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In this issue
- 2022 Clinical Integration Program
- Epic Connect Program Update
- Update NPI Record
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Clinical Integration Program
2022 CI Program
Through our APP CI program, we continue to provide high-quality patient care while driving success in value-based programs.
We remain focused on stronger alignment with Advocate Aurora Health quality metrics, while also evaluating current CI measures to remove those that have become less relevant and propose new measures that prioritize health outcomes, reduce burden and give you more time focus on your patients.
What you need to know for 2022:
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PCPs: We are excited to announce significant program changes. There will be just 33 metrics, down from 96. The point value will also increase on core population health measures to reflect the work effort required. The changes will allow focus on the most important things that achieve high quality patient care by supporting evidence-based practice while reducing costs.
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Specialists: Minimal changes have been made to specialty metrics. We will redesign the measure set for 2023.
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Learn more in this on-demand webinar.
Additional CI Updates
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Latest performance: Our nine core adult measures are more heavily weighted in the CI program, are reported on a rolling year basis and align with measures in most value-based agreements. We have an opportunity for improvement. View latest results.
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APP Epic Connect Program Update
As you've likely heard, we have made the decision to temporarily pause the full launch of our Epic Connect Program. Here’s why:
- We were intentional in launching the program with a pilot to learn what works well and what can be improved.
- Since our first six APP practices went live on Epic Connect in September, they’ve continued to face significant post-go-live challenges.
- With any large technology implementation we anticipate bumps in the road. However, some issues we’ve faced have been unexpected and significantly impacted these practices.
- Your colleagues have shared their experience has been difficult and not as smooth as planned.
- This is our top priority. We must use our time and resources to support your colleagues before launching additional waves.
The additional effort required of our pilot practices is greatly appreciated. We remain fully committed to supporting the program as having our physicians on Epic will allow us to provide outstanding safe, quality care and strengthen our role as national leaders in transforming health care.
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Supporting Your Practice
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No Surprises Act: Effective January 1, 2022, this new legislation creates protections for individuals against the cost of unanticipated medical bills, commonly referred to as “surprise bills.” Below are two key things to know about the law.
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Change 1: Includes protections against the cost of unanticipated out-of-network medical bills for emergency services and certain services provided by out-of-network clinicians at in-network facilities.
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Change 2: Requires that written Good Faith Estimates are provided to uninsured/self-pay patients who schedule in-person or virtual services.
- In addition to your uninsured patients, a GFE is needed for:
- Patients who may have health care coverage but do not have benefits for an item/service under their plan.
- Patients who may choose not to submit a claim to their plan.
- Refer to these CMS provided documents:
- Good Faith Estimate Template
- Good Faith Estimate Data Element
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Learn more from CMS and the AMA.
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CMS Reminder - Update your NPI record by Dec. 31: CMS regulations included in the 21st Century Cures Act and the 2020 Promoting Interoperability and Patient Access Final Rule require physicians and APCs to update their NPI records with their Direct Address and digital endpoint contact in the National Plan and Provider Enumeration System (NPPES). An email outlining this CMS requirement was sent on Dec. 6 with your specific Epic direct address. View here and contact the Advocate Aurora Payer Activation team with questions at AMG-PayerActivation@aah.org. Learn more in these updated documents as of Dec. 9: Overview, tip sheet and video.
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Experian Mediconnect Update: After a compliance and legal review, APP is no longer able to supply APP aligned practices access to Medonnect, the Experian real time eligibility verification product located on APP Pro. Effective Dec. 31, the link will be removed. If your practice does not already have a solution to validate insurance coverage real time for all payers, Experian has provided the following contact to discuss their options: Taylor Bockweg, Experian Health Regional Sales Director, 502-744-4847. Note: You are not required to use Experian as your vendor for this information.
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Critical blood shortages continue: Like other health care systems across the nation, Advocate Aurora continues to manage intermittent, critical shortages of blood products. Our blood suppliers in Wisconsin (Versiti) and Illinois (American Red Cross) say inventories are critically low and forecast shortages will continue into 2022 due to pandemic-related concerns, decreased blood donations and staffing shortages. Each of us has a role to play. Physicians and APCs are asked to keep conservation and clinically-appropriate use of blood products top of mind whenever deciding to transfuse blood products. There is a significant body of clinical evidence that supports a conservative approach to blood transfusion as good patient care and good stewardship of this resource. All those who are able are asked to consider donating blood at a location near you: Illinois | Wisconsin.
- Please click “read more” for additional important updates:
- Billing traditional Medicaid
- New provider calling guide
- October Advocate Aurora policy updates
- Pharmacy and therapeutics November updates
- Patient outreach
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Elevating Our Expertise
Breast cancer study is first to jointly open at all community cancer clinics: Community cancer clinics across Advocate Aurora Health joined a clinical trial evaluating a potential combination therapy to treat patients with high-risk human epidermal growth factor receptor 2 (HER2)-positive breast cancer. The study is the first to open at all Advocate Aurora National Cancer Institute Community Oncology Research Program (NCORP) sites. Learn more and read this month’s research enewsletter.
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Updated limited visitor policy: As COVID-19 cases continue to surge across our communities and peak season for other viruses begin, effective Dec. 13, we’re updating our Limited Visitor Policy for non-COVID-19 patients in our adult hospitals, outpatient, emergency departments as well as clinics who share a hospital entrance from one visitor at a time allowed in a patient’s room with additional visitors onsite to two designated visitors allowed onsite for the duration of the patient’s stay with one visitor in the patient’s room at a time. As part of our SafeCare Promise, the updated policy is an additional step we’re taking to help limit the spread of viruses. Screeners will assist in directing visitors based on our policy.
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FDA expands authorization of two monoclonal antibodies: The U.S. Food and Drug Administration has revised the EUA of bamlanivimab and etesevimab to allow them to be administered together for the treatment of mild to moderate COVID-19 in all younger pediatric patients, including newborns, who have a positive COVID-19 test and are at high risk for progression to severe COVID-19, including hospitalization or death. This revision also authorizes them to be administered together, for post-exposure prophylaxis for prevention of COVID-19 in all pediatric patients, including newborns, at high risk of progression to severe COVID-19, including hospitalization or death. Read more.
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PPE guidance: The practice of reusing PPE was discontinued earlier in 2021 after an increase in supply production enabled our team to adequately resource supplies. Masks used for transmission-based or standard precautions should be discarded immediately after doffing (removing). The only exception to this practice is when using your universal mask or to prevent cross contamination by extending the use of N95s when caring for multiple COVID-19 patients on a COVID-19 designated unit.
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Pediatric vaccines open to non-patients: COVID-19 vaccination scheduling is open to non-Advocate Aurora pediatric patients. This enables us to vaccinate more children, an important step in protecting our communities and helping to bring an end to this pandemic. Parents or legal guardians can schedule their children’s vaccination via LiveWell once they’ve connected their account to their child’s or minor’s account via proxy access, at aah.org or 866-443-2584.
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Continuing Medical Education
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CME Website: Webinars & Recordings
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