Prepare a presentation for the physician group stakeholders detailing how the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) will affect reimbursement practices and customer services.

Introduction: Note: The assessments in this course build upon each other, so you are strongly encouraged to complete them in sequence.

For this assessment, you will look at the different forms of payment in healthcare and why this makes healthcare unique from any other industry. You will dive into the new payment method of value-based purchasing and how that differs between healthcare organizations, including hospitals, skilled nursing facilities, and physician offices. Finally, you will look at how the quality of patient care has become the center of how organizations are paid and the metrics used to measure quality.

You will also explore the different types of data used to measure performance in health. You will look at financial data and quality data and how it is used both internally and externally to benchmark healthcare organizations not only against each other but also against their own goals. You will look at data mining and the different types of analytics to understand their impact on operations and forecasting.

SCENARIO: Imagine that you are the office manager for a successful physician's group. You need to prepare a presentation for your physician group, detailing how the changes in MACRA requiring value-based purchasing and Merit-Based Incentive Payment Systems (MIPS) versus advanced Alternative Payment Models (APMs) will affect reimbursement and customer services.

In this assessment, you will prepare a presentation for the physician group stakeholders, detailing how MACRA will affect reimbursement practices and customer services. You will provide relevant evidence of the changes to support your explanation to the stakeholders.

PREPARATION: Conduct independent research about changes in reimbursement practices and customer services due to MACRA.

• Review the "Merit-Based Incentive Payment System (MIPS): Participation Options Overview" resource from the Quality Payment Program website by the Centers for Medicare & Medicaid Services.
  • Merit-Based Incentive Payment System (MIPS).
• Use the Capella University Library and the Internet to locate resources and information on health care revenue cycles and billing processes.
• Conduct independent research on value-based purchasing.
• Focus your research on current resources available through scholarly and/or authoritative sources. This resource will help you identify scholarly and authoritative sources:
  • Health Administration Master's Program (MHA) Library Guide.

Note: Providing relevant evidence that supports the changes you are recommending will help to ensure buy in from the organization's stakeholders.

INSTRUCTIONS: Create a 12–15 slide presentation that details how MACRA will affect reimbursement and customer services. Include all of the following in your proposal:

• 1 slide: Explain value-based purchasing.
• 1 slide: Explain MACRA.
• 1 slide: Explain the MIPS model.
• 2 slides: Explain the APM and how it relates to MIPS.
• 2–3 slides: Outline five quality measures that you recommend the clinic focus on.
  • Include measure title, description, and primary measure steward.
• 2–3 slides: Defend your recommendations and why you feel these are the measures that the clinic should focus on.
• 2–3 slides: Analyze how the reimbursement changes will benefit the patients, physicians, and the clinic.
• 1 slide: Conclusion.

Note: To increase stakeholder buy-in, remember to provide a minimum of three current scholarly and/or authoritative resources to support the changes you are recommending. These resources should be over and above the resources in the reading list for this assessment.

ADITIONAL REQUIRMENTS: Your assessment should also meet the following requirements:

• Written communication: Be sure that your presentation is clear, logical, and succinct. It also needs to be free of errors that detract from the overall message.
• Length: 12–15 slides.
• Title and reference pages: Include a title and a reference slide. Include a minimum of three references to current scholarly and/or authoritative resources. These resources need to be over and above the resources identified for you in the suggested reading list for this assessment. Current means no more than five years old.
• APA format: Ensure in-text citations and references adhere to APA format. For an APA refresher, review the Evidence and APA section of the Writing Center.

COMPETENCIES MESURED:  By successfully completing this assessment, you will demonstrate your proficiency in the following course competencies and rubric criteria:

• Competency 1: Develop financial strategies to address dynamic environmental forces.
  • Explain value-based purchasing.
  • Explain MACRA.
• Competency 2: Analyze the cost and revenue implications for organizational changes due to environmental forces.
  • Explain MIPS and APM and how they are related.
  • Recommend five quality measures that the clinic should focus on, including the measure title, description, NQS domain, meaningful measure area, and primary measure standard for each selected measure.
  • Defend the given recommendation and why the clinic should focus on the selected quality measures.
  • Analyze how the reimbursement changes will benefit the patients, physicians, and the clinic.
• Competency 4: Communicate in a manner that is scholarly, professional, and consistent with expectations for professionals in health care administration.
  • Write content clearly and logically with the correct use of grammar, punctuation, and mechanics.
  • Format citations and references using the APA style.