Health Catalyst, Inc · NASDAQ:HCAT

Health Catalyst — Conference Presentation (2023)

72 slides from Health Catalyst's conference presentation, 2023

  1. Slide 1: What's Next for the OPPS

    What’s Next for the OPPS A Look at the 2024 Final Rule © Health Catalyst. Confidential and Proprietary.

  2. Slide 2: Disclaimer Statement

    Disclaimer Statement This webinar/presentation was current at the time it was published or provided via the web and is designed to provide accurate and authoritative information regarding the subject matter covered. The information provided is only intended to be a general overview with the understa

  3. Slide 3: Jennifer Bishop

    Jennifer Bishop RHIT, CCS, CCS-P, CHRI © Health Catalyst. Confidential and Proprietary.

  4. Slide 4: Updates Affecting OPPS Payment

    Updates Affecting OPPS Payment © Health Catalyst. Confidential and Proprietary.

  5. Slide 5: Updates Affecting OPPS Payment

    Updates Affecting OPPS Payment  Final 2024 OPPS Conversion Factor of $87.382 – Up from $85.585 for 2023  Predicted increase of 3.2% in OPPS payments to providers  The 2% reduction will still apply to hospitals not meeting quality reporting requirements – CF of $85.687  The 7.1% adjustment for ru

  6. Slide 6: Updates Affecting OPPS Payment

    Updates Affecting OPPS Payment  IPPS wage index adjustments will be used to calculate OPPS adjustments on 1/1/2024  Continuing to use revised delineations per the OMB (built from 2010 census results)  Wage index decreases will be capped at 5%; no cap on increases  All changes are budget neutral

  7. Slide 7: Updates Affecting OPPS Payment

    Updates Affecting OPPS Payment  Hospital outlier payments will be triggered when a hospital’s cost of furnishing a service exceeds 1.75x the APC payment amount AND exceeds the fixed dollar amount of $7,750 (down from $8,625 for CY 2023)  Outlier payments continue to be calculated as 50% of the amo

  8. Slide 8: Updates to Comprehensive APCs (C-APCs)

    Updates to Comprehensive APCs (C-APCs) © Health Catalyst. Confidential and Proprietary.

  9. Slide 9: Final Changes to C-APCs

    Final Changes to C-APCs  Two New C-APCs are being added for CY 2024  C-APC 5342 – Level 2 Abdominal/Peritoneal/Biliary and Related Procedures – 44950 – Appendectomy – 47541 – Placement of new access through the biliary tree and into the small bowel to assist with an endoscopic procedure – 47552 –

  10. Slide 10: Final Changes to C-APCs

    Final Changes to C-APCs  C-APC 5496 – Level 6 Intraocular – 0308T – Insertion of ocular telescope prosthesis – 0616T – Insertion of iris prosthesis without removal or insertion of lens – 0617T – Insertion of iris prosthesis with removal and insertion of lens – 0618T – Insertion of iris prosthesis w

  11. Slide 11: Updates to OPPS APC-Specific Policies

    Updates to OPPS APC-Specific Policies © Health Catalyst. Confidential and Proprietary.

  12. Slide 12: Changes to New Technology APC Groups

    Changes to New Technology APC Groups HCPCS Description 2024 APC 2024 $ 2023 APC 2023 $ Scalp cooling, mechanical; initial measurement and 0662T calibration of cap 1514 $1,251 1520 $1,851 Histotripsy (i.e., non-thermal ablation via acoustic energy delivery) of malignant hepatocellular tissue, includi

  13. Slide 13: Changes to New Technology APC Groups

    Changes to New Technology APC Groups HCPCS Description 2024 APC 2024 $ 2023 APC 2023 $ Office or other outpatient visit for an established patient that requires the supervision of a physician or other QHP G2082 and provision of up to 56 mg of esketamine nasal self- 1513 $1,151 1512 $1,051 administra

  14. Slide 14: Minimally Invasive Glaucoma Surgery

    Minimally Invasive Glaucoma Surgery 66989 – Extracapsular cataract removal with insertion of IOL and anterior segment aqueous drainage device, complex 66991 – Extracapsular cataract removal with insertion of IOL and anterior segment aqueous drainage device  Reassigned from APC 1563 (2023) to 5493 (

  15. Slide 15: Ablation of Bone Tumors

    Ablation of Bone Tumors 20982 - Ablation therapy for reduction or eradication of 1 or more bone tumors (e.g., metastasis) including adjacent soft tissue when involved by tumor extension, percutaneous, including imaging guidance when performed; radiofrequency  Reassigned from APC 5114 (2023) to 5115

