2018 PHYSICIAN ADVISOR SESSIONS

Session Summary

Half of the sessions that will be offered as part of the 2018 Leadership and Physician Advisor Conference program content is intended for physicians and physician advisors. The following is a sample of some of the topics that will be discussed.

  • Value-based integrated care management
  • Interventions to improve inpatient bed access
  • Using clinical effectiveness to lower cost
  • Reducing medicare spending per beneficiary
  • Onsite physician advisor services
  • Transforming pain management
  • Determining level of care for elective surgeries
  • Length of stay management

Session List

Registration

Monday, November 5, 2018
7:00 AM - 8:00 AM

ABSTRACT:

Pre Conference: Foundations for Physician Advisors (ADDITIONAL REGISTRATION AND FEE REQUIRED)

Monday, November 5, 2018
8:00 AM - 12:30 PM

Bruce Ermann, MD
IPAS Physician Advisor·Population Health/Care Management
Catholic Health Initiatives·Englewood, CO

ABSTRACT:
The hospital Physician Advisor to Utilization Management role and its interface with the Case Management team is becoming increasingly important and well defined, even as the role continues to evolve. Leveraging this role for success requires an understanding of the knowledge base that supports the traditional functions of the PA, as well as the opportunities that lie ahead in today's rapidly changing healthcare environment. This course is designed to equip new Physician Advisors with the knowledge required to perform effectively, and for Case Management Directors or Chief Medical Officers looking to improve their Physician Advisor Function.

LEARNING OBJECTIVES:

  1. Describe the role, responsibilities and success characteristics for Physician Advisors
  2. Understand the CMS Utilization Management Conditions of Participation and the Physician Advisor role in the UM process
  3. Understand the CMS 2 Midnight Rule and its implications for Physician Advisor work
  4. Understand the nuances of Commercial Payer UM, and how to perform successful Peer to Peer and written appeals
  5. Discuss one daily work flow model for Physician Advisors, supporting improved hospital throughput, revenue integrity, and clinical efficiency
  6. Model Physician Advisor/Case Manager, Physician Advisor/Physician, and Physician/Administration Communications

Registration

Monday, November 5, 2018
12:00 PM - 2:00 PM

ABSTRACT:

Opening Session: Leading During Times of Rapid Change: Key Success Strategies

Monday, November 5, 2018
2:00 PM - 3:00 PM

Anna Lloyd
Center for Integrated Leadership, Carlson School of Management
University of Illinois at Chicago, Liautaud School

ABSTRACT:
Addressing the delivery and coordination of health care is increasingly complex. Leaders must provide thought leadership, direction and strategic planning for the future even as systems and technology are rapidly evolving. Those responsible for coordination of care across health care settings encounter the additional burden of balancing the social, mental health and environmental factors that are barriers to health. This session will discuss key elements essential for ethical and inspiring leadership in times of change. 

LEARNING OBJECTIVES:

  1. Describe characteristics critical to successful leadership and practical application in the evolving and uncertain healthcare environment
  2. Discuss how leaders can respond to the increased ethical, social and mental health challenges in the delivery of health care
  3. Share profiles of successful leaders as agents of change

2A: A Provider Intervention to Improve Morning Inpatient Bed Access

Monday, November 5, 2018
3:15 PM - 3:45 PM

Teresa Jacobs, M.D.
Medical Director, Care Management & Professor of Neurosurgery and Neurology
Michigan Medicine, University of Michigan ·Ann Arbor, MI

Josh Thielker, MPH
Senior Project Manager, Care Management
Michigan Medicine, University of Michigan·Ann Arbor, MI

ABSTRACT:
Late day inpatient discharges are a well-established barrier to optimal patient flow for hospitals nationally, causing capacity challenges such as overcrowding and boarding in the ED, PACU, and ICUs. With so many stakeholder groups involved in coordinating for discharge, how can hospitals change culture and shift the discharge curve earlier to better meet morning demand for beds? Engaging providers to facilitate early discharges is a critical step in the journey toward unlocking hidden bed capacity. This session will provide lessons learned from a provider-centric intervention that yielded significant results.

LEARNING OBJECTIVES:

  1. Summarize the impact of and need for early day discharges
  2. Construct a thoughtful provider action plan for facilitating a culture shift to discharge patients earlier in the day
  3. Examine results and interventions of enacting provider plans for early discharge

3A: Adding Value While Reducing Medicare Spending per Beneficiary

Monday, November 5, 2018
4:00 PM - 5:00 PM

Janelle Shepard, MBA, BSN, RN-BC
Senior Director/System Officer, Care Transitions/ Utilization Management/Population Health
Texas Health Resources·Arlington, TX

ABSTRACT:
In an era of Value Based Purchasing, is your hospital meeting the benchmarks for total Medicare Spending per Beneficiary? While assessing the high cost of healthcare, analyze your post-acute spending for level of care criteria, efficient costs, quality care and readmissions. This health care system developed a transformational process to lower inappropriate post-acute utilization while maintaining quality and readmission expectations

