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

Pre-Conference: Foundations for Physician Advisors (ADDITIONAL REGISTRATION AND FEE REQUIRED)
Attention NJ Social Workers: This session is not applicable for CE’s

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

Bruce Ermann, MD
IPAS Physician Advisor·CHI IPAS Compliance Lead, East/Southeast IPAS Market Lead, Pacific Northwest IPAS Market Lead, Population Health/Care Management
Catholic Health Initiatives·Englewood, CO

SPEAKER BIO:
Dr. Ermann is a Physician Advisor in the Catholic Health Initiatives Internal Physician Advisor Service (IPAS) group, which performs secondary PA Utilization Management reviews across much of the CHI hospital system. Dr. Ermann serves as the IPAS Regulatory Compliance Lead, the IPAS Market Lead for the CHI Pacific Northwest and Southeast hospital markets, and the chair of the IPAS Education Committee. Dr. Ermann is a board-certified Internal Medicine physician who practiced primary care and Hospitalist medicine for 23 years prior to transitioning to Medical Staff and Physician Leadership roles. Dr. Ermann is a graduate of the Rosalind Franklin School of Medicine/Chicago Medical School, completed his Internal Medicine Residency at Cedars Sinai Medical Center, and served as the UCLA/Cedars Sinai Rex Kennamer Fellow where he completed research in clinical quality and efficiency. Prior to joining CHI in 2015, Dr. Ermann functioned as his hospital’s Chief of Staff and Medical Director of Clinical Process Improvement, and subsequently served as the Dignity Health system level Medical Director of Medical Management, where he led the 40 hospital system’s Physician Advisors, the Hospitalist Leadership Counsel, ICD-10 physician readiness activities, a Physician Champion Network for Clinical Documentation Improvement, and spearheaded clinical efficiency processes that helped to significantly reduce Medicare Length of Stay. Dr. Ermann has been a Physician Advisor since 2003. Dr. Ermann and his wife, Olivia, live in the San Francisco area, where they enjoy music, outdoor hiking, and looking after their four grown children.

ABSTRACT:
The hospital physician advisor (PA) to utilization management (UM) role and its interface with the case management team are 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 health care environment. This course is designed to equip new PAs 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. Identify the CMS Utilization Management Conditions of Participation and the Physician Advisor role in the UM process
  3. Describe the CMS 2 Midnight Rule and its implications for Physician Advisor work
  4. Assess 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 PA/case manager, PA/physician and physician/administration communications

1: Opening Session: Leading During Times of Rapid Change: Key Success Strategies (Participant Level - Intermediate, 1 CE)

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

Anna Lloyd
Professor, Organization Management
University of Illinois at Chicago, Laiutaud School/Center for Integrative Leadership, Carlson School of Management·Elmhurst, IL

SPEAKER BIO:
An experienced executive of organization management, leadership and the study of ethical behavior within teams, Anna is engaged in the next generation design of institutions. The co-founder of the Chicago Institute for Holistic Passionate Leadership, she provides personal, private, workplace, training for human resource executives dedicated to idea generation and thought leadership.
The integration of business objectives with social impact facilitated her serving as Founding Executive Director for the Center for Integrative Leadership, at the University of Minnesota’s Carlson School of Management, after completing eight years as President and Executive Director of the national Committee of 200 (C200), and C200 Foundation, the international women’s business organization featuring the top women corporate and entrepreneurial executives. While directing the C200 Foundation, signature research included Teens on Business, a collaboration with the Simmons School of Management, featuring high school girls’ attitudes on business and entrepreneurship. Lloyd has taught for McCormick Theological Seminary’s executive leadership institute and remains engaged with re designing tools to respond to NexGen markets with multiple sector academic research and practice partners.
Trained in New York City economic policy, serving as a vice president for the city’s Financial Services Corporation, Lloyd was active in providing financial incentives and industrial bonds to leverage the retention of jobs, contributing to the retention of Morgan Stanley (JPMorgan Chase) in New York City and the advent of the Metro Tech Corridor, a downtown Brooklyn campus that featured the expansion of Wall Street into the boroughs of New York and the alliance of technical institutes with the finance sector.
Currently living in Chicago, teaching leadership practice in organization management and social entrepreneurship to MBA students, Lloyd has recently been active in the launch of Compassion It Chicago, a citywide campaign to reclaim Chicago as a compassionate city, working with financial executives and City Hall, and promoting corporate connection with city neighborhood programs in education and sports. Adjunct teaching at the University of Chicago and the University of Illinois at Chicago, Lloyd facilitates corporate social responsibility priorities with citywide programming opportunities, recently successful in attracting Harvard’s BLab consideration of impact bonds as a tool for expanding low income housing.

