50 percent who have heard of MACRA, the majority have only heard about it but really know nothing about what it is and how it will affect them. We have created a MACRA webinar series to serve as a valuable resource to help your organization prepare now for MACRA.

This webinar is the fourth in our MACRA Webinar Series. Previous webinars include:

•The 411 on Value-Based Reimbursement
•Connecting the dots between PQRS, MIPS, & CAHPS
•MACRA under the lens of a clinically integrated network

In this webinar, Moshe Starkman explores the ins and outs of the MIPS Quality Performance Category. The Quality category accounts for 50 percent of your MIPS composite score in 2017 so there’s no time like the present to begin preparing.  In this webinar, Moshe explores:

  1. The differences between PQRS 2016 and MIPS 2017
  2. How scoring is done within the Quality category
  3. How the Quality score impacts the MIPS Composite Performance Score
  4. Considerations to ensure that you’re getting ready for MACRA

If you’d like to learn more about how we can assist you with your MACRA readiness or how our MIPS Composite Performance Score projection and monitoring tools can help you in the long term, please contact Moshe directly at or 801.783.4100.


Thought Leadership Webinar: Data-Powered Payer Rate Analysis & Management

The rate negotiation process can seem like a daunting task. Especially when you feel like your future rests on successful negotiation with your private payer plans. Nevertheless, if you utilize your data effectively, you’ll be amazed at how it will revolutionize the management and negotiation of your payer rates. Successfully negotiated payer contracts are an essential part of a sound financial strategy.

Leveling the Playing Field
Unfortunately, when physician practices negotiate contracts with payers it is rarely a level playing field. Insurance companies have vast amounts of data and sophisticated modeling tools to give them a tremendous advantage in negotiating rates. Conversely, health care providers often lack sufficient analytical tools and experience when it comes to contract knowledge. These insufficiencies can end up costing the practice millions of dollars.

In order to level the playing field, providers must utilize their billing and contract data to analyze proposed rates and their effect on a practice’s top line. In this webinar, we will step you through the process of improving your practice revenue through data-powered payer contract negotiation. You will learn how to use your own data to analyze proposed rates, better negotiate and understand the effect on the practice.

Watch this to webinar to learn how to up your payer rates game by:

  • Aggregating your clinical and financial utilization data
  • Analyzing costs and quality measures
  • Identifying inefficiencies & opportunities

Thought Leadership Webinar: What is GPRO and CAHPS?

Understanding how to navigate the new CMS value-based reimbursement reporting guidelines and regulations can be tricky, but certainly not impossible.

In this second session of our educational webinar series addressing value-based reimbursement, we explore group reporting options (GPRO), review the Consumer Assessment of Healthcare Providers and Systems (CAHPS) and examine its requirements, patient eligibility, & survey implementation.

So what exactly is GPRO and CAHPS?
Group practices with two or more eligible clinicians (ECs) can register with CMS to report PQRS data through the group practice reporting option (GPRO). These group practices must have grouped their National Provider Identifiers (NPI) under a single Taxpayer Identification Number (TIN) umbrella to be eligible. So, if your practice, hospital, and/or health network represents two or more eligible clinicians that bill under the same TIN then you’re eligible for group reporting.

CAHPS includes consumer and patient surveys that ask them to report on and evaluate their healthcare experiences. CAHPS surveys are not customer service surveys. Instead, the survey’s cover topics that are important to consumers, focusing on those aspects of quality consumers are best qualified to evaluate.

If your group practice registers for PQRS by the June 30th deadline and consists of between 2 and 99 ECs, then you may elect to include CAHPS for PQRS as part of your PQRS submission. If your group practice consists of 100 or more eligible clinicians (ECs) then it is actually required.

To learn more, watch the video below.

Thought Leadership Webinar: The 411 on MIPS

In April 2015, Congress addressed and ended the highly unpopular SGR Fee-For-Service Medicare reimbursement model in favor of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA).

MACRA moves healthcare away from a fee-for-service mindset towards a value-based care mindset where high-quality care at a reduced cost is rewarded.

Over the course of this year, we will be hosting a series of webinars to help you understand how to navigate MACRA and how to prepare for the changes.

In this webinar session, Moshe Starkman, Equation Senior Consultant and Product Specialist, discusses:

  • The creation of the Merit-Based Incentive Payment System (MIPs) including the four components of the MIPS composite performance score.
  • The differences between PQRS and Quality component of the MIPS CPS.
  • The proposed Medicare reimbursement bonus and penalty schedule.

Fill out the form below to watch the webinar.


Thought Leadership Webinar: Downstream Analysis – A Powerful Way to Serve a Patient Population

Figuring out the true value of your employed physicians can be nearly impossible unless you have access to a health system’s data — analyzing the data of a physician or clinic is not enough. You need the gamut of data to understand the value a physician or clinic has for a patient population.

Now, more than ever, we have endless data available to us — the key is aggregating, mapping, and then employing it so that it gives you insights to improve the value of care. Downstream analysis is one of the best way to do this.

Downstream Analysis can break down:

  • Physician referral patterns
  • Patient consumption patterns
  • Total cost of an episode of care
  • Population management opportunities

The above insights are key to helping leaders of a health system to truly serve its patient populations. We have recorded the following webinar to help you learn more how Downstream Analyzer can arm your healthcare system’s leaders with the right data at the right time.




Nailing PQRS in 2016 is the Best Way to Prepare for MIPS

Does MACRA (Medicare Access or CHIP Authorization Act) or MIPS (Merit-based Incentive Payment System) sound daunting? If you’re like most health systems you’ll answer with a gulping yes.

