MACRA/MIPS/APMs

  • ALEX KIRKLAND

    ALEX KIRKLAND

    Vice President

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  • ELLIS M. KNIGHT, MD

    ELLIS M. KNIGHT, MD

    Senior Vice President/Chief Medical Officer

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At Coker, we provide consultative assistance related to MACRA/MIPS Implementation to achieve five primary objectives:

  • Organizational Development
  • Program Management
  • Data Management
  • Clinician Engagement
  • Auditing and Validation

The Medicare Access and CHIP Reauthorization Act (MACRA) repealed the Sustainable Growth Rate formula, froze or minimally increased annual updates to the physician fee schedule, and created the Quality Payment Program (QPP). Under MACRA, two methods of payment have been established–the Merit-Based Incentive Payment System (MIPS) and advanced Alternative Payment Models (APM). MIPS allows for reimbursement adjustments based upon composite scores (compared to CMS-established benchmarks) in the areas of quality, cost, clinical practice improvement activities, and initiatives by the practice or system that advance care information (ACI).

These changes require providers to consider various alignment strategies so that they are well-positioned to take advantage of the MIPS and APM programs. Further, many healthcare organizations must restructure their physician compensation arrangements to align better with value-based reimbursement models, such as MIPS. Finally, provider organizations must have the technology/analytics in place and learn how to measure, aggregate, validate, and report data to the QPP to be compliant with these novel payment mechanisms.

Our advisors can provide:

  • Education and training on MACRA/MIPS and how it will affect healthcare organizations going forward
  • Help developing alignment and integration strategies that take into account MACRA incentives
  • Help designing or re-designing physician/provider compensation models that are in sync with MACRA
  • Development and build-out of the healthcare technology infrastructure required to report data under MACRA
  • Design of care processes and procedures that reliably produce higher quality at lower costs, thus assuring optimal performance under MACRA

Additionally, we assist by assembling a team of experts to address each objective through a systematic and carefully staged process. While our approach is standardized, we customize our deliverables to meet your organization’s specific needs.

Specific deliverables coinciding with each of the five objectives include:

  • Advisory services for the development of organizational/structural entities (ACOs, CINs, PCMH’s, CCMAs, SSCIPs, etc.) to organize provider activities around value-based care delivery, as called for by MACRA. These activities include overall organizational assessments and the resultant development of clinically integrated entities.
  • Gap analyses highlighting the changes needed for your organization to succeed under MACRA
  • Revenue opportunities and penalty risk assessments, i.e., financial pro formas, as you prepare to participate in MACRA
  • Operating plan impact assessments (e.g., staffing level reviews and changes to management and staff roles and responsibilities) essential to meeting MACRA requirements
  • Healthcare Technology capital plan impact assessments specifically related to the technology needs that are necessary to manage MACRA quality and cost data successfully
  • Financial modeling tools (for independent use by finance staff) that provide periodic Quality Performance Program (QPP) impact projections
  • Application of the Coker ValuePath™ Care Process Design System (CPDS), a systematic approach to changing care delivery at the frontline level by implementing care process improvement activities (CPIAs) to optimize MACRA QPP metrics
  • Step-by-step instructions related to QPP reporting requirements for all four MIPS categories: Quality, Cost, Advancing Care Information (ACI), and CPIAs

Our team has the knowledge, proficiency, and breadth of expertise to assist hospitals, health systems, and physician groups of all sizes optimize their performance under this dramatic change in the healthcare reimbursement system.

Contact us today for more information about our healthcare consulting services and learn how we can help your organization.

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