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. Analyze profiles of successful leaders as agents of change

2A: A Provider Intervention to Improve Morning Inpatient Bed Access (Participant Level - Intermediate, 0.5 CE)
Attention NJ Social Workers: This session is not applicable for CE’s

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

SPEAKER BIOS:
Dr. Teresa Jacobs is a Neurointensivist at Michigan Medicine and is the Medical director of Care Management for all the Michigan Medical Hospitals. She is a fellowship trained in neurocritical care and holds three board certifications in Neurology, Vascular Neurology and Neurocritical Care. She originated the Neurocritical Care program at the University of Michigan and nationally regarding the concept of "Brain Death".
Education is part of Dr. Jacob’s core. She has been a dedicated educator at the University of Michigan for over fourteen years, creating a multitude of new high-quality programs, developing advanced educational curriculum, and teaching medical students, residents, fellows, nursing and other allied health professionals. She has brought a lifetime of educational experience into her career as a physician, the volume and quality of her educational development endeavors are tremendous. She was recently appointed to the League of Educational Excellence for her accomplishments in education. Finally, the quality of her teaching, as evidenced by the direct comments by her learners, is striking.
Nationally, she is one of 80 charter members of the Neurocritical Care Society (NCS) and is a certified trainer in NCS Emergent Neurological Life Support Program. She served as a member of the Professional Development Committee of the American Neurological Association (ANA) as well as the Interactive Educational Program for the ANA. She has been a judge for the American Medical Association Research Symposium. She served as an advocate for the AAN's "Neurology on the Hill" program. Also, she is an ad-hoc reviewer for multiple organizations and journals. Her research work is varied within the field of Neurocritical Care. She has numerous publications related to her intensive care experience. She continues her clinical work in Neurosurgery and Neurology on a more limited basis because of her new role.

Mr. Josh Thielker is a Senior Project Manager for Care Management at the University of Michigan, Michigan Medicine and holds a Masters in Public Health with a specialization in Healthcare Administration. He has worked over the last three years to design, implement, and sustain the Priority Discharge program over the clinical enterprise, encompassing more than 50 medical/surgical services in three major hospitals. Utilizing his background in project management and lean process improvement, the program has made significant impact to Michigan Medicine patient flow and has been successfully maintained under his direction. His previous healthcare administration experience includes roles as the Practice Manager for the Division of Cognitive and Behavioral Neurology at Brigham and Women’s Hospital in Boston, Massachusetts and Special Projects Coordinator for the Executive Director at Lutheran Family Health Centers/Lutheran Medical Center in Brooklyn, New York.

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 (Participant Level - Intermediate, 1 CE)

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

SPEAKER BIO:
Janelle is a registered nurse with 40+ years’ experience in a variety of areas. She currently serves as the system leader for population health and care continuum operations for Texas Health Resources in the Dallas Fort Worth Region. She supervises approximately 330 nurses and social workers. Her other duties include work with payors, physician groups, community partners and multiple stakeholders in a complex region where the healthcare industry is competitive and complex.
Janelle has been appointed by 2 Texas governors to several state leadership boards including the Texas Commission on Judicial Conduct, The Texas Higher Education Coordinating Board and she currently sits on the Texas Woman’s University System Board of Regents. She has been recognized by the Texas Organization of Baccalaureate and Graduate Nursing Education leaders for working to increase and enhance nursing education in the state of Texas – particularly the doctorate of nursing practice programs.

