For Case Management and
Transitions of Care Professionals

1: OPENING SESSION: Journey to Value-Based Care

Sunday, November 5, 2017
2:00 PM - 3:00 PM

Brent Myers, MD, MPH
Chief Medical Officer & Executive Vice President of Medical Operations
Evolution Health ·Raleigh, NC

ABSTRACT:

The quest to provide value-based health care has led to improvements and innovations, but barriers still exist to fully implement desired changes. Given the uncertainty surrounding current National health care policy, what are the key foundational elements that have been established as well as creative opportunities to improve and transform care delivery?

This session will highlight lessons learned, common challenges, solutions, and accomplishments within a value-based care environment. Main considerations in planning to provide quality, affordable, and accessible care to patient communities will also be discussed.


LEARNING OBJECTIVES:

  1. Identify achievements and opportunities with value-based care within the current healthcare environment
  2. Apply lessons learned to improve and transform processes
  3. Create an action plan to address internal opportunities to improve care

2A: Emotional Intelligence: Essential Skills for Peer-to-Peer Negotiation

Sunday, November 5, 2017
3:15 PM - 3:45 PM

Marc Adler, MD, MBA, FACP, CHCQM
Associate Chief Medical Officer, Senior Physician Advisor, Physician Director, Value Based Purchasing, Assistant Professor of Clinical Medicine
NYU Winthrop Hospital·Mineola, NY

ABSTRACT:

Peer-to-Peer negotiations are not just limited to discussions with insurers. Process change starts with our clinical colleagues and a myriad of hospital staff. Understanding the motivations of all stakeholders is the key to influencing change and ultimately winning in the appeals process. Change management requires buy-in, and when your peers understand high impact value you can drive change.


LEARNING OBJECTIVES:

  1. Explore the motivations of all stakeholders
  2. Discuss how to apply change management techniques to achieve success in the short and long-term
  3. Integrate your skills horizontally and vertically to promote a win

3A: Transitions of Care Frontiers: The Role of the Medical Director Across the Continuum of Care

Sunday, November 5, 2017
4:00 PM - 5:00 PM

Dani Hackner, MD, MBA
VP/CMO Care Management, Health Management
Memorial Hermann·Houston, TX

ABSTRACT:

It is essential to build physician advising and medical director involvement in care coordination across the continuum. This session will share data and outcomes from implementation of models that implement appropriate decision support for clinicians in case management, monitor accountability with stakeholder groups including payors, and increase engagement in transitions of care through case-based and simulation education.


LEARNING OBJECTIVES:

  1. Describe three approaches to involvement of physician advisors and medical directors in transitions of care across the continuum
  2. Identify requirements and capabilities required to apply each approach in order to implement in their own clinical settings
  3. Appraise the data and impact of the interventions and be prepared to determine whether the goals of the programs are appropriate for their particular clinical setting

4: SUNRISE SESSION: Physician Advisor - Case Management Process Overview

Monday, November 6, 2017
7:00 AM - 8:00 AM

Nicholaos Bellos, MD, FIDSA, FACP
AVP Medical Operations PMI
Tenet Health Care ·Dallas, TX

ABSTRACT:

The physician advisor role and its interface with the case management team is increasingly becoming more well defined, even as the role continues to evolve. Leveraging this role for success requires an understanding of the tradition function of the PA and areas of influence, as well as the opportunities that lie ahead in today's rapidly changing healthcare environment.


LEARNING OBJECTIVES:

  1. Describe the role, scope and areas of influence for the physician advisor role
  2. Discuss the necessary skill set and qualities associated with an effective physician advisor
  3. Provide an overview of when physician advisor intervention occurs, and opportunities for greater impact on the effectiveness of the case management process

5: GENERAL SESSION: ICD-10-CM's Impact on CMS's Readmission Initiatives - Getting That O to E Right

Monday, November 6, 2017
8:00 AM - 9:00 AM

James Kennedy, MD, CCS, CCDS, CDIP
President
CDIMD – Physician Champions·Smyrna, TN

ABSTRACT:

Right or wrong, case management departments and their discharge planning processes are held accountable by hospital leadership for readmission rates, especially those measured by CMS and, in some states, Medicaid.  While most hospitals have an ICD-10-CM clinical documentation integrity workflow, many focus just on the documentation and coding affecting the facility’s DRGs without knowing what additional documentation affects readmission measures. 

