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By James Phelps Actuarial Specialist Reimbursement Unit Utah Medicaid and Health Financing.

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Presentation on theme: "By James Phelps Actuarial Specialist Reimbursement Unit Utah Medicaid and Health Financing."— Presentation transcript:

1 By James Phelps Actuarial Specialist Reimbursement Unit Utah Medicaid and Health Financing

2 “Utah is a place where Secure and efficient use and exchange of electronic health information will Result in improved health care, Better health care, Lower cost and healthier communities”

3 Must demonstrate qualification for incentive Payment First year must demonstrate that they are engaged in efforts to adopt, implement, or upgrade to certified EHR technology. Attest to meeting the Medicaid volumes for the Incentive payment program. Second – Sixth year demonstrate “Meaningful Use” and meet the Medicaid volume level each year.

4 American Recovery and Reinvestment Act of 2009 (ARRA) provide incentive payments for the meaningful use of certified EHR technology Stage 1 “The criteria for meaningful use focus on electronically capturing health information in a coded format, using that information to track key clinical conditions, communicating that information for care coordination purposes, and initiating the reporting of clinical quality measures and public health information.”

5 Stage 2 “ Would expand upon the Stage 1 criteria in the areas of disease management, clinical decision support, medication management, support for patient access to their health information, transitions in care, quality measurement and research, and bi-directional communication with public health agencies.”

6 Stage 3 “Would focus on achieving improvements in quality, safety and efficiency, focusing on decision support for national high priority conditions, patient access to self management tools, access to comprehensive patient data, and improving population health outcomes.”

7 Entity Minimum 90 Day Medicaid Patient Volume Threshold Physicians30% Pediatricians20% Dentist30% Certified Nurse Midwives30% *Physicians Assistants30% Nurse Practitioner30% Acute Care Hospitals10% Children HospitalsEligible Or the Medicaid EP practices predominantly in FQHC or RHC-30% "needy individual" patient volume threshold *Physicians Assistants only when practicing at an FQHC/RHC supervised by a physician

8 Cap on Net Average Allowable Costs 85% Allowed for EP Maximum Cumulative Incentive over 6 Yr Period $25,000 for Year 1 for most professionals $21,250 $63,750 $10,000 in Years 2-6 for most professionals $8,500 $16,667 in Year 1 for Pediatricians with minimum 20% patient volume, but less than 30% Medicaid patient volume $14,167 $42,500 $6,667 in Years 2-6 for pediatricians with a minimum 20% patient volume, but less than 30% Medicaid patient volume $5,667

9 2 Million Dollar Base Plus $200 for Discharges 1, ,000 Note: CMS is finalizing a formula/definition of eligible hospitals for this calculation.

10 100% FFP for Medicaid Incentive Payments Hospitals FFY 2011 Individual Physicians CY 2011

11 Survey Part One: General Respondent and Practice Information Part Two: Provider Organizational Information Part Three: Provider Incentive Eligibility Part Four: Health information Technology Part Five: Requirements Concerns

12  Estimated 55% EHR Penetration as of 1/1/10 for Outpatient  UHIN  15 yrs Experience providing administrative exchange services  Currently includes 95% of state’s providers  State’s cHIE  Providers’ Use  826 independent physicians connect to Intermountain Healthcare  Mountain Star/HCA interface with three of the largest practices in the area. Source: HealthInsight

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