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I Raise the Rates Program

Raising the Rates
A Newsletter from the American College of Physicians
September 2016



You Need a Chief Vaccination Officer (And ACP Can Help)

Increasing adult immunization rates takes more than a committed physician champion-leader; the whole health care team, including office staff, need to be on board to optimize billing, and convey the importance of vaccines to patients.

ACP invites all I Raise the Rates champions to nominate a member of their health care team to be their Chief Vaccination Officer or CVO. Select a nurse, medical assistant, practice manager or pharmacist working in your practice to:

  • Receive training on the importance of adult immunizations and how team members can help protect all of the practice’s patients. This series of three, one-hour webinars will be scheduled to accommodate availability and will be led by nurses and other team members who have been CVOs.
  • Receive telephone support for implementing a change to improve vaccinations in-practice.
  • Be recognized nationally as a CVO.
  • Have an opportunity to win an iPad and attend ACP’s Internal Medicine Meeting in San Diego, CA from March 30-April 1, all expenses paid: details to follow!

In addition, champions who nominate a CVO will receive $150 to provide lunch for their clinic staff - a great way to promote immunization and celebrate the team who does it.

Share the Love: Sponsor a Champion

Based on your success, we want to open the opportunity up to additional practices in your state. We know that you are the best person to identify your peers and let them know what to do.

Once a new champion is identified, ACP will reach out to them, providing a virtual champion training over 3 webinars and 2 personalized coaching calls to help them develop and implement a plan for increasing immunization rates in their practice. Champions will receive a $1000 stipend for participation. New champions must sign up no later than October 15th.

As a current champion we would like to reward your efforts to increase adult immunization rates. Here’s what you’ll receive for your efforts:

  • Recruit 1 champion: Free registration for the 2017 Internal Medicine Meeting in San Diego, CA from March 30-April 1
  • Recruit 2 champions: Free registration, plus two nights of lodging
  • Recruit 3 champions: Free registration, two nights of lodging, travel to and from San Diego, all expenses paid, and recognition at the QI reception

If you are interested in participating, contact Michael Cestare at or Michele Duchin at

ACP Quality Connect: Coaching Calls

The Center for Quality is excited to launch the ACP Quality Connect: Coaching Call series. These 1-hour coaching calls provide support to participants across all of our Quality Improvement (QI) programs, including adult immunization, diabetes, and chronic pain. Expert faculty will provide guidance on general QI/practice transformation strategies as well as focus on specific clinical programs. These calls are free of charge and are open to all QI Champions.

We invite you to participate in 1 or more of these coaching calls. Weekly calls will take place beginning May 31st and will go through the end of September. Click here to sign up!

Flu Season is Here: Are You Prepared?

Dr. C. Michael Soppet

Influenza season is officially upon us. As in years past, we have a number of vaccines to choose from, and we must each decide which is best for our patients.

We currently have available the inactivated trivalent; inactivated quadrivalent; inactivated high dose products for seniors; and the recombinant products. We also have a newer adjuvanted vaccine. Under the 2014 terminology, these are notated as IIV3, IIV4, IIV3HD, RIV3, and IIV3AD.

The current G0008 payment level nationally for the administration of the influenza vaccine to patients who are covered by traditional Medicare Plans is $25.42, but the amount will be slightly different for your Medicare Administrative Contractor (MAC) Area. The MAC areas for New Jersey, Florida, Louisiana, and Arkansas are as follows with the current payment rates:

Miami (0910204) - $26.58
Fort Lauderdale (0910203) - $26.25
Rest of Florida (0910299) - $24.77
Northern New Jersey (1240201) - $29.15
Rest of New Jersey (1240299) - $27.98
Louisiana-New Orleans (0720201) - $25.24
Rest of Louisiana (0720299) - $23.35
Arkansas (0710213) - $22.73
Alabama (1010200) - $23.12

Here are the current Medicare payment rates for the different influenza vaccines:

Formulation CPT Code Payment (95% of AWP) Maximum Purchase Price
IIV-3 90656 $17.17 $10.00/dose
IIV-4 90686 $19.03 $16.63/dose
IIV3-HD 90662 $42.72 $36.42/dose
RIV3 90673 $40.61 TBD

The payment rates above for the administration fee are set yearly, so these are relevant until January 1, 2017. The above are averages because the Average Wholesale Price is actually set by the specific vaccine you order and the specific manufacturer (HCPCS Q codes are used to identify the actual product). The payment for the vaccine itself will be adjusted quarterly as the new Average Wholesale Pricing Catalogues are updated at the Part B drugs portion of the CMS website.

