January, 2010

We continue to get daily calls and requests for information about the ARRA funding.  We were even told by a potential client that they went with a well-known (but little liked) vendor now in order to maximize their ARRA $$, even though the money itself may be a mirage and they don't even know what their state is going to do. 

Big sigh.

One thing we do know is that, for pediatricians, there is a "20% Medicaid" requirement on the Federal level.  Note that individual states may have additional requirements, we just don't know what they are, yet.   So, how many pediatricians actually qualify for the minimum known requirement so far?  

One-third.  1/3.  Not even, really - 31%!

That's right - only one-third of you private practice pediatricians appear to have 20% or more of your visits fall under the Medicaid category.  Sure, PCC's sample is likely to be biased (we don't have a massive RHC contingent), but I bet it's pretty close to reality. 

Here's how we figured this out.

According to CMS:

"Ps must annually meet patient volume thresholds, measured by a ratio where the numerator is the total number of Medicaid patient encounters (or, in the case of eligible professionals practicing predominately at FQHCs and RHCs, needy individual encounters) over any representative continuous 90-day period in the most recent calendar year and the denominator is all patient encounters over that same 90-day period.  For all EPs except pediatricians, the patient volume threshold is 30 percent; for pediatricians, it is 20 percent."

Each state is then responsible for certifying patient volume and distributing the money via Medicaid.  

Well, we counted up the total visits for each of our "full time" providers and counted the Medicaid visits.  Overall, 18% of the visits were Medicaid, which means that the "average" pediatrician doesn't qualify.  Still, Medicaid visits are not distributed evenly, so it turns out that 31% of PCC's providers reach ARRA's minimum standard for ARRA fundin.  It's possible that a few more might qualify during any given quarter (you don't need to have that volume for an entire year), but we have already learned that moving 5-10% of your visits from private pay to Medicaid for even a quarter eats up your funding pretty quickly.

I don't know what to think except that a lot of the SOAPM folks I know are not even close to the required Medicaid volume.

Thoughts?

A few years ago I passed a church as a wedding party pushed out onto the lawn at the end of the ceremony. My boys were in the back seat and the younger looked out the window and said out loud, "Dad, I don't want to have to get married."

I wasn't too surprised, really, because even then, at the age of4 or 5, he was full of funny exclamations. "Why not, buddy?"

"Because sometimes...sometimes, I just need a day off."

Well, I need a day off from "work" so I can get to the blog. Whenever you see a gap in my posts like I've had recently, it's because there's so much happening in the world of pediatrics that I don't have time to blog it all. Thus, I'm relegated to the shotgun post.

• PCC has another AAP endorsed pediatric coding and practice management event in Miami, FL at the end of January. I know a few of you are already signed up, but we still have room. For non-PCCers who have attended similar events, there are a few new classes. For PCCers who attend everything we do (you know who you are, Lynn Cramer), there's at least one AWESOME new class in here that will make the entire trip worth your while.

  We're about to announce an other event in Virginia any moment now.

• Many of you probably already read the HISTalk interview with Bill Zurhellen, but if you haven't, please do. Bill was the brave soul who stood up at the CCHIT committee meeting and said, "...if our work isn't about improving healthcare, then why are we here?" I don't know if he realizes - and is therefore thankful or spiteful - that I put the HISTalk folks in touch with him or not. I think the interview is excellent, though I am a little dissapointed that he toned it down!
• PCC's world has started to circle around the Meaningful Use drain, though we're doing our best to get caught in it as little as possible. I remember learning about the "Bread and Circus" back in junior high and I can't think of a better analogy. Nearly everyone we speak to these days wants to know if they're going to get their money. I've written about this issue for the AAP before. Pediatricians need to focus on REAL meaningful use, imo. If you want to read the 700+ pages related to the bill - in it's "Preliminary Final" form (what does that mean?), you can get the details here and here.
  You can also find some interesting summaries and helpful documents here and this summary by HISTalk is quite helpful.

How is this not a giant waste of money?