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 health care, 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

Session 4: Sunrise Session: The Benefits of Proactive Utilization Management in the Emergency Department - A Payer’s Perspective (Participant Level -Intermediate, 1 CE)

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

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

SPEAKER BIO:
Diana Cokingtin, MD joined the team of physicians at Change Healthcare in 2017 with over 20 years of experience in medical management. She was formerly with Molina Health Insurance overseeing the development of evidenced based policies, streamlining the prior-authorization process, and managing the transplant program.
Prior to working for Molina, she worked with Aetna/Coventry initially as a CMO, then moving to a corporate role writing evidence-based policy, leading medical director education, and running the transplant program.
Dr. Cokingtin has successfully taken a plan through their first NCQA accreditation and worked in other areas of Quality and Appeals. She has a passion for concurrent review and evidence-based medicine. Her favorite saying is “show me the evidence”.
Dr. Cokingtin received her BA/MD from the University of Missouri, Kansas City and did her residency training with a dual internal medicine and pediatrics program. She practiced primary care in Milwaukee and New Berlin, WI, and Raytown, Missouri before entering the world of medical management as a physician advisor with Blue Cross Blue Shield Kansas City in 1995.

ABSTRACT:
Admitting a patient through the emergency department (ED) still represents one of the costliest decisions in health care. Hospitals are increasingly 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? How—and when—should you engage with your payer? During this session, 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 will discuss 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

Session 5: Patients and Lawyers and Regulators: Navigating Legal Considerations for Care Management Leaders (Participant level - Intermediate, 1 CE)

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

SPEAKER BIOS:
Edward Fabi is Registered In-House Counsel for Sutter Health, the largest non-profit health care organization in Northern California. His primary practice areas of patient areas of patient-centered health law revolve around bio-ethics, regulatory compliance, medical research, and patient consent issues.
Ed is also a Lieutenant Colonel in the United States Air Force Judge Advocate General Corps Reserves after spent nearly ten years in active duty service and the past eight as a reservist specializing primarily in Federal Civil and Criminal Litigation. Initially designated as a criminal prosecutor, he then served as regional general counsel providing legal advice to the Air Force's largest medical-legal region of 20 medical facilities from California to Korea. Ed then moved to the headquarters in Washington, DC to defend complex litigation and claims of medical malpractice against the United States across the globe.

Linda Bjorklund serves as an Enterprise Risk Consultant for Health Care Risk Services within the Office of General Counsel of Sutter Health. She is responsible for providing consultative support to multiple Hospital and Physician Office Risk Managers. She collaborates with the Health Law Services Attorneys in responding to risk topics, legal issues and difficult discharges. In addition, Linda supports The Joint Commission hospital readiness activities. Her areas of support include the Emergency Department, the Surgery Department and Diagnostic Imaging.
Linda has developed a Sutter Health Scope of Practice team to research and respond to questions and issues for healthcare roles within California. Over the past several years, Linda has co-presented on Registered Nurse Scope and Standardized Procedures and the Scope of the Medical Assistant in the office setting. As a risk manager for Sutter Health, Linda has proactively led teams to address the identification and prevention of Pressure Ulcers in the Emergency Department and the Surgery Department. Linda is a co-author for an article published in the Journal of Emergency Nursing on pressure injury reduction.
Linda has co-presented with the Sutter legal team on the topic of police in the Emergency Department at the American Society of Healthcare Risk Managers (ASHRM).
Her past experience in Nursing and Healthcare include a broad array of patient care and administrative experience in acute and ambulatory settings as well as serving in health services for US national parks.

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. Learn from different case studies that will highlight key success strategies to minimize legal risk for providers, staff and leaders. 