  16. Slide 16: Autologous Adipose-Derived Regenerative Cell (ADRC) Therapy

    Autologous Adipose-Derived Regenerative Cell (ADRC) Therapy 0717T – Harvesting, isolation, and preparation of cells prior to ADRC therapy for partial-thickness rotator cuff tear 0718T – Injection into supraspinatus tendon of ADRC therapy for partial-thickness rotator cuff tear  Placed in APC 5055 (

  17. Slide 17: Barostim Heart Failure Device

    Barostim™ Heart Failure Device 0266T – Implantation or replacement of carotid sinus baroreflex activation device; total system  Reassigned from APC 5465 (2023) to 1580 (2024)  Status indicator changing from J1 (2023) to S (2024)  Reimbursement change from $29,358 (2023) to $45,001 (2024)  Associ

  18. Slide 18: Biliary Endoscopy

    Biliary Endoscopy  47564 – Laparoscopy, surgical; cholecystectomy with exploration of common duct  Reassigned from APC 5361 (2023) to 5362 (2024)  No change in Status Indicator (J1)  Reimbursement change from $5,212 (2023) to $9,818 (2024) © Health Catalyst. Confidential and Proprietary.

  19. Slide 19: Bone Density Tests

    Bone Density Tests  0555T and 0558T have been reassigned from Status Indicator E1 to S  0554T, 0556T, 0557T, and 0743T have been reassigned from Status Indicator E1 to M  CMS received multiple comments stating that Biomechanical Computed Tomography (BCT) Analysis and Digital X-ray Radiogrammetry-

  20. Slide 20: Leadless Pacemaker Procedures

    Leadless Pacemaker Procedures • Aveir VR was approved by the FDA in March 2022 and was eligible for payment • Aveir AR and Aveir DR received approval in June 2023 • CMS is restructuring status indicators and APC assignments for devices for consistency © Health Catalyst. Confidential and Proprietary.

  21. Slide 21: Leadless Pacemaker Procedures

    Leadless Pacemaker Procedures Code Description 2023 2023 $$ 2024 2024 $$ SI/APC SI/APC 33274 Insertion of RV leadless pacemaker J1/5194 $17,178 J1/5224 $18,585 0795T Insertion of dual-chamber leadless pacemaker E1 $0 J1/5224 $18,585 0796T Insertion of RA leadless pacemaker E1 $0 J1/5224 $18,585 0797

  22. Slide 22: Leadless Pacemaker Procedures

    Leadless Pacemaker Procedures Code Description 2023 2023 $$ 2024 2024 $$ SI/APC SI/APC 0801T Removal & Replacement of dual-chamber leadless E1 $0 J1/5224 $18,585 pacemaker 0802T Removal & Replacement of RA leadless pacemaker E1 $0 J1/5224 $18,585 0803T Removal & Replacement of RV leadless pacemaker

  23. Slide 23: Leadless Pacemaker Procedures

    Leadless Pacemaker Procedures Code Description 2023 2023 $$ 2024 2024 $$ SI/APC SI/APC 0798T Removal of dual-chamber leadless pacemaker E1 $0 J1/5183 $3,040 0799T Removal of RA leadless pacemaker E1 $0 J1/5183 $3,040 0800T Removal of RV leadless pacemaker J1/5183 $2,979 J1/5183 $3,040 0824T Removal

  24. Slide 24: EchoGo Image Processing

    EchoGo Image Processing C9786 – Echocardiography image post processing for computer aided detection of heart failure with preserved ejection fraction, including interpretation and report  Reassigned from APC 5742 (2023) to APC 5743 (2024)  Status indicator of S remains unchanged  Reimbursement ch

  25. Slide 25: Fluorescence In Situ Hybridization (FISH)

    Fluorescence In Situ Hybridization (FISH) 88366 – In situ hybridization (eg, FISH), per specimen; each multiplex probe stain procedure  Reassigned from APC 5673 (2023) to 5672 (2024)  Status indicator remains Q1  Reimbursement change from $324 (2023) to $163 (2024) © Health Catalyst. Confidential

  26. Slide 26: LimFlow TADV Procedure

    LimFlow TADV Procedure 0620T – Endovascular venous arterialization, tibial or peroneal vein, with transcatheter placement of intravascular stent graft(s) and closure by any method, including percutaneous or open vascular access, ultrasound guidance for vascular access when performed, all catheteriza

  27. Slide 27: Total Shoulder Arthroplasty

    Total Shoulder Arthroplasty 23472 – Arthroplasty, glenohumeral joint; total shoulder (glenoid and proximal humeral replacement (e.g., total shoulder))  APC changed from 5115 (2023) to 5116 (2024)  Status indicator remains J1  Reimbursement change from $13,048 (2023) to $17,775 (2024) © Health Cat

