Healthcare Compliance Consultants – Why you might need one & how to pick the right one. With the Affordable Care Act going into effect, the sheer number of hospitals, insurance companies, and other healthcare providers, that have struggled to successfully implement major changes in their working – without assistance – has increased drastically. Before that, most of the physicians were comfortable in their working. With the major reforms looming; many doctors decided to join hospitals, and by default – leave their private practice. If only they approached the correct issues by hiring the right team, or even the right person, everything would have been different. This is where a healthcare compliance consultant becomes the most useful. Healthcare compliance consultants can notice the full potential of a practice, a hospital, or any other health facility. They base their strategies on data analysis, knowledge, professionalism, and dedication – while showing the right way to an efficient, low-cost working. Therefore, many healthcare providers since have decided to hire a healthcare compliance consultant. The global healthcare consulting market is constantly growing. With a value of over $6 billion in 2014, the market amounts to 7% of the whole healthcare consultant industry. With the aspect of further growth, especially in the U.S. – which holds almost two-thirds (62%) of the whole $6.33 billion because of the reforms – the competition in the field is also rising. Meaning, finding the right consultant, whether an individual or an agency, can be challenging. What to Look for in Healthcare Compliance Consultants Due to the consultant’s high level of importance to their client, one might ask – what should you even begin to look for in a healthcare reform consultant? My first response to that question is knowledge, this is essential. You need an individual or a team that understands the emerging healthcare market. Reliable consultants have the tools to monitor trends and factors that influence the industry. They depend on data, but still develop their own view of the way the entire system functions. An independent thinker will always understand things better than anyone else. Look for someone that has a unique point of view. It can be wise to test the person’s or the team’s knowledge by having them around for a while. It is a small investment, but it will eventually pay off. Look for someone that will blend with your team and will be interested enough to see what’s beyond the medical practice. These individuals develop suitable strategies that will help you save, improve your management, and teach you how to stand on your own feet. Always look for a well-educated, experienced person. In the healthcare compliance consulting field, a Bachelor degree is the minimum criteria. In case you decide to hire a consultant company, inform yourself on their latest successful projects. Evaluate their views, approaches, and values. It is important for the company to invest in professional development and growth. Getting references can be helpful during the evaluation. However, consultants only show their success. Digging a little bit deeper, for example, spending time in networking can reveal some unexpected information. Secondly, look for experience. In consulting, the power of experience can’t be underestimated. Many companies don’t include individuals with a minimum of 10 years of experience as their team members. While the size of the consultant company doesn’t make a huge difference, many years of experience are an advantage in solving big projects. Finally, you must take into account the overall efficiency of your new consultant.The right consultant will have backup plans, but still get manage to finish the project on time. Simply because the team has failed to finish a project in a timely manner before; doesn’t mean that you should hesitate to hire another consultant now. Additionally, an efficient consultant will approach the problem with long-term goals in mind, offering quality work that will stay with your practice, even after the project is officially over. They will provide you with the necessary guidance that will help you manage your practice in a more profitable and efficient way. Benefits that come from having the right consultant on-hand. Now as you could imagine, there’s a vast amount of benefits that can come from having a consultant on your team throughout the healthcare reform and implementation processes. First and foremost, the overall easier managing of large projects is one of the main benefits that’s noticeable almost right away. Have you ever tried to fix a problem without a success? With the consultant’s management skills and technical expertise, your project has higher chances to succeed. It is of great value that a consultant develops a strategy by finding the causes of the problem. They will focus on the major issues that need to be solved and by making the project a priority, you will maintain profitability and improve patient service. The consultant is an outsider. Sometimes the issues you might not know you’ve had, will be revealed by a person that is not familiar with the situation and has a clear point of view. Meaning, you need an individual or a team that will commit and spend their time focusing their attention on a particular field. The second benefit is huge: the increased ROI. The initial cost of the consultant won’t overweight the saving that you will make in the long run. Consultants develop an in-depth strategy that includes all your costs, research on your competitors, measures that you can take to save, and much more, that contribute to organized, effective, and improved practice. Keep in mind that bringing your practice to that level requires an individual or a team that is able to see the flaws and propose an efficient approach. Watch your practice grow exponentially. As well, you begin to learn how to run a practice as it is – a business. Many physicians and hospitals are dedicated and focused on providing the best medical service to their patients. Usually, they don’t think of running their practice as a business. This brings them to the point when they face many problems and hope to solve them on their own, or with a help of their team. Eventually, they realize that their team can’t solve all of those problems. Dealing with a complex issue that requires dedication, plan, and analysis can’t be solved by a non-expert team in the field. Healthcare consultants have the required tools and a team that not only will help you solve your problem, but understand the operating and management your business needs. Next, you will save time figuring out everything by yourself. Implementing planning strategies in your practice is not your expertise. Even if you think you know the best way to run your business, trust me, there is someone that is much better. Spare yourself of all the struggles. You will save time, energy, and money. And save your team the extra effort of figuring everything out. Let them do what they do best. Serve your patients. In conclusion, you will also improve the quality of your services and operations. Healthcare compliance consultants pay attention to every detail in your practice. They collaborate with your team, developing a new way to improve everyday operations, which leads to the final goal – helping patients. By improving the quality of your overall working, you have higher chances to reduce medical errors, improve patient safety, improve staff, and create a safe environment. Healthcare compliance consultants provide a plan with realistic goals for your organization, set a reasonable deadline, and finished the project successfully. They are well-informed, knowledgeable, innovative, and great leaders.