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 (Participant Level - Intermediate, 1 CE)

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

SPEAKER BIOS:
Dr. Lisa Flynn is Tenet’s Executive of Clinical Innovation and Documentation Integrity. A major focus of her role is the creation and implementation of an onsite physician advisor program across all Tenet hospitals. She works in close collaboration with Tenet’s case management and health information management leaders. Prior to this, Dr. Flynn served as a Regional Medical Director of Informatics for Tenet. She has also worked for Accretive Health (now R1) in the Physician Advisory Services division.
Dr. Flynn earned her medical degree from Wayne State University in Detroit. She completed a residency in General Surgery and fellowships in Vascular Surgery and Surgical Critical Care in Detroit. She also has master’s degrees in healthcare ethics and in health informatics.
She is certified as a Physician Advisor in Health Care Quality Management by ABQAURP. She is a member of the American College of Physician Advisors and numerous other professional societies.

Linda Van Allen serves as Tenet’s vice president of case management and continuing care, leading all of Tenet’s case management and continuing care network services overseeing including strategic planning, program development and implementation and performance improvement to support home office and hospital business objectives. Previously, Van Allen served as Tenet’s vice president of performance excellence, leading all of Tenet’s patient throughput activities for emergency department, perioperative, inpatient and case management services.
Prior to joining Tenet, Van Allen served as vice president for the Abrazo market in Phoenix under Vanguard Health. She also served as a regional director at Sutter Health where she directed case management and social work services for the Sacramento region and was awarded the 2003 Franklin Award of Distinction by The Joint Commission and the American Case Management Association. She served as a regional director Kaiser Permanente as director of case management, outside care management, ambulance and post-acute services. Linda is a Registered Nurse with clinical experience in emergency, cardiac medical, oncology, and maternity care.
Van Allen earned her bachelor’s degree in Science Nursing from Biola University in La Mirada, California. She is a Fellow of the California Healthcare Leadership program at University of San Francisco, California.
She is affiliated currently with the American Case Management Association where she served on the national board from 2006 – 2012 and held the office of President from 2010 – 2012. Linda is a frequent national speaker on case management topics and has published articles on case management and nursing issues in Collaborative Case Management and Nurse Leader.

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 PA 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 PA. You will take away a clear outline on the key implementation steps from planning through deployment as well as strategies to partner with PA services companies to successfully navigate the challenges of transition.

LEARNING OBJECTIVES:

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

Session 7: Value-Based Integrated Case Management - A Needed Advance (Participant Level, Intermediate, 1 CE)

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

SPEAKER BIO:
An innovative, accomplished Physician Executive with extensive experience in all aspects of health care, including health insurance, care management, utilization management, network management, hospital and primary care services delivery serving in a broad range of leadership positions. Successful in consulting for healthcare and medico-legal related activities. Broad engagement and participation with physician-based medical societies, legal review, medical malpractice support, community organizations and health-related advocacy efforts.
Dr. Dehnel has been specifically engaged in enhancing and improving care and case management for over twenty years. This started through his work as the executive medical director for a large pediatric hospital/clinic network in the Minneapolis/St. Paul, MN region. For the last decade he has focused on expanding the efforts of complex case management to meet the “Triple Aim” goals of improved outcomes, better patient experience and improved cost trajectory. He is a co-author of two books on this topic: “Physician’s Guide: Understanding and Working with Integrated Case Managers” (Springer 2016) and “The Integrated Case Management Manual – 2nd Edition” (Springer 2018).

ABSTRACT:
Understand the necessary components of an effective care management strategy for their patients with a high level of health complexity. Gain the tools to be able to develop and implement an effective case management process within your own organization. When implemented well, these programs will demonstrate a positive return on investment to the sponsoring institution or organization. 

