Medicaid Set to Mail “Sample” Reports

Initial Set of Episodes:  Acute Upper Respiratory Infections, ADHD, and Pregnancy Episodes

Within the next couple of days, physicians and other providers who have been identified as principal accountable providers (PAP) for the first set of episodes will begin receiving reports on their cost of care for 2011.  These reports are informational only but serve as an example of where an individual PAP would be had the program been in place during 2011.  The actual program will not be “live” until October 1.  Patients seen for any of the initial episodes after October 1 will begin counting towards the PAP’s actual performance report.  We understand the reporting/performance period will be 12 months.

The reports are quite detailed but pay particular attention to the chart that shows your average cost per episode along the range of commendable, acceptable, and “unacceptable” average costs.  Were the program to be live at this point, average costs in the unacceptable range would lead to risk sharing.  Average costs in the commendable range would lead to shared savings.  Most physicians’ average costs will fall into the acceptable or commendable range.  If your average costs fall into the unacceptable range, the report should help identify why (i.e. high antibiotic prescribing rate for upper respiratory infections).

AMS encourages its members to review these reports carefully, question anything that does not appear to be accurate, and begin to understand how this new model might impact you and your practice, what if any, changes in your practice might be warranted to avoid risk sharing, and what changes might be appropriate to bring average costs into the commendable level in order to receive shared savings.

Medicaid has provided a  “Guide to Reading Your Report”  you may find helpful in addition to the materials and sample performance reports you will receive.