The Electronic Healthcare Records Incentive Program

The Agency for Healthcare Administration Version 1.1

Jennifer Paparelli July 2011

Table of Contents
Table of Contents....................................................................2 I. Executive Summary..............................................................1 II. Introduction........................................................................1 III. Resources..........................................................................2 IV. Scope of Work...................................................................2 V. Goals..................................................................................2 VI. Assumptions and Constraints..............................................3
Assumptions.................................................................................3 Constraints...................................................................................3

VII. Alternative Solutions.........................................................3 VIII. Project Breakdown Schedule.............................................5 IX. Task Breakdown.................................................................5 X. Project Budget....................................................................6 XI. Summary of Project ...........................................................7
Summary of Budget.......................................................................6

Microsoft Project File....................................................................5

I. Executive Summary
The State of Florida Medicaid Electronic Health Record (EHR) Incentive Program is eliminating the use of paper records and enticing hospitals and providers to move to electronic records. To attract them, Floridas Medicaid EHR Incentive Program is providing incentive dollars to the hospitals and providers who qualify. The Agency for Healthcare Administration (AHCA) has been charged with the EHR Incentive Program. The Agency is using 5 years of hospital cost reports from years 2005 to 2010. Using these reports, analysts at the Agency are responsible for determining the dollar amounts that hospitals and providers will receive. Analysts will use a master spreadsheet, which includes the amount every hospital and provider will receive. Hospitals and providers will estimate the amount they expect to receive using the 2005 to 2010 hospital cost reports. These are the same reports sent to the Agency for Healthcare Administration each year. Using a master spreadsheet that is created, the analysts will compare the amount the hospital or provider has submitted to ensure the statistics match. In the event the amounts do not match, an analyst will be responsible for contacting the hospital or provider and correcting the miscalculation. The end result will provide accurate calculations of incentive payments for each of the hospitals and providers so the Agency can verify payment amounts against the estimate each hospital claims and provide payment.

II. Introduction
The Florida Statutes created the Agency for Healthcare Administration (AHCA). It serves as the chief health policy and planning entity for the state. AHCA is primarily responsible for the state's $18 billion Medicaid program that serves over 2.7 million Floridians, the licensure of the state's 41,000 health care facilities and the sharing of health care data through the Florida Center for Health Information and Policy Analysis. Floridas strategic plan for the states Electronic Healthcare Records (EHR) Incentive Program will provide incentive payments to eligible professionals, eligible hospitals and Critical Access Hospitals as they adopt, implement, upgrade and demonstrate meaningful use of certified EHR technology. In March of 2011, professionals and hospitals received information on how to begin applying for the incentive program. As of June 3, 2011, four hospitals have submitted their calculations for the amount of money they will receive for implementing electronic records. It is the responsibility of analysts at AHCA to determine if the hospitals calculations are correct. This will take place prior to hospitals submitting their calculations. AHCA will compile the correct amounts each provider is projected to receive and then compare them to the hospitals submission. If the two calculations do not match, AHCA will contact the hospitals accounting department to find out what numbers they used for their calculation. Florida will begin making the Florida Medicaid EHR incentive payments in August 2011 to all hospitals and professionals who have agreed to participate in electronic records. In order to prepare, AHCAs analysts are calculating the amount every participant in Florida is projected to receive in order to have the incentive funds ready for disbursements. Once participants submit their calculations, analysts will confirm the

AHCA Electronic Healthcare Incentive Program

amounts they submit correlate with planned amounts in order to prevent fraud.

III. Resources
Technology Laptops running at least Windows XP which can handle Microsoft Excel and Medicaid HIT Inbox. Medicaid IT Inbox is for receiving the templates from hospitals and calculators (for use when excluding specifics captured as a total in the reports). 5 years of hospital cost report paper records. This is where the data for the calculations can be found.

IV. Scope of Work

Three analysts employed by the Agency for Healthcare Administration are responsible for completing the calculation of Medicaid electronic health care incentive payments for eligible hospitals and to ensure all calculations are true and completed on time. Successful completion of this project will be dependent on the following: Hospitals submitting the correct data from the appropriate years on the formulated payment calculation templates they received; Agency staff completing the process of creating a compiled spreadsheet that will be the auditable source for accurate payment amounts. Agency staff extracting all the data needed to complete the calculations from the hospital cost reports. Accuracy of data being used for the payment calculations. Completing this process by July 31, 2011.