LEARNING OBJECTIVES:

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

8A: Air Traffic Control (Participant Level - Intermediate, 1 CE)

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

Rebecca Gomez, MD
Medical Director, Observation
Central Florida Hospital Partners·Altamonte springs, Florida

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

SPEAKER BIOS:
Rebecca Gomez, MD attended medical school at the University of Florida College of Medicine and completed her residency in Family Medicine at Florida Hospital Orlando in 2011, where she also served as Chief Resident. She has since worked for Central Florida Hospitalist Partners as a hospitalist in Orlando. She has practiced primarily observation medicine and is currently the Medical Director for the observation unit at Florida Hospital Orlando. She is also the chair of the Observation Governance Committee, which oversees an additional seven observation units in the Florida Hospital System and participates in many quality improvement projects both at the campus and system level.

Tia Llewellyn attended graduate school at the University of Central Florida and earned a master's Degree in social work in 1997. After graduation she went to work for the State of Florida in the Child Welfare arena. She helped transition the state from public to private sector services. She was a key player in opening the Children's Advocacy Center in Orange County. After a successful career in the public/private sector of child welfare she transitioned to Hospital Care management at Florida Hospital. Where she serves as the Operations Manager for Observation, Emergency Department, Palliative Care and Psych Units.

Christin Ray graduated from Adventist University and earned a Bachelor’s Degree in Nursing. After graduation she has worked at Florida Hospital Orlando in the PCU, ICU, and Observation setting. After successful growth within the organization, Christin transitioned from bedside nurse to nursing leader, educator, and then manager. She has served as the Administrative Nurse Manger for Observation since 2015 where she actively participates in driving progress, change, and growth for the nursing team and interdepartmental stakeholders.

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 (Participant Level - Intermediate, 1 CE)

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

SPEAKER BIOS:
Sam Antonios is a Board-Certified Internist and Physician Executive. He has received a Masters in Medical Management and currently is employed as chief medical officer, medical director of information systems, utilization management medical director, physician advisor, and HIM committee chair for Via Christi in Wichita, Kansas. In his role, he serves in planning, implementing, and managing the hospital EHR system and all required updates. In an ever-changing regulatory world, he works closely with the quality leaders to stay ahead of the operational needs to manage and tackle challenging documentation and quality requirements. In addition to his role at Via Christi, he serves as an Advisory Board Member of both ACDIS and The American College of Physician Advisors, Inc. and is a Board Member of the Kansas Healthcare Collaborative.

Robyn Chadwick, is a native of Kansas and has spent her career in healthcare, first as a medical social worker, then moving into administrative roles. She received her Masters in Social Work from the University of Kansas School of Social Welfare in Lawrence, KS. She has held positions at Wesley Medical Center (HCA), Director of Care Coordination; Hutchinson Regional Medical Center, VP Quality, and Via Christi Health, VP Operations. In her current role at Via Christi, she is responsible for case management, transitions of care programs, Via Christi Direct (call and transfer center), and the Behavioral Health Service Line, including both inpatient and outpatient services for adults, adolescents and children. She has demonstrated expertise in patient throughput in acute care hospitals; length of stay management strategies; collaboration with post-acute care providers; building collaborative relationships and agreements with community partners; developing strategies for growth. Robyn led the development of new models of care programs to address psychosocial determinants of health, which impact a person’s ability to manage their own health and to avoid unnecessary readmissions to the hospital. Those programs include Transitions of Care ( for patients without a primary care provider); an APRN program to provide home-based provider visits to persons living with end stage COPD and HF; and a Community Paramedic program, in collaboration with the local county EMS provider, to see HF patients within 24 hours of discharge from acute care. She developed and implemented partnerships with a local law firm to provide a discounted program to establish guardianship for patients needing this intervention; and, agreements with area skilled facilities to provide charity care for uninsured patients needing that level of care when discharging from acute care. She partnered with Via Christi pharmacy leaders to bring the Dispensary of Hope program to Via Christi, providing access to free medications to persons who qualify for the DOH program.

