Trying to make sense of government regulations and turning a complex year-long process into a digestible, simple to use, reference guide is a tall order. That was the problem faced by a national medical association with the goal to help their members meet federal reporting requirements. PSC was chosen to help modernize the association’s application to increase member compliance amidst challenging governmental requirements and deadlines.
The U.S. government’s Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) was due to be fully implemented by the end of 2017. The MACRA regulations were put in place to provide a structured reimbursement process for doctors who were treating Medicare patients. For doctors and other medical professionals to meet the MACRA requirements, they must meet several reporting goals throughout the year.
Additionally, some of the submission methods were time dependent. For full compliance, reports must be submitted for a full 12 months, and to achieve minimum compliance, submissions were required for a minimum of 90 days. Providing the tools to help with member compliance was critical to the association team.
The requirements for complete MACRA compliance were set to start Jan 1st. The project did not begin until the second quarter, immediately putting the development team under pressure. Meeting the mid-year release date was essential to ensure that the proper tools and assistance were available once association members started to pay attention to the requirements necessary for completing the year. Members of the association thought that the regulations were hard to understand and they needed clear guidance.
The association had previously created a web-based, desktop accessible knowledge base. The new application needed to build on the existing application and be accessible on mobile devices. There was minimal documentation on the original application, and it was not compliant with the association’s IT policies. Continued development required multiple waivers and exceptions.
Since the process of compliance takes many months, many users would need to re-visit the application for reference over time, so there needed to be a way to register users and seamlessly record progress.
Due to the complexity of the regulations (there were over 120 different options for meeting varying levels of compliance), the application required a significant amount of testing across a broad range of web-accessible devices/browsers.
PSC worked directly with the business owners and IT support staff to provide a mobile-accessible, web-based capability to assist users to comply with the timeline for submission/milestones, based on their unique situations.
The application presents users with a series of questions and answers. To achieve compliance, members had to attain one of three main levels: minimum, partial and full. Twelve different logical “paths” through the application led to the attainment of the three distinct levels. Depending on the input, users navigated through one of these paths to the final steps necessary for compliance.
Each of the twelve paths presented the user with either a set of questions to derive more information about their situation or provided the date sensitive information necessary for them to meet compliance based on their situation. The variance in the required paths and steps within each reflected the amount of participation in Medicare, the size of the medical practice, the maturity of reporting practices and other relevant information.
Based on the time of year that the user started to use the tool and their answers to the questions, certain date-based gateway milestones are required. If the application determines that compliance is in jeopardy or failing, it suggests alternative paths. In this manner, the application assists members in making the best of their current situation and provides guidance on how to improve it.
The application is available to registered association members and anonymous non-members as a general reference tool. The benefit to members is that the app automatically saves their progress through the question and answer timeline and when they return to the app, their progress is retained. Non-members were able to use the reference guide but had to start from question 1 each time they returned to the app.
Planning tools are available so that once the previous year’s submissions were complete, suggestions for where and when to begin the process again were available. The system is now value add for users and process compliant for all involved.