  28. Slide 28: Peroral Endoscopic Myotomy (POEM)

    Peroral Endoscopic Myotomy (POEM) 43497 – Lower esophageal myotomy, transoral (i.e., peroral endoscopic myotomy [POEM])  Reassigned from APC 5303 (2023) to APC 5331 (2024)  Status indicator remains J1  Reimbursement change from $3,261 (2023) to $5,436 (2024) © Health Catalyst. Confidential and Pr

  29. Slide 29: Percutaneous Thrombectomy

    Percutaneous Thrombectomy 37184 – Primary percutaneous transluminal mechanical thrombectomy, noncoronary, non-intracranial, arterial or arterial bypass graft, including fluoroscopic guidance and intraprocedural pharmacological thrombolytic injection(s); initial vessel Reassigned from APC 5193 (202

  30. Slide 30: Scleral Reinforcement

    Scleral Reinforcement 67255 – Scleral reinforcement (separate procedure); with graft  Reassigned from APC 5491 (2023) to APC 5492 (2024)  Status indicator remains J1  Reimbursement change from $2,159 (2023) to $3,878 (2024) © Health Catalyst. Confidential and Proprietary.

  31. Slide 31: Xen Glaucoma Treatment

    Xen Glaucoma Treatment 0449T – Insertion of aqueous drainage device, without extraocular reservoir, internal approach, into the subconjunctival space; initial device  Reassigned from APC 5492 (2023) to APC 5493 (2024)  Status indicator remains J1  Reimbursement change from $3,996 (2023) to $4,985

  32. Slide 32: OPPS Payment For Devices

    OPPS Payment For Devices © Health Catalyst. Confidential and Proprietary.

  33. Slide 33: Pass-Through Status for Devices

    Pass-Through Status for Devices There are 8 devices whose pass-through status will expire in 2023. HCPCS Long Descriptor Product Name Expiration Code Date C1052 Hemostatic agent, gastrointestinal, topical Hemospray® 12/31/23 C1062 Intravertebral body fracture augmentation with implant (e.g., metal,

  34. Slide 34: Pass-Through Status for Devices

    Pass-Through Status for Devices There are 7 devices whose pass-through status expires in 2024/2025. HCPCS Long Descriptor Product Name Expiration Code Date C1761 Catheter, transluminal intravascular lithotripsy, coronary Shockwave C2 Intravascular 6/30/24 Lithotripsy Catheter C1831 Interbody cage, a

  35. Slide 35: Pass-Through Status for Devices

    Pass-Through Status for Devices There are 4 new devices with pass-through status on 1/1/2024. HCPCS Code Long Descriptor Product Name C1600 Catheter, transluminal intravascular lesion preparation device, bladed, sheathed FLEX VP™ System (insertable) C1601 Endoscope, single-use (i.e. disposable), pul

  36. Slide 36: New Procedure-to-Device Edit

    New Procedure-to-Device Edit CMS is creating new procedure-to-device edits for procedures assigned to APC 5496 (Level 6 Intraocular Procedures)  0308T – C1840  0616T – C1839  0617T – C1839  0618T – C1839 CMS declines to reinstate any other procedure-to-device edits at the current time © Health C

  37. Slide 37: Drugs, Biologicals & Radiopharmaceuticals

    Drugs, Biologicals & Radiopharmaceuticals © Health Catalyst. Confidential and Proprietary.

  38. Slide 38: Pass-Through Packaging Threshold

    Pass-Through Packaging Threshold  Packaging threshold will remain at $135 for CY 2024  Packaging determinations made once a year  Based on 2nd Quarter 2023 ASP data from manufacturers  Drugs without ASP information use mean unit cost derived from claims data  There are 11 drugs and biologicals

  39. Slide 39: Reports Available on Dashboard

    Reports Available on Dashboard © Health Catalyst. Confidential and Proprietary.

  40. Slide 40: APC Changes Information

    APC Changes Information © Health Catalyst. Confidential and Proprietary.

  41. Slide 41: Policy-Packaged Drugs, Biologicals, and Radiopharmaceuticals

    Policy-Packaged Drugs, Biologicals, and Radiopharmaceuticals  Anesthesia  Diagnostic radiopharmaceuticals  Contrast agents  Pharmacologic stress agents  Skin substitutes  Implanted biologics  Postsurgical pain management © Health Catalyst. Confidential and Proprietary.