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. Interpret management and measurement processes of LOS
  2. Review Transfer DRGs and potential impact
  3. Examine workflows of working DRGs

Session 10: Difficult Physician Advisor Status Reviews (Participant Level - Intermediate, 1 CE)

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

Bruce Ermann, MD
IPAS Physician Advisor·CHI IPAS Compliance Lead, East/Southeast IPAS Market Lead, Pacific Northwest IPAS Market Lead, Population Health/Case Management
Catholic Health Charities·Englewood, CO

SPEAKER BIO:
Dr. Ermann is a Physician Advisor in the Catholic Health Initiatives Internal Physician Advisor Service (IPAS) group, which performs secondary PA Utilization Management reviews across much of the CHI hospital system. Dr. Ermann serves as the IPAS Regulatory Compliance Lead, the IPAS Market Lead for the CHI Pacific Northwest and Southeast hospital markets, and the chair of the IPAS Education Committee. Dr. Ermann is a board-certified Internal Medicine physician who practiced primary care and Hospitalist medicine for 23 years prior to transitioning to Medical Staff and Physician Leadership roles. Dr. Ermann is a graduate of the Rosalind Franklin School of Medicine/Chicago Medical School, completed his Internal Medicine Residency at Cedars Sinai Medical Center, and served as the UCLA/Cedars Sinai Rex Kennamer Fellow where he completed research in clinical quality and efficiency. Prior to joining CHI in 2015, Dr. Ermann functioned as his hospital’s Chief of Staff and Medical Director of Clinical Process Improvement, and subsequently served as the Dignity Health system level Medical Director of Medical Management, where he led the 40 hospital system’s Physician Advisors, the Hospitalist Leadership Counsel, ICD-10 physician readiness activities, a Physician Champion Network for Clinical Documentation Improvement, and spearheaded clinical efficiency processes that helped to significantly reduce Medicare Length of Stay. Dr. Ermann has been a Physician Advisor since 2003. Dr. Ermann and his wife, Olivia, live in the San Francisco area, where they enjoy music, outdoor hiking, and looking after their four grown children.

ABSTRACT:

The final status determination for a Physician Advisor second level review is often a difficult decision, and some cases can be determined differently by different Physician Advisors.  Physician Advisors often work alone, without the benefit of discussions with or opinions of their colleagues.  In this session, we will present common, difficult clinical cases, and use a group voting methodology to make our status determinations together as a group.  We will then follow with a discussion of the nuances that might impact differing determinations.

 

LEARNING OBJECTIVES:

  1. Discuss factors impacting differing Physician Advisor determinations based on the same clinical information.
  2. Using group voting methodology, identify critical clinical indicators and clinician documentation to support the medical necessity for a two midnight expectation, or the SI/IS for Inpatient Status when shorter stays of less than two midnights might be possible.
  3. Explore differing philosophies and opinions regarding the Physician Advisor review process, and how they impact the status determinations of your colleagues.

Session 11: Transforming Pain Care in America: Promoting Adaptive Pain Self-Management (Participant Level - Intermediate, 1 CE)

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

SPEAKER BIO:
Robert D Kerns, Ph.D. is a clinical psychologist with a longstanding interest and commitment to improving pain care. Dr. Kerns is Professor of Psychiatry, Neurology and Psychology at Yale University. He is currently the Program Director of the National Institutes of Health-Department of Defense-Department of Veterans Affairs Pain Management Collaboratory. Dr. Kerns has an extensive background as a clinician, educator, scientist, administrator, advocate and policy maker in the area of pain management. As evidence of his recognition as a thought leader in the field, he was invited to serve as a member of the Institute of Medicine’s Committee on Advancing Pain Research, Care and Education and as one of the work group chairs for the development of the National Pain Strategy.
Dr. Kerns also contributed to the development of the Federal Pain Research Strategy published in late 2017. Most recently, he has been appointed by the Secretary of the Department of Health and Human Service to the Interagency Pain Research Coordinating Committee that provides national leadership to enhance pain research efforts and promote collaboration across the government, with the ultimate goals of advancing the fundamental understanding of pain and improving pain-related treatment. Also, of relevance, he chaired a Federal Interagency Workgroup that developed a National Action Plan for Prevention of Opioid-Related Adverse Drug Events. He has a strong record of federally funded research on pain management, and he is the author of over 250 original, peer-reviewed publications, books and chapters. His most important contributions focus on comprehensive pain assessment, non-pharmacological approaches for the management of pain, pain and comorbidities, individual differences and disparities in pain care, safe and effective opioid therapy, the design and conduct of pragmatic pain trials and promotion of organizational improvements in pain care. He is the recipient of numerous awards including the John and Emma Bonica Public Service Award and the Wilbert E. Fordyce Clinical Investigator Award from the American Pain Society and the Nathan W. Perry, Jr. Award for Career Service to Health Psychology from the Society for Health Psychology and an American Psychological Association Presidential Citation.

