Muller Consulting & Data Analytics specializes in strategic data intelligence in the U.S. healthcare space. MCDA combines significant subject matter expertise, data, and computational power to address a broad spectrum of client needs.
MCDA is available to help with:
Medicare Physician Fee Schedule (PFS) Payment System
Skilled Nursing Facility Prospective Payment System (SNF-PPS)
CMS Proposed/Final Rule Comment Development
Payment and Quality Policy Analysis and Development
Healthcare Operator and Market Profiling
Litigation and Mediation Support
Patient Disease Profiling
Quality Measure Development & Replication
Medicare Physician Fee Schedule Analysis
MCDA maintains a full replication of Medicare's Physician Fee Schedule (PFS) Practice Expense Relative Value Unit (PE RVU) rate-setting calculation. This calculation is the most complex component of Medicare's PFS payment methodology.
Our replication is used to advise on many situations:
Likely reimbursement outcomes for services nominated for revision, either through conversion from "Category III" carrier priced codes to the "Category I" traditional methodology, or through CMS or AMA review of the make-up of a service's payment level.
Simulation of the effects of fundamental changes to the PFS rate-setting methodology, such as those policy changes being implemented by CMS in order to increase reimbursement to Evaluation & Management services.
Reimbursement strategy development, through understanding which factors increase/decrease reimbursement the most, and which are less significant.
Development of CPT "Category I" applications for the American Medical Association's (AMA) RVU Update Committee (RUC), to maximize reimbursement.
Informing and developing PFS proposed and final rule comments
Identifying and analyzing problems with the CMS own implementation of their methodology
In addition to technical support using our infrastructure, MCDA is available for training on how the PFS methodology works, and is available for advice on how to understand and navigate reimbursement changes generally.
CMS PROPOSED/FINAL RULE COMMENT DEVELOPMENT
MCDA has significant experience in supporting and developing comments to CMS policy proposals published in Federal Register rules, both from the consulting perspective and the provider association perspective. MCDA is available to support and assist in the development of comments to CMS proposed and final rules around the Physician Fee Schedule, Skilled Nursing Facility Prospective Payment System, and others as needed.
PAYMENT AND QUALITY POLICY ANALYSIS AND DEVELOPMENT
As well as direct support with developing comments to CMS rules around the Physician Fee Schedule (PFS) and Skilled Nursing Facility Prospective Payment System (SNF-PPS), MCDA has extensive experience with healthcare policy analysis and development more broadly. This includes complete development of proposals for redesign of existing payment systems, developing detailed technical recommendations for policy development initiatives by CMS and others, and analysis of impacts of policy proposals on healthcare industries and provider groups.
HEALTHCARE OPERATOR AND MARKET PROFILING
MCDA has extensive experience in profiling the operations, finances, patients, healthcare outcomes, and clinical patterns of healthcare providers, physician practices, and markets. These types of data intelligence profiles are particularly useful to sellers to healthcare providers, device and pharmaceutical manufacturers, and investors in device manufacturers, drug manufacturers, and healthcare providers.
PATIENT DISEASE PROFILING
MCDA regularly develops profiles of patient disease cohorts. These deep-dive profiles help clients to understand a patient market, their service utilization and healthcare costs, and their clinical characteristics and outcomes. Typically, these kinds of profiles are useful to device and drug manufacturers, patient advocacy organizations, and physician specialty associations.
Strategic Reimbursement Consulting for New Device Manufacturers
How the company behind a new product is structured determines how it will eventually be paid. MCDA works with new companies on how to structure themselves to optimize their long term survivability.
LITIGATION AND MEDIATION SUPPORT
MCDA provides litigation and mediation support on a case-by-case basis, with experience reviewing the practices of healthcare insurers and providers in their reimbursement, self-referral ("Stark Law"), and policy management practices. James Muller has experience as an expert/fact witness in deposition and tribunal settings.
SKILLED NURSING FACILITY PROSPECTIVE PAYMENT SYSTEM (SNF-PPS)
James Muller and MCDA have extensive experience with the SNF-PPS, including having designed components of the SNF Value Based Purchasing (SNF-VBP) policy currently being used to adjust payments to nursing homes, and previously the development of a SNF Wage Index as a proposal for CMS to adopt.
MCDA has deep knowledge of the SNF industry and its reimbursement and quality landscape, including the pending Unified Post Acute Care Payment System being developed by MedPAC and others. MCDA is available for engagements in the SNF landscape.
QUALITY MEASURE DEVELOPMENT & REPLICATION
MCDA has extensive experience in developing new healthcare quality measures, and in replicating existing quality measures for healthcare data analytics vendors. This expertise is primarily in the acute hospital and long term care domains, and James Muller has led seven successful National Quality Forum (NQF) quality measure applications for endorsements.
Through the COVID-19 pandemic, MCDA has been and will continue to perform a large amount of analysis and modeling of the epidemic's dynamics, provider and patient risks and outcomes, and development of policy recommendations to mitigate spread and harm. MCDA is maintaining a robust analytical infrastructure supporting collaborations and client engagements around this, and is actively supporting a spectrum of stakeholders from academic institutions, government agencies, provider support organizations, and healthcare investors.
MCDA maintains an extensive geospatial infrastructure used to analyze and visualize markets, the geographic distribution of patients and providers, and trends across the US. This database includes linkage between population data, provider data, and Medicare claims data.