ACOs are not big organizations. And everyone has a job to do, without a lot of time built in for unexpected work.
The core mission is managing risk, coordinating care, measuring quality and generally engaging providers in ways meaningful to them. MACRA is a topic that didn't exist when ACOs were created, and it is a rare ACO that dedicates a MACRA team for supporting all TINs.
Part of the problem is, given the complexity of MACRA, its requirement to coordinate information across a large number of unrelated TINs, just how do you go about figuring out what staff you might need?
We manage MACRA for a number of ACOs, and we face that problem every day in our business. And as 2019 ramps up with new challenges, we have had to build out staffing projections based on the unique characteristics of each of our clients.
So ... here is a useful link to a staffing spreadsheet we use with existing clients, and in projecting out our needs with a new client. The variables are not as obvious as you might think. For example, the number of providers in a TIN is not really all that important. In fact, larger TINs often require less effort, because they can afford to specialize someone on staff to MACRA.
We find that the single largest metric is number of TINs, and secondarily, the nature of EHR technology across our portfolio of TINs. Beyond TIN volume, the next metric is the degree of automation. For example, most EHRs (even the small ones) can generate MIPS data in a newer QRDA-3 format. But unless the ACO has the ability to integrate QRDA-3, the ACO MACRA staff is limited to working with spreadsheets and PDF-based reporting. This one capabillity alone makes automation worth while, but is far from the only feature driving staffing levels.
The structure of an ACO's MACRA program itself is an important driver. A program that meets with each TIN separately each month will require different staffing from a program that meets will all TINs in one setting, and only meets individually with TINs needing help.
So check out our staffing model, and let us know what you think.
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MACRA Monitor is an subscription-based product from C3 Partners that combines a MACRA database with dedicated Concierge service for ACOs and other complex organizations