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 (Participant Level - Intermediate, 1 CE)

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

SPEAKER BIOS:
Dr. Fainman is the Physician Advisor, Medical Director for Care Management, Clinical Documentation Improvement and Social Work at Advocate Lutheran General Hospital, an academic and research, Level 1 Trauma Center located in Park Ridge, Illinois. He provides oversight over Care Management, Clinical Documentation Improvement, Social Work and Utilization Management, a position he has held since 2011. Dr. Fainman is the founder of the Physician Advisor Committee for the Advocate System. He chaired this committee from its inception until 2014. Dr. Fainman was the Physician Advisor and Medical Director for Clinical Documentation Improvement for Advocate Christ Hospital from 2005-2011, prior to that, 1993-2005, he was a Unit Medical Director and Chair, Medical Director Quality Council at Advocate Lutheran General Hospital. He had also served as the Division Director for General Internal Medicine. Dr. Fainman was a member of a practice in general internal medicine at Advocate Lutheran General from 1979-2000. Dr. Fainman has spoken at numerous educational forums across the United States. Topics include: Engaging Physicians, Documentation for Medical Necessity, Building a Leading Physician Advisor Program, Two Midnight Rule, Physician Advisor Collaboration, Compliance with Level of Care Certification Requirements and Clinical Documentation Improvement, and Using Metrics to Strengthen Relationships between Clinical Documentation Specialists and Physicians.

Ann Haefke is a surgical clinical reviewer RN at Advocate Lutheran General Hospital, located in Park Ridge, Illinois. Ann has been a registered nurse for 35 years at Advocate Lutheran General Hospital. She started her career in leadership in physical medicine and rehabilitation, she then transitioned to utilization management and care management. Ann has successfully developed the process for identifying level of care for the surgical patient preoperatively. Ann has since educated departments throughout the Advocate system and has helped with the development of the program at other Advocate sites.

ABSTRACT:
Panelists at this session will share expertise to establish a process for determination of the appropriate level of care for elective surgical cases. Centers for Medicare & Medicaid Services (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

Session 13: Fast Track Your Ideas to Achieve Results (Participant Level - Intermediate, 1 CE)

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.
Boston, Massachusetts

SPEAKER BIO:
Saurabha Bhatnagar, MD, FAAPMR is a computer scientist turned physician at Harvard Medical School in the Department of Physical Medicine and Rehabilitation. He helps healthcare organizations think about how to ensure strategic and operational excellence by aligning people with process and technologies. His work focuses on innovation in healthcare, utilizing techniques in human-centered design, Lean/Six Sigma systems improvement, and value-based healthcare. He has consulted in the above methodologies and leads a variety of healthcare teams with these efforts.
He is the Associate Director in the Department of PM&R Residency Program at Harvard Medical School / Spaulding Rehabilitation Hospital. He also serves as the Acting, Assistant Deputy Undersecretary for Health/Chief in Quality, Safety & Value in the Department of Veterans Affairs (VA). He has previously served as the Acting, Chief Medical Information Officer for EHR Modernization and also Innovation Officer to develop the national strategy at the VA. Dr. Bhatnagar has a bachelor’s degree in Computer Science. He completed a Neurorehabilitation / Traumatic Brain Injury Fellowship at Harvard Medical School.

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 four-step process to build excitement and gain support for new ideas


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