Do You Even Qualify For the ARRA Money?

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.