V. Goals
1. Using the spreadsheet provided by the state, understand how the state
calculates each formula, including the Excel if, then statements. a. Review each of the formulas to understand what information is needed b. Test each formula against the Centers for Medicare and Medicaid Services (CMS) approved payment calculation template to verify accurate payment calculations 2. Create an Excel document where data for all hospitals will be accessible in one place. a. Create columns for numerical data being pulled from the hospital cost reports. b. Add additional columns for the calculations generated from the data 3. Using hospital cost reports, begin entering information for all of the hospitals. a. Once the master spreadsheet has been approved, enter data from hospital cost reports from 2006 to 2010.

4. Review all data to ensure all calculations are correct and ready to be compared against submission of hospitals. a. There are 3 analysts working with their own spreadsheet. After 2 analysts have

AHCA Electronic Healthcare Incentive Program

entered data and calculations, the third analyst will compile and compare the two spreadsheets for discrepancies. b. The third analyst will research any errors and make corrections. c. The third analyst will also compare the amounts calculated by the Agency with the amounts calculated by hospitals. If there are discrepancies, the analyst will contact the hospital to provide technical assistance and see what data they used to determine their amounts.

VI. Assumptions and Constraints

Assumptions
1. Hospitals and eligible providers will want to join the EHR program. 2. The money will be released on time by the state. 3. Calculations will be done using the Office of the National Coordinators (ONCs)
guidelines and will be correct.

4. Data entry and calculations done by analysts will be correct.

Constraints
1. The project is only allowed 3 months for completion. 2. The ability to read and understand hospital cost reports.

VII. Alternative Solutions

There are two alternatives the Agency could choose as solutions for the Medicaid Electronic Health Care Incentive Payments project. The first is to hire a temporary accounting professional from an agency such as Robert Half. The second alternative is to appoint someone from their own accounting department. If the Agency chose to hire an accounting consultant, this individual would align with the scope because they have the knowledge of accounting, formulas and equations. This person would also have the knowledge to comprehend hospital cost reports and find the correct information quickly. This would lead to accuracy and time saved locating the correct information, resulting in the accomplishment of the project on time or before. The assumption made with this solution is this person would be able to complete the analysis of hospital calculations faster and more precisely than someone at the Agency. Another assumption is the person chosen by the Agency would understand the project quickly and grasp which numbers are needed from the hospital reports in order to assure accuracy. This solution provides the Agency with professionals who can complete the project faster and more efficiently than their own employees. There is a problem with this solution as this individual may not have ties to the Agency and is therefore, is not invested emotionally the way someone who works for the Agency would be. They may not care to complete the project as quickly or put in the same effort a regular employee would. Another problem that could potentially arise is if this person quits half way through the project and leaves behind no documentation pertaining to how they were progressing. Should the consultant leave before the project is finished, the organization would not know how close the project was to completion. Someone who may be assigned to the project next may have to start over, resulting in the project not being completed on time.

AHCA Electronic Healthcare Incentive Program

A constraint with this solution is time. Hiring someone this late in June and educating him or her regarding the Electronic Health Care Incentive payment project would take a few days. They would need time to read documentation regarding the project in order to understand which information the Agency needs as well as how to find the correct information for each calculation. Another constraint is money, the Agency would have to budget how much they would pay this individual per hour and how many hours would be needed. A second constraint is money, the Agency would need to do an evaluation of the budget would needed to be conducted to see if money for an accounting professional is available. Due to time and budgetary constraints as well as the need for the analysts to be fully familiar with and engaged in this project, the Agency may have to spend more money than they have available for consulting. The second solution is to employ someone from the Agencys accounting division. This individual aligns with the scope, as they are an Agency employee with knowledge of formulas and hospital reports. This person would be the most familiar with the data and would complete the process more quickly than anyone else. Their information is likely to be more accurate as they have a background in accounting. The drawback to having an employee from the accounting division is time needed for training. This employee is most likely not familiar with the Medicaid Electronic Health Care Incentive Payments project and would need a few days to read through materials in order to understand the project. They may also have questions and need clarification from other employees before they can begin. The constraint of this solution is money. Being that the individual would be an employee of the accounting division and not the executive direction division, their compensation would require money from the budget of the executive direction division. They would be responsible for paying this individual for the length of the time spent on the project. The agency must consider if the money is available to pay this person and if this solution justifies spending the money. The preferred solution is to have three ACHA employees act as two employees (analysts) devoting 30 hours per week. One analyst is able to devote 30 hours while two others are not. These other two analysts will devote 15 hours each to equal a full 30 hours. One analyst will create the master spreadsheet before the project begins. This person should be given 3 weeks time using 30 hours of each week. Once the master spreadsheet is approved, the first analyst will devote 30 hours of their week to the project. In this way, the analysts are devoting enough of their time to guarantee the project will be completed by July 31, 2011. In this solution, there are 3 analysts and the time each is currently devoting each week is sufficient. If one analyst makes an error, there are two others who can make the correction. With three people, the amount of time given to verify the hospitals calculations should be adequate. Should the hospitals calculations be incorrect, the three analysts have the time and energy to devote to rectifying the problem. This aligns with the scope as the employees are emotionally invested in the project