This session will orient the audience in how CMS and some states use ICD-10-CM and other billing data to categorize and gauge the potential risk of readmissions and offer solutions as to how case managers in concert with their quality and coding teams can develop systems that integrates these principles with other workflows


6A: Assuring Success of a Clinical Documentation Program

Monday, November 6, 2017
9:15 AM - 10:15 AM

Stephen Crouch, MD, FACEP
Medical Director, Care Management
Advocate Health Care·Downers Grove, IL

Dheeraj Mahajan, MD, FACP, CMD, CIC, CHCQM
Physician Advisor
Advocate Healthcare·Downers Grove, IL

ABSTRACT:

Healthcare systems are seeking to deliver safe and reliable high-quality care while attempting to control cost. Standardization of a CDI program decreases variation among individual sites within an integrated system. This session will describe a collaborative, metric driven approach to standardize a large health system’s CDI program and improve documentation that reflects the patient’s acuity and supports medical necessity while maintaining a consistent care coordination workflow.


LEARNING OBJECTIVES:

  1. Discuss the external and internal forces that created the need for standardization and centralization of a health systems CDI program
  2. Identify the role that system and site leadership has in the design and implementation of a health systems CDI program
  3. Explore the use of data and industry leading practice to guide decision making to set the ground work for success

7A: Metrics and Benchmarking for the Physician Advisor

Monday, November 6, 2017
11:15 AM - 11:45 AM

Ralph Wuebker, MD, MBA
Chief Medical Officer, Physician Advisory Services
Optum EHR ·Newtown Square, PA

ABSTRACT:

This presentation will discuss how physician advisors can focus on and measure areas where they have the greatest impact. Learn metrics for the 2-midnight rule, methods for evaluating PEPPER, how to build a utilization review dashboard, and more.


LEARNING OBJECTIVES:

  1. Discuss identification of metrics that document outcomes and reflect the value of the physician advisor role
  2. Explain meaningful measurement for 2-midnight rule, payment patterns, etc.
  3. Illustrate the building of a utilization review dashboard

8A: Ten Commandments for an Observation Unit

Monday, November 6, 2017
11:45 AM - 12:15 PM

Bela Nand, MD
Medical Director, Care Management
Advocate Christ Medical Center·La Grange Park, IL

ABSTRACT:

Residents in this one of a kind model of care are being exposed to a fine blend of clinical care, fiscal responsibility, and patient accountability. This model is a win-win proposition for all stakeholders-hospitals, physicians, residents, and most importantly the patients we serve


LEARNING OBJECTIVES:

  1. Review how enhancements and the overall progression of an Observation Unit improves quality of care
  2. Recognize the benefits of working with a multidisciplinary team to increase efficiency
  3. Discuss Impact of Internal Medicine residents in Observation Units

9A: OPTIONAL PHYSICIAN ADVISOR SESSION: The Once and Future Physician Advisor Roundtable Discussion

Monday, November 6, 2017
1:15 PM - 2:15 PM

Paul Simmons, MD
Assistant Chief Medical Officer/ Physician Advisor/ Assistant Professor of Medicine, Case Management
Massachusetts General Hospital/Harvard ·Boston, MA

ABSTRACT:

This provocative presentation is designed as a platform for discussion about the past, present and, most important, the future of Physician Advisors in U.S. hospitals.


LEARNING OBJECTIVES:

  1. Describe the current state of the physician advisor role
  2. Discuss the pros and cons, real and potential issues, of our current state
  3. Stimulate thinking and conversation about the future of physician advising

10AB: Legislative and Regulatory Update

Monday, November 6, 2017
2:15 PM - 3:15 PM

Nicholaos Bellos, MD, FIDSA, FACP
AVP Medical Operations PMI
Tenet Health Care·Dallas, TX

ABSTRACT:

Update on relevant legislative and regulatory considerations that impact clinicians, patients and families, and the case management process.


11A: FOUNDATIONAL SESSION: Revenue Cycle 101

Monday, November 6, 2017
3:30 PM - 4:30 PM

Rebecca Zickler
Assistant Vice President of Care Management
Ochsner Health System·New Orleans, LA

Richard Joint
Director, Revenue Cycle/HIM Consulting
Ochsner Health System·New Orleans, LA

ABSTRACT:

This session will provide a fundamental overview of the revenue cycle and increase understanding of the denial process and how to positively influence efficiency and revenue capture.