Before I answer your question about the best way to prepare for MIPS, let’s just make sure we are on the same page by answering the following:

What exactly is MIPS?

Starting CY2017, MIPS will annually measure Medicare Part B providers in four performance categories to derive a “MIPS score” (0 to 100), which can significantly change a provider’s Medicare reimbursement in each payment year. The performance categories and point allocations for the CY2017 performance year are 50 points for quality (PQRS/VBM), 25 points for meaningful use, 15 points for clinical practice improvement, and 10 points for resource use.

The MIPS final rule (due late this year) will determine how points are earned within each component.

The financial impacts of the MIPS scoring system can be significant. The following diagram shows how it works:

Screen Shot 2016-04-30 at 1.04.20 AM


Each performance year (say 2017, corresponding to the Payment Year 2019 in the diagram above), CMS sets a “performance threshold” (PT) number of points at which a provider earning PT points receives 0% adjustment to their Medicare Part B payments.

If PT = 50, then only a provider earning exactly 50 points will get 0% payment adjustment. A provider earning 51 points earns an incentive, whereas one achieving only 49 points will be assessed a penalty. These payment adjustments increase in size linearly as the point value further deviates from the PT value of 50 until maximum incentives are penalties are reached.

Furthermore, as can be seen in the diagram, the maximum base payment adjustment can range up to a 9% x 3.0 = 27% incentive or down to a -9% penalty.

Medicare is able to reward winners so much more than losers because the entire MIPS program is designed to be budget neutral, whereby the national incentive pool is set equal to the national penalties applies. Since there are anticipated to be more losers than winners, winners can reap substantial financial rewards under MIPS.

The performance threshold PT is determined annually as the mean or median of the MIPS scores for all EPs in a prior period as selected by CMS. For the initial two payment years (2019 and 2020), the PT will not be based on historical MIPS scores but rather on a combination of historical performance on measures and activities related to PQRS, MU, VBM, and possibly other factors as determined by CMS.

Now there is some additional nuance that isn’t covered above, such as alternate payment models. In the coming weeks we’ll detail all fo the nuance and diagram the most optimal path to take. Now on to the pressing question:

How can I prepare now for MIPS?

Nail PQRS today with a monitoring model. Some readers may be reading this and saying to themselves, “well, this seems simple.” All I need to do is nail PQRS, I have been doing that for years now.” But, have you been monitoring and trending it in such a way where you know how things are progressing at any given point? MIPS is very much focused on improvement and if you’re not monitoring PQRS for improvement now, how will you do it when you have many different clinical improvement measure that need to be tracked? If you couldn’t read into where  CMS is trying to take MIPS then let me say it simply — MIPS is the beginning of the era of improving quality measures while also lowering the cost of healthcare (two of the three triple aims).

Equation’s PQRS Offering

Sound daunting? It shouldn’t be, not if you have Equation helping you. In the coming weeks Equation will be releasing more details about how it will help health systems nail MIPS. A major part of preparing for MIPS is utilizing Equation to calculate PQRS measures now and then to utilize that data to begin tracking progress towards hitting MIPS. Keep your ear to this blog because we will announce soon in greater detail how we can help you best prepare for MIPS.

If you are interested to have Equation calculate and submit PQRS measures then please reach out to Mike Romney at 801.783.4100 or email him at

DataRiver Training: How to Evaluate Payer Mix in DataRiver

In order to ensure a practice is financially healthy, it is imperative that the payer mix is balanced.

DataRiver makes it easy to effectively evaluate payer mix and devise a strategy that will provide the practice with the best financial picture.

In this webinar, participants will learn how to do the following in DataRiver:

• Analyze payer mix
• Determine how changes can affect revenue

Click on this link to view the webinar: How to Evaluate Payer Mix in DataRiver

Click on this link to view the worksheet used in the webinar: Payer Mix Workbook

Thought Leadership Webinar: Using Visit Coding Data to Find Revenue Gaps and Opportunities

Visit coding is a critical component to the sustained strength of a physician’s practice. But how do you know whether or not the services provided are being coded correctly?

In this webinar session, you will learn how to utilize visit coding data to validate services rendered, maximize revenue, and avoid potential compliance issues.


DataRiver Training: Utilizing DataRiver to Rethink Physician Productivity

Although wRVUs are an age-old criterion for measuring physician productivity, today’s healthcare analyst needs to move beyond tradition thinking to position him or herself for success.

In this webinar, we will show you how DataRiver can help you rethink the way you quantify and monitor physician productivity data. You will learn how to move beyond just wRVUs to obtain a valid view of physician performance by utilizing the various data views within DataRiver, from dashboard down to pivot table.

DataRiver Training: Calculating Days in Accounts Receivable in DataRiver

DataRiver provides an effective way to monitor the overall performance of your accounts receivable efforts.

In this DataRiver User Training webinar, you will learn how to:
• Accurately and effectively calculate days in accounts receivable in DataRiver
• Trend days in accounts receivable over time in DataRiver
• Drill down days in accounts receivable to department and/or specific providers in DataRiver

Whether you are new to DataRiver or are a power user, this training will help you to get the most out of DataRiver.

Download spreadsheet used in the training webinar here: Days in AR Webinar Worksheet

Presenter: Tom Sherwood

Tom Sherwood is an analyst at Equation and has been in this role for almost a year. Prior to joining Equation, Tom completed a Masters in Healthcare Administration at the University of Michigan (Go Blue!). Tom has several years of experience with data analytics, visualization, and helping clients understand and learn from their data.