The updated pricing will appear in the next month or two at the Seasonal Influenza Vaccine Pricing sheet. Until then, the above payment rates are what you will receive for these influenza vaccine formulations. Remember, use Modifier 25 on the E and M code line if you submit an E and M code with the vaccine. Also, be sure to include the National Drug Code for the product off of the package label. The last column of the table above includes a reasonable purchase price for these vaccines which practices can access through group purchasing. If no more than the price above is paid, then the return on additional investment for those vaccines for this year should be in the following ranges depending upon MAC area administration fee pricing:

Formulation Return on Additional Investment
IIV3 (90656) 200 + % (dependent on manufacturer-Q code)
IIV4 (90686) 122%
IIVHD (90662) 60%
RIV3 (90673) TBD

As always, you must use good judgement when deciding which vaccine is best for your patients, and administer according to their needs. For additional information, review the CDC's recommendations for the 2016-17 flu season. Next month, we will review updated pricing if it is available and will also review updated reporting from CDC regarding actual vaccine usage across the country.

Highlights from the Field

Raising Rates in the Big Easy

Since last year, Dr. David Borne and Nurse Practitioner Debra Brown have been quietly building support for their immunization program at LSU Health in New Orleans. Successful efforts to increase adult immunization in a hospital or clinical setting have something in common: resident involvement; the core component of LSU's efforts. It also doesn't hurt that they have the support of Lee Engel, MD, PhD, Associate Professor of Clinical Medicine, and Associate Program Director of the Internal Medicine Residency Program at LSU Health (Dr, Engel is also the Louisiana ACP Chapter Governor).

Their team has written letters to all internal medicine physicians and residents, and have distributed important, timely information on immunizations, including how to use standing orders, which have been in place at the hospital before the program's inception. "If residents haven't given any recommended vaccinations, they are reminded of it when they print their statistics and see their administration rates," said Dr. Borne. "A big '0' does wonders for behavior works."

This strategy, combined with elements of friendly competition, and reinforcement of standing orders for vaccines such as influenza and pneumococcal, are finally bringing attention to the importance of adult vaccinations, and how they affect overall population health. While it has been tough keeping the momentum going for a program such as I Raise the Rates, Dr. Borne and his team are doing a great job at keeping residents engaged, and interested. "We're really focused on getting residents to administer the vaccines whenever necessary. Our mantra is - just give the shot!"

Champion Resources

Monthly Flu Posters for your practice or clinic: The Alliance for Immunization in Michigan

Poster: Pneumococcal Disease: Hard to Say It, Easy to Get Vaccinated

Adjustments to CDC's recommended temperature range for refrigerated vaccine storage: Q&A - June '16

Coding for Immunizations and Reporting National Drug Codes: Resources from Sanofi Pasteur.

For additional materials and resources, email

Patient Resources

What's your Flu Plan?

Patient Infographic: P
neumococcal Disease

IAC: Vaccines for Adults with Diabetes: English and Spanish

    I Raise the Rates Webinars

    Flu Clinic 101
    Friday, September 23, 2016 | 2:00 pm Eastern Daylight Time (GMT-04:00)

    Join Dr. Mike Soppet for a webinar on how to plan and execute a successful flu clinic with your practice. You can join the webinar directly HERE - no need to pre-register!

    Information related to October's webinar will be shared via email. Be sure to visit the ACP Website for periodic updates and information for future webinars.

    Immunization News

    Experimental Shingles Vaccine Shows Promise
    UPI, September 14, 2016

    Read the Full Article in the New England Journal of Medicine


    Dr. Cynthia Miller Receives 2016 ACP I Raise Award at Annual Scientific Meeting

    In March, Dr. Miller approached the head of the North Pinellas County Faith Community Nurses about conducting a joint project to increase vaccination rates in the local churches. Previously, Dr. Miller and her colleagues have worked with the organization to increase diabetes screening rates in the Tampa Bay Area. Their needs assessment had recently been completed and indicated several need, including education on HPV vaccine, and a need to improve the health of diabetics through routine vaccination.

    Dr. Miller's team immediately got to work on a proposal for a CEU program to meet Faith Community Nursing's needs. The program included education on HPV vaccine, and key information on communicating about vaccines such as pneumonia and influenza, which are crucial for diabetic health. Her team also administered a survey about healthcare provider vaccine hesitancy, finding a 65-75% rate of flu vaccination, well below the target rate of 90%. Evaluation efforts will take place within the next six months, with the hope of an increase in knowledge around vaccinations for diabetic health. Read the report for more.