LEARNING OBJECTIVES:

  1. Analyze and critique your current Medicare Spending per Beneficiary Spending
  2. Develop and implement a consistent criteria for appropriate and efficient post-acute level of care placement
  3. Build and support an aligned post-acute network of providers with a strong collaboration

Opening Reception with Sponsors and Exhibitors

Monday, November 5, 2018
5:00 PM - 7:00 PM

ABSTRACT:

4: Sunrise Session: The Benefits of Proactive Utilization Management in the Emergency Department - A Payer’s Perspective

Tuesday, November 6, 2018
7:00 AM - 8:00 AM

Diana Cokingtin, MD, FAAP
FAA Medical Director, Customer Experience
Change Healthcare·Nashville, TN

ABSTRACT:
Admitting a patient through the ED still represents one of the costliest decisions in healthcare. Increasingly hospitals are staffing case management in the ED to minimize the risk of unnecessary admission and the costs associated with them. But do the benefits of proactive case management in the ED outweigh the costs? And how – and when – should you engage with your payer? During this presentation, the speaker will share medical management expertise and insights to stay ahead of the curve in terms of both admission and discharge planning, tips for engaging payers to reduce denials and the critical role that technology plays in streamlining case management.

LEARNING OBJECTIVES:

  1. Discover the strategies hospitals are using to address the challenge of implementing Case Management in the ED
  2. Develop best practices for implementing and streamlining ED Case Management
  3. Implement new approaches for collaborating with payers to ensure patients are receiving the most appropriate care and denials are reduced

5: General Session: Patients and Lawyers and Regulators: Navigating Legal Considerations for Care Management Leaders

Tuesday, November 6, 2018
8:15 AM - 9:15 AM

Edward S. Fabi
In-House Counsel
Sutter Health·Sacramento, CA

Linda Bjorklund, RN, BSN, MHS, CPHQ
Risk Management Consultant with the Office of General Counsel, Health Law Services Team
Sutter Health·Sacramento, CA

ABSTRACT:
This session will provide an overview of legal considerations for physician care management leaders, physicians in the physician advisor role, and care management leaders of all disciplines. Case studies will be presented to highlight key success strategies to minimize legal risk for providers, staff and leaders in these roles.

LEARNING OBJECTIVES:

  1. Discuss legal considerations and potential liability for physician and care management leader roles in care management
  2. Provide case studies that illustrate successful strategies for high risk scenarios in which care management has a key role
  3. Explain key elements of practice for care managers to minimize risk and provide maximum patient care benefit

6A: Successfully Transitioning From Outsourced to Onsite Physician Advisor Program

Tuesday, November 6, 2018
9:30 AM - 10:30 AM

Lisa Flynn, MD, MS, FACS, CHCQM
Executive of Clinical Innovation and Documentation Integrity, Hospital Service Center
Tenet Health·Dallas, TX

Linda Van Allen, RN, BSN, CPUM, ACM
Performance Excellence
Tenet Health·Dallas, TX

ABSTRACT:
Join us on the journey to transition from a fully outsourced remote Physician Advisor program to an on-site Physician Advisor program. Whether you are a single hospital provider or a multi-site system your Physician Advisor plays a key role in leading clinical documentation, patient throughput and revenue performance. This session will describe the drivers and business case for the expanded role of the hospital Physician Advisor. Participants will take away a clear outline on the key implementation steps from planning through deployment as well as strategies to partner with Physician Advisor services companies to successfully navigate the challenges of transition.

LEARNING OBJECTIVES:

  1. Understand the industry drivers impacting the role of hospital physician advisors
  2. Build the business case to secure the resources needed for a physician advisor program
  3. Outline key steps to implementing an onsite hospital physician advisor program

7: Value Based Integrated Case Management - A Needed Advance

Tuesday, November 6, 2018
11:30 AM - 12:30 PM

Peter Dehnel, MD
Medical Director, CentraCare Connect
CentraCare Health/St. Cloud Hospital·St. Cloud, MN

ABSTRACT:
This session will enable participants to understand the necessary components of an effective care management strategy for their patients with a high level of health complexity. Through participation in this session, participants will gain the tools to be able to develop and implement an effective case management process within their own organization going forward. Finally, when implemented well, these programs will be able to demonstrate a positive return on investment to the sponsoring institution or organization.

LEARNING OBJECTIVES:

  1. Fully know the foundations of effective complexity case management
  2. Understand to concepts of a complexity grid, a care plan and an outcome tracking system
  3. Understand the training needs, staff credentials and organizational support needed for a successful program

8A: Air Traffic Control

Tuesday, November 6, 2018
2:30 PM - 3:30 PM

Rebecca Gomez, MD
Medical Director, Observation

Tia Llewellyn, MSW
Operations Manager, Case Management
Florida Hospital Orlando·Orlando, FL

Christin Ray, RN
Nurse Manager, Case Management
Central Florida Hospitalist Partners·Apopka, FL

ABSTRACT:
It is vital to create an environment of ownership for the patient and identify barriers to a safe discharge early on. Learn firsthand from an open, 75 bed observation unit at a quaternary care hospital that accepts all observation patients, regardless or diagnosis or complexity, and coordinates care among a large number of hospitalists and specialists. Discuss specific challenges and successes in building efficiency, ensuring quality of care, and driving down costs in this busy observation unit. discover the unique ways that this unit has found to work more efficiently and improve outcomes for patients through consistent physician, nursing, and care management leadership.