  42. Slide 42: Packaging Exception for Biosimilars

    Packaging Exception for Biosimilars  Biosimilars will be excepted from the threshold packaging policies when their reference product is not packaged (paid separately)  Biosimilars will be reimbursed even if they fail to meet the per-day cost threshold of $135  ASP add-on for biosimilars is equal

  43. Slide 43: Reversal of Alternate Payment Methodology for 340B Drugs

    Reversal of Alternate Payment Methodology for 340B Drugs CMS has finalized their remedy for 340B-acquired drug payment policy for CY 2018- 2022  CMS is providing lump-sum payments to affected 340B providers – Estimated that these providers received $10.6 billion less than they would have without th

  44. Slide 44: Modifier Use for 340B Drugs

    Modifier Use for 340B Drugs CMS continues to require modifier use for separately-payable drugs acquired through the 340B Program for tracking of Part B inflation rebate  Modifier JG may continue to be assigned through December 31, 2024, but will be deleted at that time  Modifier TB may be assigned

  45. Slide 45: Skin Substitute Products

    Skin Substitute Products  Skin substitute products that have been assigned A2xxx codes will be automatically assigned to high-cost skin substitute group until cost data can be obtained  Five skin substitute products are being reassigned from low-cost to high-cost group for CY 2024  Q4135 - Medisk

  46. Slide 46: Payment for Radioisotopes Derived from non-HEU Sources

    Payment for Radioisotopes Derived from non-HEU Sources  Radioisotopes that are at least 95% derived from non-HEU sources are paid an additional $10 when reported with Q9969 (TC- 99m from non-highly enriched uranium source, full cost recovery add-on per study dose)  Payment will continue through De

  47. Slide 47: JW and JZ Modifiers

    JW and JZ Modifiers  New JZ modifier (Zero drug amount discarded/not administered to any patient)  All claims with single-use vials will require a modifier  JW on a separate line to identify waste  JZ on the same claim line to identify no waste  Claim edits implemented on October 1, 2023 © Heal

  48. Slide 48: Outpatient Psychiatric Services

    Outpatient Psychiatric Services © Health Catalyst. Confidential and Proprietary.

  49. Slide 49: Revisions to PHP Physician Certification Requirements

    Revisions to PHP Physician Certification Requirements  A physician must certify that each patient needs a minimum of 20 hours of PHP services per week  Initial recertification must occur after 18 days with subsequent recertifications no less frequently than every 30 days  No changes to requiremen

  50. Slide 50: Intensive Outpatient Program (IOP)

    Intensive Outpatient Program (IOP)  Definition – A distinct and organized intensive ambulatory treatment program that offers less than 24-hour daily care other than in an individual’s home or in an inpatient or residential setting and furnishes the services as described in the regulations  Individ

  51. Slide 51: Intensive Outpatient Program (IOP)

    Intensive Outpatient Program (IOP)  Patient eligibility criteria is mostly the same as that of the PHP program  A physician must certify that each patient needs a minimum of 9 hours of IOP services per week  No requirement that physician must also certify that the patient would require inpatient

  52. Slide 52: Intensive Outpatient Program

    Intensive Outpatient Program Coding and Billing for IOP services  Condition Code 92 must be used by hospitals and CMHCs when reporting intensive outpatient services  Condition Code 41 will still be used by hospitals for PHP services; as of January 1, 2024, CMHCs must also report Condition Code 41

  53. Slide 53: CY 2024 Payment Rates for PHP/IOP

    CY 2024 Payment Rates for PHP/IOP APC APC Title 2024 $$ 5851 Intensive Outpatient (3 services) for CMHCs $87.66 5852 Intensive Outpatient (4 services) for CMHCs $157.58 5853 Partial Hospitalization (3 services) for CMHCs $87.66 5854 Partial Hospitalization (4 services) for CMHCs $157.58 5861 Intensi

  54. Slide 54: Intensive Outpatient Program (IOP)

    Intensive Outpatient Program (IOP)  IOP is a permanent benefit for RHCs and FQHCs as of 1/1/2024 – Paid at a rate equal to APC 5861 ($259.40) for CY 2024  “Opioid Treatment Program (OTP) intensive outpatient services” is a new covered Part B benefit incorporated into the opioid use disorder treatm

  55. Slide 55: Changes to Inpatient Only (IPO) List

    Changes to Inpatient Only (IPO) List © Health Catalyst. Confidential and Proprietary.

  56. Slide 56: Codes Added to IPO for CY 2024

    Codes Added to IPO for CY 2024 Code Long Descriptor 0646T Transcatheter tricuspid valve implantation (ttvi)/replacement with prosthetic valve, percutaneous approach, including right heart catheterization, temporary pacemaker insertion, and selective right ventricular or right atrial angiography, whe

  57. Slide 57: Non-recurring Policy Changes

    Non-recurring Policy Changes © Health Catalyst. Confidential and Proprietary.