LEARNING OBJECTIVES:

  1. Provide a fundamental overview of the full revenue cycle
  2. Discuss the denial process with the revenue cycle and a proactive approach to denials management
  3. Explain how denials are categorized related to issues such as fall-documentation, authorization, and medical necessity; and the approach to secondary and tertiary denial appeals letters

12: SUNRISE SESSION: Communicating the Physician Advisor Role - I'm Here to Help

Tuesday, November 7, 2017
7:00 AM - 8:00 AM

Robert T. Grant, MD, MSc, FACS
Physician Advisor and Chairman Utilization Management Committee
NewYork-Presbyterian ·New York City, NY

Lory David Wiviott, MD
Chairman of Medicine & Medical Director
California Pacific Medical Center·San Francisco, CA

ABSTRACT:

The Physician Advisor is a critical team member, regardless of hospital system size.  Training and orientation to the physician advisor role, for case management team members, physician peers and others across the enterprise, increases the effectiveness of the role. The importance of this communication, and its impact on patient experience and cost of care, will be discussed in this session.


LEARNING OBJECTIVES:

  1. Describe training sessions used to explain the role of the Physician Advisor
  2. Describe how PA can improve CM-MD communication through structured mentoring sessions with CM’s
  3. Recognize the PA’s potential impact on patient discharge experience HCAHPS and Value-Based Purchasing

13A: Addressing Short Stay Patient Reviews: A Case Study

Tuesday, November 7, 2017
8:00 AM - 9:00 AM

Bruce Ermann, MD
IPAS Physician Advisor
Catholic Health Charities·Englewood, CO

ABSTRACT:

Since the implementation of the FY 2014 IPPS and initiation of the “Two Midnight Rule,” CMS has stated that Medicare FFS patients with lengths of stay less than two midnights are generally expected to be hospitalized in the Outpatient Status and billed as Part B encounters. Yet, exceptions to the two midnight rule exist, and the Utilization Management Team cannot get to every short Inpatient Stay prior to discharge. This session will provide a case study illustrating a retrospective Utilization Management workflow for Medicare Short Stay encounters, and a physician advisor chart review strategy.


LEARNING OBJECTIVES:

  1. Explain a strong team based process to review Medicare FFS short Inpatient stays, utilizing the concepts of Inpatient Qualifiers, Automatic Exceptions, Time Spent in Outpatient or-Pre Transfer Environment, and Physician Documentation Supporting 2 Midnight Expectation and Unusual Event or Recovery
  2. Discuss the controversies regarding the original 1599 2 Midnight Rule and the 2016 OPPS variances, and share current experience regarding how these have affected Short Stay Medicare Inpatient stay reviews
  3. Utilize a case study to demonstrate session concepts

14A: KEPRO: A QIO Perspective on Short Stay Patient Reviews

Tuesday, November 7, 2017
9:15 AM - 10:15 AM

Ferdinand Richards III, MD
Chief Medical Officer
KEPRO·Tampa, FL

David R Miller RN MHA
Operations Director·Short Stay Reviews
KEPRO·Tampa, FL

ABSTRACT:

This presentation follows the discussion related to patient short stay reviews and will provide the QIO perspective.  As a Quality Improvement Organization (QIO), KEPRO offers information and assistance to Medicare providers and Medicare patients and their families regarding processes and rights related to beneficiary complaints, discharge appeals, and immediate advocacy.


LEARNING OBJECTIVES:

  1. Identify how issues related to patient short stays may align with KEPRO’S services
  2. Identify opportunities to partner with KEPRO

15: CLOSING SESSION: Health Care Equity

Tuesday, November 7, 2017
10:30 AM - 11:30 AM

Anurag Gupta, MPhil, JD
Founder & CEO
Be More America ·Brooklyn, NY

ABSTRACT:

Providing access to high-quality, effective and efficient health care for society's most vulnerable populations is both an area of focus and a challenge facing healthcare systems nationally. During this interactive session, health determinants and common barriers will be explored. Evidenced based policies and approaches will be applied to address barriers and examine infrastructures to empower affected populations.


LEARNING OBJECTIVES:

  1. Description of healthcare inequities among populations and barriers to access care
  2. Discussion of the impact on patients' healthcare outcomes
  3. Strategies to address inequities and improve healthcare outcomes


View Leadership Conference Sessions