2014 ACMA Medical Director Forum

Session 1: High Reliability, Care Quality and Utilization

Saturday, November 22, 2014
8:15 AM - 9:15 AM

M. Michael Shabot, MD, FACS, FCCM, FACMI
System Chief Medical Officer·Office of the President
Memorial Hermann Health System·Houston, TX

ABSTRACT:
High Reliability Organizations (HROs) have developed a culture of quality and safety. This session will discuss how an HRO can impact care delivery by addressing underlying systemic causes and examining the relationships between safety and utilization.

LEARNING OBJECTIVES:

  1. List the reasons high reliability health care improves care safety and quality
  2. Improve utilization by determining and addressing the underlying systematic causes of poor care quality
  3. Demonstrate the relationships between high reliability, safety and improved utilization

Session 2: Observation Services Management and the Modern Hospital

Saturday, November 22, 2014
9:30 AM - 10:30 AM

David Duncan, MD, MBA
Senior Physician Advisor·Case Management and Utilization Review
Inova Fairfax Hospital·Falls Church, VA

ABSTRACT:
This session will discuss changes in Medicare rules and the impact on hospitals and physicians. The presenter will share case management strategies and reporting metrics to promote organizational change in physician practice and hospital operations.

LEARNING OBJECTIVES:

  1. Understand the various modalities of communicating the changes in Medicare rules and the impact on providers
  2. Review daily strategies that will allow case management/utilization review (UR) staff and physicians to identify patients appropriate for observation units
  3. Recognize the need for reporting metrics to demonstrate effective management of observation patients
  4. Demonstrate how the Two-Midnight Rule and effective placement of human capital will avoid unintentional lapses

Session 3: Understanding and Applying the Two-Midnight Rule

Saturday, November 22, 2014
10:45 AM - 11:45 AM

Ronald J. Rejzer, MD
Sr. Vice President/Chief Physician Advisor
Parkland Health & Hospital System·Dallas, TX

ABSTRACT:
This session will discuss the new rule change in Medicare’s inpatient definition, known as the two-midnight rule, implemented October 1, 2013. Case examples will be used to illustrate the clinical decision process to assist in determining which patients are appropriate for inpatient admission. The speaker will also examine the role Medicare Administrative Contractors (MACs) and the Recovery Contractors (RACs) will play in monitoring provider performance.

LEARNING OBJECTIVES:

  1. Explain the background for CMS Final Rule 1599-F and identify its key components
  2. Demonstrate knowledge of the two-midnight rule with sample cases of admission vs. observation
  3. Discuss the role of the MACs and RACs in relation to the two-midnight rule

Session 4: Physician Advisor: A Day in the Life

Saturday, November 22, 2014
12:30 PM - 1:30 PM

Zachary S. Fainman, MD
Co-Medical Director·Care Management
Advocate Lutheran General Hospital·Park Ridge, IL

ABSTRACT:
This session will examine the role of the physician advisor in day-to-day hospital care management operations. The speaker will discuss the various components of this unique role, such as regulatory compliance, and provide insight into strategies to effectively engage physicians and hospital staff.

LEARNING OBJECTIVES:

  1. Describe the physician advisor role
  2. Discuss the regulatory compliance components of utilization review and discharge planning
  3. Examine strategies to engage physicians and hospital staff to affect practice change

Session 5: Physician Advisor Services: Outsourcing vs. Homegrown - A Scenario and Situational Analysis

Saturday, November 22, 2014
1:45 PM - 2:45 PM

David Duncan, MD, MBA
Senior Physician Advisor·Case Management and Utilization Review
Inova Fairfax Hospital·Falls Church, VA

ABSTRACT:
This session will examine the return on investment (ROI) when using external physician advisor services versus building an internal physician advisor program. There are key considerations that an organization should include as part of the business plan analysis and cultural fit.

LEARNING OBJECTIVES:

  1. Recognize physicians on your hospital staff who would be able to fulfill the role of Physician Advisor
  2. Understand the potential cost implications and potential limitations of outsourcing
  3. Understand the “politics of in-sourcing”
  4. Review the full costs and potential financial benefits of both options

Session 6: Prepayment Review: A Significant Cash Flow Impact on Hospitals - Another Important Role for the Physician Advisor

Saturday, November 22, 2014
3:00 PM - 4:00 PM

Mark S. Michaelman, MD, MBA
Vice President·Medical Affairs
Morton Plant Mease Health Care·Clearwater, FL

ABSTRACT:
CMS' pre-payment review program can impact a provider’s cash flow and net revenue. This session will examine the purpose of the pre-payment program and strategies to prevent payment denials. The speaker will also discuss the role of the physician advisor as a key component in physician education and governance.

LEARNING OBJECTIVES:

  1. Discuss the rationale behind the pre-payment review program
  2. Discuss the documentation required to minimize/prevent hospital denials
  3. Describe an effective overall process to prevent denials and the role your Physician Advisor should play in this important process
  4. Discuss the impact on physician payment

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