LEARNING OBJECTIVES:

  1. Analyze strategies for becoming sustainably cost-effective to meet the expanding role of observation care
  2. Develop consistent procedures to decrease length of stay in a large, open unit
  3. Discuss mechanisms to manage a high volume unit with many providers while maintaining high quality outcomes

9A: The Schizophrenia of Length of Stay Management

Tuesday, November 6, 2018
3:45 PM - 5:00 PM

Sam Antonios, MD, MMM, FACP, SFHM, CPE, CCDS
Chief Medical Officer, Administration
Via Christi Hospitals, Wichita·Wichita, KS

Robyn Chadwick,
VP Operations, Case Management and Behavioral Health, Administration
Via Christi Hospitals, Wichita·Wichita, KS

ABSTRACT:
Management of Length Of Stay (LOS) and patient status is the bread and butter of the work of Case Managers, Clinicians and Physician Advisors. Yet, the layers of rule that govern LOS are complex, impacting reimbursement, patient disposition, accountability and the sanity of all involved. This session will discuss the management of LOS in the context of medical necessity for inpatient care, management of days in the hospital, and the tightrope dance involving Transfer DRGs and payment adjustments. The session will explore strategies to help mitigate some of those challenges and manage the care of patients in the best possible way.

LEARNING OBJECTIVES:

  1. Learn about Management of LOS and measurement
  2. Review Transfer DRGs and potential impact
  3. Examine workflows of Working DRGs

10: Sunrise Session

Wednesday, November 7, 2018
7:00 AM - 8:00 AM

ABSTRACT:

11: Transforming Pain Care in America: Promoting Adaptive Pain Management

Wednesday, November 7, 2018
8:15 AM - 9:15 AM

Robert D. Kerns, Ph.D.
Professor of Psychiatry, Neurology and Psychology
Yale University·New Haven, CT

ABSTRACT:
A National Pain Strategy has been published to address the public health problem of undertreated pain, and relatedly, the opioid epidemic. Patient education and activation, care coordination resources, access to multimodal care and decision support to advance provider education and treatment planning are key aspects of the Strategy. In this session, an expert thought leader in the field of pain management will share insights regarding pain research, treatment strategies and interventions to provide coordinated seamless pain management and care coordination for patients and families.

LEARNING OBJECTIVES:

  1. Examine pain research and efficacy of current treatment approaches in pain care
  2. Describe the concept of readiness to adopt a self-management approach to chronic pain
  3. List at least one psychological/behavioral and one exercise/movement approach that have sufficient evidence to support their routine availability for the management of chronic pain
  4. Apply effective pain management care delivery model strategies within case management practice

12A: Determination of Level of Care for Elective Surgeries

Wednesday, November 7, 2018
9:30 AM - 10:30 AM

Zachary S. Fainman, MD
Medical Director/Physician Advisor, Care Management/Clinical Documentation Integrity/Social Work
Advocate Lutheran General Hospital·Park Ridge, IL

Ann Haefke, RN
Surgical Clinical Reviewer RN, Care Management Administration
Advocate Lutheran General Hospital·Park Ridge, IL

ABSTRACT:
Panelists at this session will share expertise to establish a process for determination of the appropriate level of care for elective surgical cases.  CMS two midnight rule, managed care and the Medicare inpatient only list requirements will be discussed related to preoperative and postoperative determinations. 

LEARNING OBJECTIVES:

  1. Discuss the CMS two-midnight rule
  2. Identify ways to determine the appropriate level of care prior to surgical procedures
  3. Define processes for changes in level of care postoperatively

13: Closing Session: Fast Track Your Ideas to Achieve Results

Wednesday, November 7, 2018
10:45 AM - 11:45 AM

Saurabha Bhatnagar
Associate Director - PM&R Residency, Harvard Medical School, Massachusetts General Hospital, Spaulding Rehab.

ABSTRACT:
As organizations prepare to transform for the next era of health care, the future rests upon leaders whose strategic vision, operational plan and implementation design will revolutionize care delivery within multiple settings. They must be equipped to listen and learn, flex and adapt and apply a clear vision and plan. When change needs to occur, what proven strategies are most effective to expedite implementation and achieve results? During this session, evidenced based practice will be shared to overcome barriers and establish a foundation for action. Through interactive learning experiences, attendees will apply essential skills to identify core problems and opportunities, gain focus and fast track action plans.

LEARNING OBJECTIVES:

  1. Discuss evidence based practice and leadership approaches within a healthcare model for change
  2. Describe key components to identify core problems and focus ideas
  3. Apply a 4-step process to build excitement and gain support for new ideas


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