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The Wisconsin Department of Health Services (DHS) has announced that 2024 will be the last year it will offer a straight incentive under the HIE pay-for-performance (P4P) program it started in 2021. DHS has identified 166 hospitals in the state that are eligible to receive a share of $8 million available to those that participate in real-time patient data exchange with WISHIN.
DHS is providing these incentive payments to join WISHIN, an independent, not-for-profit, vendor-agnostic HIE that enables immediate and meaningful clinical and whole-person data-sharing amongst all participants in an expanding network that features more than 2,200 sites of care. The incentive payments cover the cost of implementation and WISHIN Pulse subscription fees.
By the end of 2024, DHS expects all eligible hospitals to obtain a “live” status with WISHIN in three interfaces:
- Admit, Discharge, and Transfer (ADT)
- Consolidated Clinical Document Architecture (CCDA)
- Lab, Pathology and Radiology
*Partial incentive payments will be made if all three are not met
As stated in the DHS MY2024 Hospital P4P Guide, effective 2025 a 1.5% withhold will be applied to all Inpatient and Outpatient Fee-for-Service claims for hospitals that have not obtained a “live” status with WISHIN. The new 1.5% withhold is in addition to the 3% Potentially Preventable Readmission (PPR) program withhold, which is applied to all IP FFS claims for eligible hospitals.
- If you have already signed up with WISHIN and obtained “live” status, you don’t need to do a thing.
- If you have signed up with WISHIN and are in the process of obtaining “live” status, WISHIN will continue to work with you to achieve “live” status by December 31, 2024.
- If your hospital has not taken advantage of the incentive and has not started the process of going “live” with WISHIN, it’s not too late. Contact WISHIN at wishin@wishin.org for details on how you can join the network and contribute patient data, receive an incentive payment, and avoid a 1.5% withhold from DHS.
WISHIN encourages all eligible hospitals that have not signed up for “live” status with WISHIN to reach out today to secure the greatest incentive amount possible and avoid the 2025 Medicaid reimbursement withhold of 1.5%.
