We have recently sent a link to the new HHSC program application for the Texas Incentives for Physician and Professional Services (TIPPS) and wanted to give you a more detailed look at the program. The application is due April 5th, and you will apply under the physician NPI. TIPPS Application
TIPPS is a value-based physician-directed payment program for hospitals to transition from Network Access Improvement Program (NAIP) and Delivery System Reform Incentive Payment (DSRIP) groups. The new program will incentivize applicants to improve quality, access, and innovations in providing medical services to persons with Medicaid.
The program is open to physician groups defined as:
- Health Related Institution (HRI) – network physician group owned or operated by an institution. Further defined, an HRI is a medical institute.
- Indirect Medical Education (IME) – network physician group contracted with, owned, or operated by a hospital receiving either a medical education add-on or a teaching medical education add-on, for which the hospital performs the billing.
- Other physician group – network physician group other than those listed above that can meet the volume requirements, is located in a service delivery area with at least one sponsoring governmental entity and served at least 250 unique Medicaid managed care clients in the prior state fiscal year. Many of you will fall into this category as a rural hospital but may not meet the 250 requirement per participating NPI.
There are three components to the program:
- Paid as a per-member-per-month (PMPM) payment, triggered by reporting on quality improvement activities. HRIs and IMEs only are eligible.
- Serves as a performance incentive payment based on achievement of quality metrics focused on primary care and chronic care. HRIs and IMEs only are eligible.
- Serves as a rate enhancement for certain outpatient services based on achievement of quality metrics. All physician practice groups are eligible.
Physician practice groups must have a minimum denominator volume of 30 Medicaid patients in at least 50 percent of the quality metrics in CY2021 for Component 2 and/or 3 to be eligible to participate. The following link will give more specifics on the requirements. TIPPS requirements
For those that may not initially meet the 250 unique Medicaid managed care requirement; Discovery Medical Network (DMN) is determining how best to implement the program with their employed physicians. DMN should have a blueprint on how this can effectively operate within the next few months. As DMN identifies the benefits to clients, they will reach out to all facilities to discuss the next steps and future opportunity.
We are available for any questions you have on this new program so please do not hesitate to reach out.
- Mark Havins at firstname.lastname@example.org
- Shonna Cannady at email@example.com
- Crystal Roach at firstname.lastname@example.org