AHCA Electronic Healthcare Incentive Program

and they understand the goals and the objective to finish on time. These individuals understand the urgency of the analysis of the Medicaid Electronic Health care Incentive Payments and that the data they collect must be correct and true. Employees are also more familiar with the time frame and can plan their workdays accordingly. This solution assumes the analysts are able to stay on track and that no new issues will arise. It also assumes the hospitals calculations are correct. If they are not, and an analyst must take the time to find the errors, this will take more of their time than originally planned. Another issue could result from the information entered by an analyst, if the hospitals calculation does not match the Agencys, it could be the result of an error by an analyst, not the hospital. This would take time to discover and would slow the process. The problem with this solution is human error. If an analyst or a hospitals calculation is incorrect, it will take time to revise. The constraint of this project is time and if human error occurs, the project may not be completed on time. This is true for all three solutions, as the analysts are finding errors in the hospitals calculations. Whichever solution is chosen, human error may occur as no human is perfect, because of this it is important to include a step in the project for time needed for revisions.

VIII. Project Breakdown Schedule

Microsoft Project File

IX. Task Breakdown

1. Initial project introduction 2. Create master spreadsheet

AHCA Electronic Healthcare Incentive Program

3. Spreadsheet 1 work 4. Spreadsheet 2 work 5. Comparison of spreadsheets 1 and 2

X. Project Budget
Summary of Budget
I. Initial project introduction a. As employees of the Agency for Healthcare Administration Jaime, Alex and Jennifer were presented with the project. 1-2 hours b. Collect data by visiting the 2nd floor and understanding where files were kept 30 minutes c. Obtain a copy of the formulas set forth by the State and gain an understanding of what data they require 3 to 7 days II. Create the master spreadsheet a. Jennifer will create the master spreadsheet using a blank excel document and the formulas given by the State 17 days b. Test each column in master spreadsheet for accuracy. 7 days III. Spreadsheet 1 Work a. Enter data from hospital cost reports into a blank Microsoft Excel spreadsheet 17 days b. Import data from spreadsheet 1 into the master spreadsheet. 1 day c. Check to ensure calculations are occurring correctly in master spreadsheet with data from spreadsheet 1 7 days IV. Spreadsheet 2 Work a. Enter data from the hospital cost reports into spreadsheet 2 39 days b. Import data from spreadsheet 2 into the master spreadsheet 3 days c. Check to ensure calculations are occurring correctly in master spreadsheet from spreadsheet 2 6 days V. Compare calculations of Spreadsheets 1 and 2 a. Audit master spreadsheet to ensure data is correct and calculations are true. 11 days b. Pick the winner between spreadsheets 1 and 2 based on the audit of master spreadsheet 4 days c. Collect hospital and provider submitted data and verify against master spreadsheet. 603 days

AHCA Electronic Healthcare Incentive Program

XI. Summary of Project

The State Medicaid Electronic Health Record (EHR) Incentive Program proposes to eliminate some of the obstacles and to ease a portion of the financial burden associated with the pressure for hospitals and providers to move their practices to electronic records. To successfully achieve these objectives, Floridas Medicaid EHR Incentive Program must be targeted and efficient in getting incentive dollars into the hands of the eligible professionals and hospitals that qualify. The accounting division of the Agency for Healthcare Administration is currently receiving a spreadsheet from hospitals with their own calculations, using the accounting records from 5 previous fiscal years. The Agency has 5 years of hospital cost reports from 2005 to 2010 and uses the reports to determine how much money each hospital receives for implementing electronic health records. The Agency will compare the amount calculated by the hospitals to the amount calculated by the Agency. If these amounts do not match, analysts at the Agency will contact the hospital to locate the error. As of July 29, 2011, the accounting division has completed the calculated amounts each hospital will receive for implementing electronic records by July 31, 2011. The Agency must have these amounts as the hospitals have already begun submitting their calculations.

AHCA Electronic Healthcare Incentive Program