  58. Slide 58: Remote Mental Health Services

    Remote Mental Health Services Hospital staff may continue to provide remote mental health services  Patient must be located at home – includes temporary shelters  Provider must be appropriately licensed with the state  Patients must have an initial in-person visit within 6 months and subsequent v

  59. Slide 59: Remote Mental Health Services

    Remote Mental Health Services HCPCS Long Descriptor 2023 $ Code C7900 Service for diagnosis, evaluation, or treatment of a mental health or substance use disorder, initial 15-29 minutes, $28 provided remotely by hospital staff who are licensed to provide mental health services under applicable state

  60. Slide 60: Remote Outpatient Therapies

    Remote Outpatient Therapies Hospital staff may continue to provide remote services through the end of 2024  Physical Therapy  Occupational Therapy  Speech-Language Pathology Services  Diabetes Self-Management Training  Medical Nutrition Therapy  Modifier 95 should be appended to services provi

  61. Slide 61: Supervision Requirements

    Supervision Requirements  Cardiac Rehab (CR), Intensive Cardiac Rehab (ICR), and Pulmonary Rehab (PR) services may meet the direct supervision requirement through audio-video real-time communications technology through 12/31/2024  Supervising practitioners for CR, ICR, and PR services have been ex

  62. Slide 62: Intensive Cardiac Rehab in HOPD

    Intensive Cardiac Rehab in HOPD To correct an inadvertent error, intensive cardiac rehab services (G0422 and G0423) will be reimbursed at 100% OPPS rate when provided in offsite hospital outpatient departments  Reported using PN modifier © Health Catalyst. Confidential and Proprietary.

  63. Slide 63: OPPS Payment for Dental Services

    OPPS Payment for Dental Services  Dental procedures that are inextricably linked to other covered services will be paid when payment and coverage requirements are met  Other covered services include organ transplant, cardiac valve replacement, valvuloplasty, treatment of head and neck cancer  Oth

  64. Slide 64: OPPS Payment for Dental Services

    OPPS Payment for Dental Services  HCPCS code G0330 (Facility services for dental rehab) should only be assigned when no specific code exists to describe the service provide  MAY ONLY BE ASSIGNED WHEN THE SERVICE MEETS COVERAGE AND BILLING REQUIREMENTS  For CY 2024, APC for G0330 is being reassign

  65. Slide 65: Hospital Outpatient Quality Reporting Program

    Hospital Outpatient Quality Reporting Program © Health Catalyst. Confidential and Proprietary.

  66. Slide 66: Measures Added for Reporting

    Measures Added for Reporting  Risk-Standardized Patient-Reported Outcome-Based Performance Measure (PRO–PM) Following Elective Primary Total Hip Arthroplasty (THA) and/or Total Knee Arthroplasty (TKA) in the HOPD Setting (THA/TKA PRO–PM)  Voluntary Reporting for CY 2025 – Mandatory for CY 2028  E

  67. Slide 67: Measures Modified for CY 2024 Reporting

    Measures Modified for CY 2024 Reporting  COVID-19 Vaccination Coverage Among Health Care Personnel (HCP)  Hospitals must report the number of HCP who are “up to date” with vaccinations; HCP with contraindications to the vaccine are still not included  Cataracts: Improvement in Patient’s Visual Fu

  68. Slide 68: Measures Modified for CY 2024 Reporting

    Measures Modified for CY 2024 Reporting  Appropriate Follow-Up Interval for Normal Colonoscopy in Average Risk Patients  Patients tracked will now include all patients between the ages of 45 and 75  Median Time for Discharged ED Patients – Transfer Patients and Median Time for Discharged ED Patie

  69. Slide 69: Hospital Price Transparency

    Hospital Price Transparency © Health Catalyst. Confidential and Proprietary.

  70. Slide 70: New Requirements for January 1, 2024

    New Requirements for January 1, 2024  The public website must include a .txt file in the root folder with a standardized set of fields  Hospital location name(s) that correspond to the Machine-Readable File (MRF)  Source page URL that hosts the MRF  A direct link to the MRF URL  Hospital Point

  71. Slide 71: More Information on Hospital Price Transparency Requirements

    More Information on Hospital Price Transparency Requirements  Webinar on 12/6/23 at 12:00 CST  More information will be available soon © Health Catalyst. Confidential and Proprietary.

  72. Slide 72: Questions?

    Questions? Jennifer Bishop [email protected] © Health Catalyst. Confidential and Proprietary.

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