This is an internal Advocate Health newsletter and safe to open. Use Chrome for best viewing.

December 22, 2022

In this issue

• APP fee schedule adjustment for 2023
• Patient payment incentive model
• Supporting your practice: Quality reporting, COVID billing changes
• Leader announcement
• Epic updates
• CME



Note: When accessing APP Pro links below, you may need to sign in again if you are not taken directly to the referenced page or information.

APP Fee Schedule Adjustment for 2023

The APP Board of Directors has approved the 2023 APP Fee Schedule as recommended by the Contracting and Finance Committee.

Despite your financial stewardship efforts, APP has experienced significant losses in 2021 and 2022 on capitated products. Fee Schedule related expenses have continued to climb, increasing by 28% since 2019. To improve our financial performance, APP will be decreasing the fee schedule for commercial HMO products from 110% of the CMS fee schedule to 105%.

In addition, the following changes will be made for 2023:

• Following Medicare payment guidelines, providers will be paid based on their actual practice location instead of defaulting to Locale 16 rates.
• DME L codes payments will be reduced from 80% to 70% of CMS/DME.
• Following Medicare guidelines, APP will discontinue payment of Consult Codes.
• Global OB Delivery will be reduced from 130% of RBRVS to 125%.
• Immunizations/devices without a CMS fee schedule value will be paid at a flat rate equivalent to the acquisition cost via the APP Premier GPO.
• Payment for any non-valued codes will either be discontinued or reduced from 50% to 44.63% of charges.

Our current losses do not allow for us to bring providers to 120% of Medicare as the first draw of the 2022 incentive payout (paid in 2023). We hope, however, to do so for the 2023 incentive payout (paid in 2024) if our fee schedule changes generate surplus to allow this. 

Patient payment incentive model

As a reminder, the incentive payment has shifted to a “payment per patient” methodology. The focus is on achieving the most dollars for every patient in each CI measure rather than the overall CI score. Physicians who have higher volume and perform well on the higher weighted measures will earn more incentive. Physicians that have a population of patients that do not qualify for many measures in the CI program will have a lower incentive opportunity than in years past. Learn more. Visit the APP incentive transformation page for more information.

2022 MSSP Quality Reporting: Through the Medicare Shared Savings Program (MSSP), our ACO must accurately report quality data each year to CMS. This information is used to calculate our overall MSSP performance and is tied to our shared savings and Advanced APM incentive payment. APP aligned practices in our MSSP ACO are required to participate in reporting and can anticipate outreach from the APP Quality Improvement team via fax around mid-January to collect data on patients/measures sampled for 2022 reporting. 

Clinical Integration updates: View the latest program update.

Patient outreach: We are conducting patient outreach on your behalf to support quality outcomes and close quality care gaps. Read more.

Updated COVID billing protocol: Early in the pandemic, the United States Congress prohibited payers from passing COVID-related bills to patients and established funding programs to reimburse physicians and APCs for associated costs. These programs have ended, and federal money for COVID testing and vaccination will stop at the end of the year. Beginning Jan. 1, 2023, we will join other health systems across the country in billing patients for out-of-pocket costs related to COVID vaccination, testing and care. Learn more.

EDs to stop offering COVID vaccines: Beginning Jan. 2, all Advocate Health Care and Aurora Health Care EDs will stop administering COVID vaccinations due to the low amount given within the last year and the widespread availability in other settings. The vaccines continue to be available at our ambulatory and community retail pharmacy locations.

Medicare changes to prescribing for controlled substances: Effective Jan. 1, 2023, Medicare is requiring any controlled substance prescriptions covered under Medicare Part D plans to be electronically prescribed. Prescriptions for patients at Long-Term Care facilities will be an exception up until

Jan. 1, 2025.

Resources:

• Medicare CY 2022 Physician Fee Schedule Final Rule

• Medicare E-Prescribing

Social Drivers of Health inpatient screening: As part of our commitment to improve health equity, a systemwide standard Social Drivers of Health (SDoH) screening is required in Epic for all inpatients effective Dec. 15. This screening will help to identify and address patients’ health-related social needs through resource referrals to community-based organizations. The SDOH Fundamentals learning is available in Workday. Review SBAR.

Holiday Hours: In observance of Christmas and New Year’s Day, APP will be closed on Monday, Dec. 26 and Monday, Jan 2. 2.

Advancing Research:

• Fewer seniors return to ED after outpatient care
• WGN: Study examines lessening chemo in breast cancer
• A new drug for eosinophilic esophagitis (EoE)?

Announcement

Michael Logan, MD, has been named Medical Director of Advocate Lutheran General PHO, effective immediately. Read the announcement here. 

Epic Update: Ambulatory Epic Connect: Stop printing the AVS, In Basket – saving a click and more.

Epic Update: Hospital edition for Physicians and APCs: Winter 2022 Epic upgrade, Ceftriaxone stop date pilot, upcoming changes to prescribing for controlled substances for IL only and more.

Continuing Medical Education

Upcoming CME



Jan. 11: Get Climate Smart | Why Us? Climate and health overview

Jan. 23: Get Climate Smart | Air quality

Feb. 1: Get Climate Smart | Rising temperature

Feb. 8: 16th Annual Advocate Heart Institute Symposium: Prevention to Cure