MMIPS requires that reporting is done either under a group or as an individual. This reporting is guided by the MACRA statute guidelines on the working of physicians. The reporting is done according to the individual physician’s choice on their participation in the MIPS. The reporting programs for quality previously guided that individuals could only participate in the group reporting and PQRS for larger practices. MACRA has changed everything significantly in that individuals can now report collectively for MIPS data if they exist in groups of two or more. In this way, sub-specialists benefit a lot from this reporting and can succeed in MIPS, (MIPS Program: Choosing Individual Vs. Group Reporting). Moreover, administrative issues for many practices can be successfully eased with time. The practice specialty a physician also matters and is a determinant of the reporting method. The method of reporting whether individual or group depends on the type of practices that a physician is engaging in. MACRA has successfully changed the way that medical care is being offered through its new regulations that have been passed into law. The method of integrating quality measurement into payment has been changed by the new law all thanks to MACRA. Alternative models of defrayment offer incentives on participation all thanks to MACRA. Operation of groups under MIPS Most AMCs employ group reporting under MIPS. Depending on the performances of the group reporting, eligible clinicians can get adjustments of payments. If the group is performing well then the payment is adjusted to be better and vice versa for an underperforming group. Alternatively, there is a choice for EC to join APMs to offer services and where they are supposed to offer services responsibly. The tactic is consequential for the type of services being offered to any beneficiaries depending on the quality and cost, (Cohen and Crane, “CMS Releases MACRA Final Rule, Easing 2017 Reporting Requirements – Health Law & Policy Matters”). All the consequences are determined by the ability of the participants in the APMs to meet a certain threshold of standards. This tactic ensures that there are consequences if a group is failing where it should be performing well. There is an APM special scoring standard used to maintain the performances of the ECs. These standards are used to rate how the different ECs are doing in their respective positions. There are also standards or thresholds that are specially maintained for checking in on the performances of the individual ECs. MIPS vs PQRS The CMS has just released a report on how to take care of key qualities that a medical organization should provide while at the same time paying accordingly. The payment should always be done according to the quality of service being delivered from the medical department offering the services. The MIPS reporting currently include offering information on the quality, advancing care, and any improvement activities present or being conducted by the company. The PQRS bears similarities to MIPS. The similarities go up to around 60% of those found the MIPS program, (MIPS Program: Choosing Individual Vs. Group Reporting). Due to criticisms, CMS tries to ensure that all ECs are given more flexible to enable them to report properly to the QRS. Moreover, there are key requirements for the MIPS to work properly. The clinicians are supposed to report at least 6 key measures of quality that they have taken. Any PQRS has an obligation to report on any quality measure which is not specified in the MIPS. Moreover, there are sets of NQS which are to exist but not in the MIPS program. Such an arrangement assist in fostering competition for the benefits of improving the quality. Clinician claims assist ECs to report the MIPS measures. The bottom line is that CMS has now decided to streamline the programs for payment and quality. Final rule for MACRA by CMS CMS has plans to make the year 2017 a year of transition by reducing the requirements for reporting and focusing on widespread participation goals and more education for the clinicians. The final rule by CMS for MIPS assists in offering the program more flexibility as opposed to what was present before. Thus, any clinicians who are trying to avoid adjustments by MIPS also have alternatives. The can do full reporting, minimum reporting or minimum submission. Hence, more is concentrated on the services that the clinicians are supposed to offer rather than on reporting by the clinicians. For full reporting, moderate payment is a guarantee as long as the clinicians keep reporting continuously for three months’ periods, (Cohen and Crane, “CMS Releases MACRA Final Rule, Easing 2017 Reporting Requirements – Health Law & Policy Matters”). This reporting is also paid for according to the score of the clinicians. For the partial reporting, the clinicians can only choose one quality measure and report on it. In this reporting option, the clinicians usually do not receive any payment adjustment. In case there is a payment, it is usually very small according to the score that they have attained. For the last reporting alternative, minimum submission, one quality measure and activity in the category of improvements is reported. Unlike the other reporting options, this alternative does not have to be reported continuously. Clinicians operating under this option are never evaluated for positive increases as well as fines.