DHS Announces HIE “Pay For Performance” Measurement Criteria For 2022
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DHS Announces HIE “Pay For Performance” Measurement Criteria For 2022

The Wisconsin Department of Health Services (DHS) has informed Wisconsin hospitals of the measurement criteria DHS will use in 2022 to administer the HIE pay-for-performance (P4P) program established by 2019 Wisconsin Act 185.

The 2022 criteria largely mirror those in 2021, the first year of the program.  Hospitals can qualify for incentive payments, without a withhold, that vary based on the hospital’s relative Medicaid claims volume and the volume of data shared with the WISHIN network.

As in 2021, hospitals can qualify for incentive payments of $15,000 – $40,000 for contracting for each of three interface criteria: (1) Admit/discharge/transfer messages; (2) CCDAs (electronic care summaries) and (3) the combination of lab results, pathology results and radiology results.

In 2021, 19 new hospitals joined the WISHIN network and an additional 16 already-contracted hospitals agreed to share all possible data types to maximize the incentives they would receive.

DHS will expect the hospitals that contracted during or before 2021 to have made progress in 2022 to qualify for incentive payments this year.  All hospitals and interfaces that were contracted in 2021 are either currently in work or implemented.

Hospitals that were in work or live with the specified interfaces before 2021 also receive the incentive payments, which in aggregate were roughly 2.5 years’ worth of WISHIN subscription fees for the affected hospitals, based on WISHIN’s  2021 fee schedule.

Hospitals will not have to do any attestation to receive the incentives.  WISHIN will provide reports to DHS on the status of each hospital.

DHS also explained its plans for administering the P4P program after 2022.  DHS’ plans are to continue the incentive payments for hospitals that reach live status   by the end of 2023 and convert to a penalty for hospitals not in live status in 2024.